Helping Teachers to Help Children Living with a Mentally Ill Parent Teachers’ Perceptions on Identification and Policy Issues I. BIBOU-NAKOU Department of Education, Aristotle University of Thessaloniki, Greece
ABSTRACT The material presented here is based on a pilot European project (Daphne Project, 2000/EU funding, collaboration of Greece and England) regarding parental mental illness and children’s welfare and needs1.The presentation focuses upon the responses of a group of teachers working in primary education in relation to identification issues and assessment needs regarding children who live with a mentally ill parent. The results showed that although the teachers are able to identify risks and protective factors in the cases of a parental mental illness, there is a lack of early identification mechanisms in the school setting and an absence of a shared understanding of relevant issues across services and agencies. The results are discussed in relation to school-based prevention initiatives that empower teachers to feel that they contribute to change in their schools as well as in their own practice in the classroom.
Introduction Children of parents with mental illness are known to be at increased risk of psychiatric problems, but there is little systematic research examining the effects of preventive activities in this group (Beadslee, 2002). The present study2 focuses upon primary teachers’ reflections about issues of identifying children who live with a mentally ill parent and of collaborating with specialist services to support them in the school setting and deal effectively with their needs. Please address correspondence to: Dr I. Bibou-Nakou, P. Mela 35, 54623, Thessaloniki, Greece. E-mail:
[email protected] School Psychology International Copyright © 2003 SAGE Publications (London, Thousand Oaks, CA and New Delhi), Vol. 24(3): 000–000. [0143–0343 (200308) 24:3; xx–xx; 000000]
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School Psychology International (2003), Vol. 24(3) Mental illness in parents represents a risk for children in the family. These children have a higher risk for developing significant psychosocial problems and disorders than other chidren (Beidel and Turner, 1997; Chase, 1999; Garber and Little, 1999). Providing more support and attention to the children of a distressed parent therefore forms a strategy of selective prevention (WHO, 2002) that helps prevent psychological problems from passing from one generation to the next. Children of primary and secondary school age are readily available for preventive intervention because of the fact that they attend school. Through schools, mental health promotion and care can reach more children and adolescents with less stigma and provide greater access for families (Weist et al., 2002). These children have also been characterized as ‘invisible children’ (Anthony and Cohler, 1989; Gopfert et al., 1996a; Vanharen et al., 1993), since it is only recently that researchers and professionals have examined the psychosocial and daily impact of parental mental illness on children and started to consider the types of support or services they need. On the other hand, the parents when asked, are quite clear about the types of assistance they feel would be useful for their families. For their children, parents need , amongst other services, opportunities for them to get a proper education, to meet adults they can trust, and to participate in activities where they can meet other children (Falkov, 1998). Mental illness affects parents’ emotional and behavioural responses in a way that impacts on their parenting capacity and the parent-child relationship (Gopfert et al., 1996a). On the other hand, children, particularly those with emotional and behavioral difficulties can precipitate or exacerbate mental illness in their parents/ carers (Falkov, 2001). The present paper forms part of a general project dealing with parental mental illness, funded by the EU (DAPHNE 2000)3. Recent findings suggest that children who live with a mentally ill parent are more likely to express behavioural and learning difficulties and to be identified as having sperial educational needs than comparison children (Beardslee et al., 1983; Gopfert et al., 1996a). Research has also shown that it is not the mental illness itself, but the chronic nature and associated psychosocial disturbances that contribute most to the risk of the children (Beardslee, 2002; Blanch et al., 1994; Duncan and Reder, 2000; Rutter and Quinton, 1984). A wealth of research supports the idea that specific training and learning in child development and mental health are key to high quality education for school aged children’s well being. Working with children and their families requires the cooperation of a wide range of professionals with different tasks (Gopfert et al., 1996a; Hetherington 6
Bibou-Nakou: Children Living with a Mentally Ill Parent et al., 1997). There is growing awareness world-wide that efforts to promote youth mental health broadly, as well as to identify and intervene to assess problems early, remain underdeveloped (Weist et al., 2002). The emphasis on interventions that reflect a collaborative and interdisciplinary effort between schools, families and community agencies is based on the recognition that schools can not do all the work on their own (David, 1993; Peake and Turner, 1999). There is need for a more comprehensive systems of care approach and co-ordinated mechanisms for service delivery in the cases of children living with a mentally ill parent (Gopfert et al., 1996b). In this article, we attempt to understand the distinctive potential contribution of teachers in facilitating the systematic daily monitoring where there is concern about a child who lives with a mentally ill parent. There are very few studies, as far as we know, that