Parental Psychiatric Disorder: Distressed Parents and their Families

Cover......Page 1
Half-title......Page 3
Title......Page 5
Copyright......Page 6
Dedication......Page 7
Contents......Page 9
Contributors......Page 12
Foreword......Page 15
Preface......Page 17
Acknowledgements......Page 18
Part I Basic issues......Page 19
Introduce yourself, tell us who you are and what your job is......Page 21
Ask us what we know and what we think — we live with our parents, we know how they are behaving — ask us!......Page 22
Please don’t ignore us, remember we are part of the family and we live there too......Page 23
REFERENCES......Page 24
Introduction......Page 26
Perspectives of power and hierarchy in mental health services......Page 27
Why does it matter?......Page 29
Prevention......Page 30
Gender......Page 32
Legal/ethical issues......Page 33
Issues for the psychiatrist......Page 34
Conclusion......Page 35
REFERENCES......Page 36
Childhood disorder......Page 40
Death......Page 42
Child maltreatment......Page 44
Attachment and the quality of the mother—child relationship......Page 46
Attachment and decisions regarding placement......Page 47
Distress......Page 48
Case 1: Amanda......Page 50
Case 2: Stephen......Page 51
Constitutional factors......Page 52
Temperament......Page 53
Genetic endowment......Page 54
Early mother—infant relationships......Page 55
Socio-cultural factors......Page 56
Life events......Page 57
The interaction of risk and protective factors......Page 58
REFERENCES......Page 59
Attachment — background......Page 68
Attachment — the parent’s contribution......Page 69
The risks for psychiatric disorder also affect the parent—child relationship......Page 72
Psychiatric disorder alone may affect the parent—child relationship......Page 74
Factors that might be associated with preservation of secure attachment in the face of parental psychiatric disorder......Page 75
REFERENCES......Page 77
Definition......Page 80
The relative value of parents and children......Page 81
The role-relationship paradigm......Page 82
Parent role and mental disorder......Page 83
The parent as patient and the helping relationship......Page 84
Professional role in relation to patient......Page 85
Parental role and mental illness......Page 86
Parental role and personality disorder......Page 87
Spouse/partner......Page 88
Parentification: the effects on the child of role reversal; becoming a young carer......Page 89
The role of extended family and community in relation to the task of parenting......Page 90
Clinical implications of the role-relationship model......Page 92
Swings and roundabouts of policy between statute and therapeutic support......Page 93
The contribution of service culture to outcome......Page 94
Conclusion......Page 95
REFERENCES......Page 96
Part II Comprehensive assessment and treatment......Page 103
6 ‘The same as they treat everybody else’......Page 105
Professionals should be more willing to listen to and value a parent’s points of view and experience......Page 106
Professional support is needed for the partner when a parent is acutely ill, and education to prepare for ongoing treatment, convalescence and recovery......Page 107
Respect a right to privacy......Page 108
Acknowledgements......Page 109
REFERENCES......Page 110
Commitment to the parent......Page 111
Timing......Page 112
Take time to clarify the reason for the assessment......Page 113
Coordination of professional contributions......Page 114
Focus on role of parent......Page 115
Focus on mental illness and the interface of role of parent and role of patient......Page 117
Focus on role of context/extended family......Page 118
Standards......Page 119
Content......Page 120
Methods of assessment/intervention......Page 121
Family group conferences......Page 122
Assessment of the needs of mentally ill parents and their children......Page 123
REFERENCES......Page 127
Components of a comprehensive evaluation......Page 130
Maternal attachment......Page 131
Services for pregnant mothers......Page 132
Psychotic denial of pregnancy......Page 133
Intervening in the postpartum period......Page 134
Parent coaching, skills training and parenting groups......Page 135
The parent’s clinic at the University of Illinois......Page 136
Mother—infant psychotherapy......Page 137
REFERENCES......Page 138
Part IV Specific treatments and service needs......Page 257
16 Psychopharmacology and motherhood......Page 259
Breast-feeding......Page 261
REFERENCES......Page 265
Introduction......Page 267
Case example: Linda......Page 268
Implications of the case example......Page 269
Parent and service provider perceptions of the child welfare agency......Page 271
Two systems at odds......Page 272
