Being a parent can be tough—sleepless nights, constantly being on-call and lack of time out to name just a few challenges. For those with a mental illness, pregnancy and the postpartum period can trigger first episodes or relapses—due to multiple stresses, sleep deprivation and stopping medication for the health of the infant. Many of the risk factors for mental health problems overlap with the risk for parenting difficulties that begin at this time, causing further pressure at a time families expect will be joyful. Poverty, domestic violence or parenting alone all add to the stress; in addition, if the parent’s own childhood was traumatic, memories of this often resurface, causing distress—and often because of the trauma with their own parenting experience there was a lack of positive role model, and no one currently to offer support.
Each year some sixty thousand cases of neglect, emotional, physical and sexual abuse of children are substantiated across Australia. In many of these factors such as mental illness and drug abuse are cited as factors. Protective services in order to determine the level of risk—and whether reunification is possible—require expert assessment and opinion from qualified independent experts. Where mental illness is a concern, it is the role of the mental health clinician to make sense of the severity of their illness, and how it, and the family background and circumstances affect attachment, identification and response to risk, ability to identify and prioritize the child’s needs and to take charge.
These are high stakes assessments—while no single expert will definitively be in charge of the child’s future, the judge relies on expert opinion to make rulings on how frequent access is, whether is must be supervised and when and whether the child is returned to one or both parents. Poor mental outcomes for the child are associated with unsuccessful attempts at reunification and with multiple foster care placements—and any time apart from the parent when the child is likely to impact attachment and behavior, which in turn may affect confidence, the quality of future relationships and increase the risk for educational difficulties and mental illness.
Yet the protective system is stretched, with overworked under-resourced often junior workers making key decisions. The families enter the system with little knowledge and agency, and the medical and legal system serve them badly; the Legal Aid bar is far too low to allow suitable ongoing representation and medical services are not timely and suitably targeted. The court is understandably risk adverse—but physical risk trumps psychological, and months can go past with little change, while the child is not being provided with optimal care, either with their parents and adequate support, or with a long term stable carer. Substantial overhaul is required to ensure a better, fairer system. In the meantime, helping disadvantaged mentally ill parents understand and negotiate the system—and as a health professional being proactive in being available and responsive is critical.
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Professor Anne Buist is our May Seminar guest.
She will be discussing this topic on 7th May at 7pm to 8:30pm at the Melbourne Clinic.
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