investigate the teachers’ identification of children living with a mentally ill parent. From the existing research, teachers tend to under-report these children’s problems (Canino et al., 1990). Although not all children living with a mentally ill parent develop psychosocial problems (Falkov, 1998; 2001), the school is important in terms of educational needs and possible achievement of these children in need, as well as in terms of their social experience and the development of a stable identity. Competence and achievement of recognition in school and spare time activities have been shown to be protective factors for the child who lives with a mentally ill parent (Falkov, 1998; Jennings,and Kennedy, 1996; Kendall-Tackett, 1996). As the children spend most of their day in school, it could be a secure base for them provided that the educational staff are able to maintain a stable and organized setting that may be lacking in these children’s families (Calder and Horwarth, 1999; Dowling and Osborne, 1994).
Context of the research setting Despite attempts to shift public attitudes in Greece, current representations of parental mental illness are dominated by blame, stigma and moral retribution (Madianos et al., 1999). This means that parents with a mental illness have to balance the potential consequences of disclosure with their need for support in the face of the psychological discomfort. As part of gradual deinstitutionalization, many adults with mental health problems spend the majority of their time in the community. That is, the distressed parent is parenting in high risk conditions (Downey, and Coyne, 1998; Nicholson et al., 1998). On the other hand, the existing mental health programs are far behind in responding to these families’ needs and their children’s well being. The 7
School Psychology International (2003), Vol. 24(3) position of the family which includes a mentally ill person is still largely ignored, unrecognized and without adequate moral, financial and professional support. This is very similar not only in Europe, but in other countries worldwide which share the same system of economy and social policy (Hetherington, 2000). Efforts to promote youth mental health in Greece broadly remain limited and in some rural areas even non-existent. The main movements that are initiated, stem from university programs. These movements attempt to expand mental health programs for children in school and to create initiatives that address barriers to learning and help to reduce emotional and behavioural concerns in children (Bibou-Nakou, 2001a). Apart from these initiatives, there is a complete lack of interagency networks, of active monitoring of fieldwork practices or of guidelines for inter professional management in the educational services. In addition, no school psychological services exist that could set up supportive frameworks for teachers, children and parents to work together. We know that Greek teacher perceptions of competent children are consistent with the results in other Western countries and favour those children who are sociable and manageable for teachers and parents, with good academic performance and the ability to engage in classroom activities (Bibou-Nakou et al., 1999; Motti-Stefanidi et al., 1993). Further, recent findings from studies in Greece suggest that teachers tend to adopt a linear and immediate connection between a child’s problem and disposition and familial factors, and home factors are cited as being implicated in the difficult behaviour of the children (Bibou-Nakou, 2000). As we may realize, these attributions are extremely crucial in the cases of distressed parents who feel that they have to struggle between their own needs as patients and their children’s educational needs as identified by the teachers. In relation to the family setting, although family structures in Greece have undergone some change and one should be cautious about stereotypical generalizations, children’s needs are not seen separately from family needs and legal/ welfare or educational intervention is often seen as a threat to families. The problem of protecting the parents’ rights as a parent while at the same time safeguarding the child against the harmful effects of the parents’ mental illness poses complex policy decisions (Reder et al., 2000). All these issues are allied to an understanding of the social institutions through which child welfare is managed (Hetherington, 2000; Stevenson, 1998). The place of family life and children within the Greek society has to confront a social and political policy that lacks a clear perspective on the management, the organization and the development of child protection practices and interventions in family life. 8
Bibou-Nakou: Children Living with a Mentally Ill Parent Aims of the research Teachers, as well as other professionals, are presented with many challenges when working with children and parents with a mental illness.The present research therefore aimed to: (a) establish the degree to which children who live with a mentally ill parent are identified in the school setting; (b) explore the ways that the school setting has developed, or needs to develop, in order to identify and help these children; (c) discuss with the teachers how they understand and appreciate the roles and responsibilities of other professional groups that are involved in the care of children living with a distressed parent; (d) stablish concerns, questions and issues for teachers and to assist in setting multi-agency agendas in the cases of parental mental health and the children’s well being; (e) establish teacher perceptions in relation to the impact of mental illness on children’s behaviour and (f) evaluate formal/ informal mechanisms for bringing together teachers and all concerned professionals to plan proactively for the needs of these children.
