Supporting parents with mental illness and their children – developments in family focused practice in the United Kingdom and Ireland

It is estimated that globally between a fifth and a third of adults receiving treatment from mental health services have children, and that between 10% and 23% of children live with at least one parent with mental health problems (Maybery, Reupert, Patrick, Goodyear, & Crase, 2009; Parker et al., 2008). However, characteristics such as the gender, race and social circumstances of parents mean that the overall picture is more nuanced and that our understanding of the lived experience for families when a member has a mental health problem is still developing (Stambaugh et al., 2017). While the overwhelming majority of children living with an adult with mental health problems are loved and well cared for, that does not mean that the circumstances such children find themselves in, including those who live with adults whose use of substances is problematic, does not have an impact upon them. Additionally, in a small number of families there are more significant challenges for parents in meeting the needs of their children, including keeping children safe from abuse or neglect (Nevriana et al., 2020). Over the past 20 years, there has been an increased focus on how to support families dealing with the mental health problems of an adult parent or adult child. This is borne from a recognition that family members need to feel supported in order to support their relative with their mental health, and that supporting an adult with their mental health has wider benefits for the entire family. Often different professionals and agencies are separately tasked with the responsibility for the care and treatment of the adult with mental health problems, and the support and protection of children. Such services and interventions have traditionally operated in tandem rather than together, leading to many individuals with lived experience of mental health problems to advocate for a more integrated approach to meeting the needs of them and their family (Reupert et al., 2018). This has led policy makers to consider how services and practice could be more family focused, while recognising the value and importance of different professionals, with their own expert knowledge and role, working in unison (Leonard, Linden, & Grant, 2018). Such family focused practice has been characterised as having a number of defining features. Foster et al. (2016) identified six core and overlapping practices within family focused practice: (1) family care planning and goal setting; (2) liaison between families and services, including family advocacy; (3) instrumental, emotional and social support; (4) assessment of family members and family functioning; (5) psychoeducation and (6) a coordinated system of care (e.g. wraparound, family collaboration, partnership) between family members and services. Marston et al. (2016) provided a similar analysis of the main components as psychoeducation; direct treatment and support for mental health and/or substance use; a focus on parenting behaviour; child risk and resilience; family communication; and family support and functioning. Family focused practice is an approach that focuses upon the family as the unit of attention, as opposed to only working with and addressing the needs of an individual service user alone, whether this is the parent with mental illness, or their child(ren) (Afzelius, Plantin, & Östman, 2018). It requires professionals to see their role as extending beyond their primary client, whether the adult or the child.