Conclusion......Page 273
REFERENCES......Page 274
Termination of parental rights......Page 275
‘Harm to the child’......Page 276
‘Inability to care for the child’......Page 277
Americans with Disabilities Act......Page 278
The ‘best interests of the child’ standard......Page 280
Parental fitness......Page 281
Effect of custodial disputes on emotional health......Page 282
Visitation rights......Page 283
Recommendations for attorneys......Page 284
REFERENCES......Page 286
The issues......Page 289
Why are legal frameworks required?......Page 290
Potential conflict of interest?......Page 291
Searching for a balance in the law......Page 293
Supporting families......Page 294
Protection of children......Page 295
Family support or child protection. What works? Striking the balance in legal intervention......Page 297
Summary and conclusions......Page 300
REFERENCES......Page 301
Part V Child-sensitive therapeutic interventions......Page 303
20 The child grown up: ‘on being and becoming mindless’: a personal account......Page 305
Does it help to talk?......Page 310
Who should do the talking?......Page 311
What do children require and what can they understand?......Page 312
Engaging a child in an ‘active’ conversation about his parent’s illness and treatment......Page 313
Didactic and dialectical approaches to talking with children......Page 314
Stress the child’s competence......Page 315
Make no interpretations or presumptions about a child’s experience…but ask......Page 316
The goal is to help the child think, not to elicit feelings — a child will show what he feels as and when he chooses......Page 317
Case example......Page 318
REFERENCES......Page 322
Why work with the family?......Page 324
Who is the family to be worked with?......Page 326
Protection and stress in families......Page 327
The Family Project at University College Hospital, London (Camden and Islington Mental Health Trust)......Page 328
Case example 1......Page 330
Case example 2......Page 332
Family ‘Mental Health Matters’ workshops......Page 333
Children’s workshops......Page 334
Working from a child-centred service: additional approaches......Page 335
Developing alternative descriptions of a parent who is also a patient......Page 336
REFERENCES......Page 337
Part VI Models for collaborative services and staff training......Page 341
Why change is necessary......Page 343
The policy context......Page 344
Building for participation......Page 345
Trust and continuity of staff......Page 346
Better joint working between child and adult services......Page 347
Conclusion......Page 348
REFERENCES......Page 349
Introduction......Page 351
Background......Page 352
Case example: John and his family vs. the system......Page 353
A survey of the needs of parents with psychotic disorders......Page 355
The needs of parents with psychotic disorders — the perspective of the health-care provider......Page 356
How can we improve services for parents with a psychotic disorder?......Page 358
Conclusions......Page 359
REFERENCES......Page 361
Problem and need......Page 363
Legal representation was missing......Page 364
The Family Support Collaborative, New Haven, Connecticut, USA......Page 365
New programme services......Page 366
Programme partnership......Page 367
Introduction and project aims......Page 368
What has been implemented......Page 369
Specific interventions......Page 370
Conclusions......Page 371
The project today......Page 372
The Building Bridges Project for parent-users of mental health services and their children, Lewisham, UK......Page 374
Review and evaluation......Page 375
Conclusion......Page 376
REFERENCES......Page 377
The ‘problem’ for families and service providers......Page 379
The European dimension......Page 380
The research methodology......Page 381
Barriers to interagency collaboration......Page 382
Organization of services......Page 383
Shared knowledge and training......Page 385
Resources......Page 386
Time, communication and trust......Page 387
Translating findings into action......Page 389
REFERENCES......Page 391
Background and context......Page 393
Crossing Bridges — The Department of Health (UK) training programme......Page 394
Requirements for the programme......Page 395
Key conceptual frameworks......Page 397
Aims......Page 398
Content......Page 399
Conceptual underpinnings — the family model......Page 400
Use of the materials......Page 401
Training the trainers — A county-wide implementation of Crossing Bridges......Page 402
Challenges to systematic implementation and evaluation of training......Page 403
Developing protocols to integrate training and practice......Page 404
Conclusion......Page 407
REFERENCES......Page 408
Afterword......Page 411
Index......Page 414