Methods and participants A combination of focus group discussions and individual responses to a case vignette were chosen to carry out the research. While group discussions provided an opportunity both to explore a breadth of views and enable participants to develop on each other’s ideas regarding policy issues, the individual responses to the case vignette were considered a way that could heighten the participants’ comprehension of the associated challenges confronting families with a mentally ill parent. Fifteen focus groups of eight teachers each were conducted. The participants were attending an in-service training at the local university. There were 68 females and 52 males and they had a teaching experience ranging from six to 18 years both in rural and inner cities schools. They were all informed about the Daphne project and gave their consent, contributing thus to its aims. A semi-structured interview schedule covering themes related to different aspects of policy and practice was adjusted from the ‘Crossing Bridges’ trainer (Falkov, 1998) to guide the discussion. The main points of the focus groups will be presented under six headings: (1) identification of children in need living with a mentally ill parent; (2) gathering information regarding the child and their family; (3) availability of inter agency collaboration; (4) access and knowledge about the other practitioners; (5) kind of support that the school setting offers and (6) evaluation of the school’s intervention. All these issues are related to service planning and policy. The taperecorded focus group discussions were transcribed and the transcripts 9
School Psychology International (2003), Vol. 24(3) were examined for dominant and recurrent themes. Once themes were established, they were coded separately by the author and at least one of the research team. Following are the dominant responses of the teachers under each main heading. 1. How many families in your school are in need of services because of parental mental illness? Forty percent of the teachers said that they would not be able to easily identify a child living with a mentally ill parent; another 35 percent would estimated that two to three children in need in every year (200 pupils per school) and 25 percent said that they came across with a child living with a mentally ill parent once or twice during their professional experience (mean number of teaching experience 12 years). As we realize, individually, teachers encounter and/or identify children living with a mentally ill parent rarely, but when they do so, they are usually troubled by the situation of the child and the consequences for that child . Even when the teachers were informed about the children’s situation, none of these children had been reported to an outside service. These findings support the little knowledge that we have about the numbers of children living with a distressed parent, not only nationally but internationally as well (Eufami, 2001; Hetherington, 2000). Such information is not routinely collected when assessing the needs of adult mentally ill parents in the community, and the same happens in the school setting. We know that this group of children has common (unmet) needs across all European Union states, since the majority of state mental health and social services do not address the whereabouts or the status of the parents’ children (Mowbray et al., 2001) and they do not collect even basic data on their clients’ parenting status (Hetherington et al., 1997). 2. How is this information collected? From the focus groups, the teachers agreed that there was a lack of information systems for monitoring the children’s needs for prevention, imputs, processes and outcomes. They reported that their schools lacked a policy that could provide a co-ordinated set of reliable and valid data in relation to the children’s needs and that could generate an ethos of mutual support and co-operation. They acknowledged that with so much pressure on schools to produce results, it is hard to justify the time spent in thoughtful collaboration with parents and colleagues about the needs of children who live with a mentally ill parent. The fragmentation of the services (especially adult and children) and the lack of educational psychological services were reported to 10
Bibou-Nakou: Children Living with a Mentally Ill Parent Table 1 needs
Sources of informal information in relation to children’s
Information given by
Percentage of teachers
Other teachers who had the child in their class/through gossips I don’t know The relatives or friends of the family The family itself The children themselves Joint gathering from the teacher and the family
44 35 26 13 9 8
pose even more difficulties. Table 1 presents the main informal sources of information given regarding the children who grow up with a mentally ill parent. 3. How do current structures facilitate intra or inter agency planning? The teachers do not have a formal structure for exploring problems or sharing access with a supportive colleague or a professional outside the educational setting. No inter-agency planning was acknowledged in 74 percent of the replies, whilst in the remaining 26 percent, the teachers suggested that they could only discuss the children’s need with the principal of the school. They also commented that they were prepared to talk about the children in need with their colleagues in the corridor, or in the staff room or that they would ask for help from a specialist on their own initiative, even with no backup from the school. ‘We are interested but we have no access’ was the prevalent argument presented during the group discussions. The lack of building effective partnerships at a whole-school level and the blurring of boundaries between the often hierarchically arranged or competing discourses of the teachers, parents and other practitioners was presented as a dominant obstacle for those teachers who were very ambivalent about asking for help. On the other hand, there is growing evidence to suggest that successful integration of children in need cannot be achieved without back-up support for the schools through a variety of external agencies (Department of Health, 1999. Gibbons et al., 1995). The teachers’ responses support the need for effective support both from within and from outside agencies. This need is greater than ever, since teachers and schools now face potentially more difficult problems in a context that is less supportive than in the past (Decker et al., 1999; Jennings and Kennedy, 1996). 11
School Psychology International (2003), Vol. 24(3) 4. What do you know about the policies, practice and priorities of the other specialists? Fifty seven percent of the teachers said that although they knew the specialist areas, they knew nothing about their different policies, practice and priorities. 22 percent of them suggested that there was no help from the other workers, according to their experience. This was due to the fact that traditionally teachers are often involved with other professionals only when something is wrong. Another 22 percent said that other professionals were able to support the school, but they were very unclear about what to expect from each of them. Therefore, there would appear to be severe barriers to seeking help in that the other professionals are infrequently consulted by the teachers and vice versa. From the focus groups, the teachers stressed the danger they faced in becoming more and more isolated professionally and in being blamed for failing to safeguard and protect ‘children in need’. 5. What form does the provision of the educational services to the children and the family take? In Greece, schools tend to address classroom ‘management’ in the sense of handling of individual cases rather than in the sense of organizational processes of planning, development and review of services and policy. However, we know that practice is not undertaken in a policy vacuum (Dowling and Osborne, 1994; Gray et al., 1994). Most of the teachers in our study would argue that there is a lack of a framework for provision of services from the schools and that they, themselves, lack a sense of a wider perspective on the task of supporting the children who live with a mentally ill parent. Although the teachers see the children’s needs as part of their responsibility, they do not necessarily feel comfortable with the idea of dealing with such a topic in their classrooms. They expressed their anxiety about the lack of suitable training and knowledge aswell as the sensitive issue of parenting capacities. They also stressed the need for personal training and development in order to fully understand the needs of children living with a mentally ill parent. It appears, therefore, that teachers have to assume roles for which they have not been trained or to deal with situations and problems that they feel are beyond their responsibility. The lack of specialized teacher-training programs in university courses until recently and the absence of teacher consultation services in Greece further exacerbates this situation. The teachers need opportunities to develop skills where appropriate without having their existing skills devaluated. 6. How are outcomes of work with families evaluated? Table 2 presents the suggestions provided by the teachers as helpful in their evaluation of possible interventions. This area poses a question of 12
Bibou-Nakou: Children Living with a Mentally Ill Parent Table 2
Evaluation of the outcomes
Area of evaluation
Percentage of teachers’ responses
Factors related to the child School attendance Peer acceptance, social function of the child Academic achievement Factors related to the parents Frequent communication with them, drop in the school Acceptance of the referral to a psychological/ social service Interaction between teacher and child Development of mutual trust I don’t know
44
17 26 13 22
validity in research terms in relation to whether or not the intervention works and in what ways. Not only the teachers, but most of the professionals who work with children and their families in the community or clinical services are ill-equipped to answer such questions in a meaningful way. Even the most convincing evidence that some children have turned out well, for example, leaves the teachers at a loss when they try to understand the process or to establish reasons definitively. The teachers need to be reassured that, despite possible slow and painful progress, they are doing the best they can do and that their efforts with pupils are valued. From Table 2, it is suggested that the participant teachers evaluate their interventions as positive when: (a) developing and reviewing procedures for managing learning difficulties and difficult child behaviour; (b) establishing positive approaches with the family and (c) improving the relationships between staff and pupils.
Teachers’ perceptions in relation to parental mental health/ill and children’s well being Following are the results from the case vignette (see Appendix). The teachers were given a case outline and were asked to give written answers to questions on this material. The teachers’ responses are presented in relation to the three examined areas: (1) in what ways does the mental health of the mother affect the child?; (2) stressors for the function of the family and (3) protectors for the function of the family. Table 3 presents the teachers’ responses in relation to the mother’s mental health and the children’s well being. There is evidence to 13
School Psychology International (2003), Vol. 24(3) Table 3 Potential impact on child of behaviours associated with the mother’s mental health Potential impact on child
Percentage of teachers’ responses
Mother not being able to provide basic care Basic needs of the child not being met Disturbing behaviour, ‘symptoms’ of the illness Repeated hospitalization of the mother Stigma-social discrimination/deterioration Mother not being able to provide stimulation Mother arousing embarrassment and fear to the children due to her strange behaviour/beliefs Emotional neglect Mother not ensuring safety for the children due to unpredictable planning Mother not being able to provide guidance and boundaries Mother does not love the children Mother’s self-preoccupation/feeling insecure herself Mother being unable to communicate properly with the children Mother being an inappropriate role model Mother being upset and worrying
47 29 28 24 19 19 18 10 7 7 5 5 3 2 1
suggest that many factors linked to parental mental illness are associated with distress of children (Beardslee, 2002. Falkov, 1998). According to the participants, the adversity experienced by children may operate acutely (e.g. in hospitalization), may recur (unpredictable planning on behalf of the mother) or may persist long-term. In a longterm perspective, the teachers suggest that a distressed mother will lack basic parenting skills that should enable her to look after her children adequately. Although we know that there is not an automatic relationship between parental behaviours and the impact on a child, some patterns that the teachers present are commonly found among these families (Blanch et al., 1994; Duncan and Reder, 2000). On the other hand, we should keep in mind that the effects of parental mental illness are mediated by complex factors such as constitutional factors of the child, developmental periods of the child and the family, the illness culture of the family, financial factors, as well as broader social and cultural factors (Gopfert et al., 1996). How teachers think makes a difference to what they can do. Thinking about a distressed mother mainly in terms of the mental health/illness narrows their thinking to fit in with the individual orientation of our health, social and community service systems. On the other hand, we strongly argue that a family or a parent in isolation cannot raise 14
Bibou-Nakou: Children Living with a Mentally Ill Parent Table 4 Risk factors/stressors for the family functioning Risk factor
Percentage of teachers’ responses
Disruption in the collaboration between services Characteristics of the mental illness-severity, relapse Hospital admission The problem of mental retardation Mother’s absence (symbolic and physical) Chronic problems due to the mental illness Symptoms of the mental illness The demands of looking after the children Family unhappiness, tension Side effects from the medication Frequent visits by the health visitor The child’s characteristics, young age
62 37 28 27 16 15 13 6 4 4 3 1
children, since there is ample evidence to suggest that children’s problems are not adequately addressed and framed purely as a parent or even family affair (Garbarino, 1987. Gopfert, et al., 1996). As we can see from Table 4, the nature and the severity of the parent’s disturbed behaviour are perceived by teachers as important factors determining the effect on children in the family. The teachers present a broad category of risk factors that refer to the chronicity and the symptoms of the illness. Symptom talk (Parker et al., 1995) as a form of narrative is very common in cases of mental illness where the focus is placed on a narrow range of observable phenomena. In addition, the chronicity involves assumptions about the biological and constitutional origins of the problem within the person. This medical discourse is quite prevalent in a wider social perspective and might serve to displace the responsibility for parenting issues away from services and professionals on to the users and the nature of the illness. Apart from the risk factors that relate to the illness, the teachers also present the children’s age as a crucial factor. We know that teachers acknowledge the developmental needs of children as part of their education. On the other hand, retaining a developmental perspective enables them to reflect better on children’s experiences, provided that they place development within the framework of family relationships and that they avoid normative descriptions that are easily used as naturalized prescriptions. (Burman, 1994). Table 5 presents the assumed protective factors according to the teachers’ responses to the case vignette. As we can see, the teachers frame children’s troubles as evidence of a complex interaction of multiple variables that have to do with supportive networks both within the family and the wider professional 15
School Psychology International (2003), Vol. 24(3) Table 5 Protective factors for the family functioning Protective factor
Percentage of teachers’ responses
The supportive relationship with the father The supportive relationship with the maternal grandmother Interagency collaboration Special needs teacher Acceptance of the illness by the mother The children as a protective factor Intact family
88 86 66 37 15 3 2
context. 37 percent of the teachers acknowledge the presence of a special needs teacher as a positive factor. What is missing from the teachers’ responses as an important protective factor is the children’s capacity to make sense of their parent’s behaviour (Duncan and Reder, 2000) which is dependent ,in part, on the complexity of the illness and the opportunities for the children to be informed. Teachers are able to provide enough information about these issues, provided that they get enough training and support to do so.
Discussion and suggestions The participant educators involved in the present study were without institutional means and resources to handle the needs of children living with a mentally ill parent. The failure to intervene earlier in the children’s life is certainly not due to lack of interest from the teachers. As we have already mentioned, the Greek educational system has a highly hierarchical and bureaucratic administration that leaves little free space to staff to promote their pupils’ mental health and psychosocial adaptation (Damanakis, 1998). Most teachers are mainly concerned with completing the curriculum and this has diminished the importance of personal and social education. The results indicated, as expected, that policy priorities of the school are largely absent or driven by individual initiatives. On the other hand, the teachers appear highly critical of the way the education services are functioning in the areas of awareness and communication in mental health/illness issues. A school-based perspective to the understanding of children’s living with a mentally ill parent is absent. Education has a vital role to play in child mental health, particularly in field of prevention and promotion (Sanders et al., 1996). One can speculate that if prevention had a higher priority in child policy development, then education would play a more prominent role in the management of child and family support services (McCay and Pollard, 1996). 16
Bibou-Nakou: Children Living with a Mentally Ill Parent It is now well documented that most of teachers see prevention as part of their function (Trowell et al., 1996). Even so, teachers do not feel necessarily comfortable with the idea of dealing with such an issue in their classrooms. The fact remains that the class teacher is unlikely to have had any training in understanding the needs of children who live with a mentally ill parent even though they deal with these children for a minimum of five hours a day, five days a week for 35 weeks a year. We argue that the educational services context is of vital importance to children and distressed parents and poses many challenges to the teachers’ work with children and parents. These challenges could be either professional ones such as the ethics of intrusion, or/and societal challenges such as the social system’s attitudes to mental illness or the dissonance between families’ practices and lifestyles and those of teachers (Manlove, 2001; Peake and Turner, 1999). We suggest that programs of educational service reform are important sites for research that aims to critically examine shifting assumptions about what the children who live with a mentally ill parent need and how they can be helped in the school setting. As we can understand, this is closely linked to shifting political and economic conditions. A major challenge for educational services will be to establish and maintain connections with allied disciplines so that existing and emerging knowledge and practice can be broadly applied in these services. As the management of children in need can be a severe organizational problem (Lloyd and Munn, 1999), it is important that teachers have guidelines about how they should work with other agencies. It is also extremely helpful to have a system of warning signs and indicators associated with parental mental illness alongside the developmental process of the child. Addressing what children living with a distressed parent means in the school setting requires a serious commitment from the staff members, provided that support is available from the school management. Teachers can help these children in a number of ways such as by: (a) improving their educational functioning and increasing their capacity to deal with academic issues; (b) rebuilding these children’s sense of self-esteem and confidence; (c) facilitating the children to cope socially with peers and begin to build adequate relationships in the school setting and (d) referring them to specialists and education support services and monitoring the effects of this collaboration. The fact that a parent experiences mental illness does not inevitably mean that she/he is unable to parent, and the fact that a child lives with a mentally ill parent does not automatically mean that there will be a negative impact on the child and on the parent-child relationship (Falkov, 1998). On the other hand, if we are targeting promotion of 17
School Psychology International (2003), Vol. 24(3) mental health, helping teachers to help those children who live with a distressed parent and are in need, provides multiple positive outcomes for both the children and their families.
Notes 1. Partners of the Daphne Project ‘Parental Mental Illness and Children’s Well-Being’: M. Antoniadou, National Partner, Social worker, Child Mental Health Services; G. Thessaloniki Fadden, International Partner, Program Manager of the Meriden Team, West Midlands, England; A. Falkov, International Partner, Consultant Child Psychiatrist, Luton CMHS, England; V. Lazaridis, National Partner, Psychiatrist, Director of AMHS; A. Thessaloniki and A. Stogianidou, Clinical/School Psychologist, Department of Psychology, Aristotle University of Thessaloniki. 2. Part of this araticle was presented at the Second World Conference on the Mental Health of Children and Adolescents, London, 11–13 September 2002. 3. In the course of the main project, the aims of this cross-national collaboration were: (a) to enhance practice and improve services for families in which mentally ill adults live together with dependent children; (b) to raise awareness, knowledge and skills amongst staff in adult mental health and children’s services, as well as within primary care and voluntary sector services; (c) to increase understanding of the ways in which parental mental ill-health can impact on disturbed relationships and on children’s welfare and practices of violence. A holistic family approach that ensures that the needs/ rights of all family members are taken into account, rather than the needs of either the parent or the child in isolation was promoted (Bibou-Nakou, 2001; Falkov, 1998).
References Altschuler, J. (1997) Working with Chronic Illness. London: Sage MacMillan Press. Anthony, E. J. and Cohler, B.J. (eds.) (1987) The Invulnerable Child, pp. 70– 84. New York: Guilford. Beardslee, W.R. (2002) Out of the Darkened Room. Protecting the Children and Strengthening the Families When a Parent is Depressed. New York: Little Brown Company. Beardslee, W.R., Bemporad, J., Keller, M. B. and Klerman, G. L. (1983) ‘Children of Parents with Major Affective Disorder: A Review’, American Journal of Psychiatry 140(7): 825–32. Beidel, D. C. and Turner, S.M. (1997) ‘At Risk for Anxiety: I. Psychopathology in the Offspring of Anxious Parents’, Journal of American Academy of Child Adolescent Psychiatry 36(7): 918–24. Beker, J. and Maier, H. (1981) ‘Emerging Issues in Child and Youth Care Education: A Platform for Planning’, Child Care Quarterly 10(3): 200–09. Bibou, I., Andreadou, N. and Iliadou, S. (1999) ‘Developmental Patterns of Elementary Teachers’ Perceptions Related to School Adjustment Problems.’, paper presented at the IXth European Conference on Developmental Psychology, Spetses, 1–5 September 1999. Bibou-Nakou, I (2000) ‘Elementary School Teachers’ Representations Regarding School Problem Behaviour. ‘Problem Teacher in Talk’, Educational and Child Psychology 17(4): 91–107.
18
Bibou-Nakou: Children Living with a Mentally Ill Parent Bibou-Nakou, I. (2001a) ‘Introduction’, in E. Dowling and E. Osborne (eds) The Family and the School. A Joint-Systems Approach to Problems with Children, 2nd edn, pp. 33–62. London: Routledge. Bibou-Nakou, I. (2001b) Daphne Report: A Comparative analysis and training for practitioners involved with parental mental illness. Mapping the types of violence in the family members. Project No: 2000/DAP/241/WC. Brussels, Belgium. Blanch, A.K., Nicholson, J.,and Purcell, J. (1994) ‘Parents with Severe Mental Illness and Their Children: The Need for Human Services Integration’. The Journal Of Mental Health Administration 21: 388–96. Burman, E. (1994) Deconstructing Developmental Psychology. London: Routledge. Calder, M. and Horwath, J. (eds) (year) Working For Children on the Child Protection Register: An Inter-Agency Practice Guide, pp 269–84. London: Ashgate. Canino, G., Bird, H., Rubio-Stipec, M., Bravo, M. and Alegria, M. (1990) ‘Children of Parents with Psychiatric Disorder in the Community’, Journal of American Academy of Child Adolescent Psychiatry 29(3): 398–406. Chase, N. D (1999) Burdened Children. Theory, Research and Treatment of Parentification. London: Sage. Damanakis, M. (1998) ;The School in Greece’, European Education 29(4): 11– 19. David, T. (1993) Child Protection and Early Year Teachers: Coping with Child Abuse, pp. 114–48. London: Open University Press. Decker, J., Kirby, S., Greenwood, A. and Moore, D. (1999) Taking Children Seriously. London: Cassel. Department of Health (1999) Framework for the Assessment of Children in Need and their Families. London: HMSO. Dowling, E. and Osborne, E. (1994) The Family and the School. A JointSystems Approach to Problems with Children, 2nd edn. London: Routledge. Downey, J. and Coyne, A. (1990) ‘Children of Depressed Patients: An Integrative Review’, Psychological Bulletin 108(1): 50–75. Duncan, S. and Reder, P.(2000) ‘Children’ s Experience of Major Psychiatric Disorder in their Parent: An Overview’, in P. Reder , M. McClure and A. Jolley (eds) Family Matters. Interface Between Children and Adult Mental Health, pp 83–96. London: Routledge Eufami (2001) The Needs of the Caring Family. A European Perspective. General review of the Eufami Survey, Barcelona Congress. Http://www.eufami.org Falkov, A. (1998) Crossing Bridges. Training Resources for Working with Mentally Ill Parents and Their Children. Department of Health.: Pavillion. Falkov, A. (2001) ‘Troubled Lives’: School Aged Children’s Understanding of Parental Psychosis. Unpublished manuscript, South London and Maudsley NHS Trust. London, U.K. Garbarino, J. (1987) ‘What Can the School do on Behalf of the Psychologically Maltreated Child in the Community?’, School Psychology Review 16: 181– 87. Garber, J. and Little, S. (1999) ‘Predictors of Competence among Offspring of Depressed Mothers’, Journal of Adolescent Research 14(1): 44–71. Gibbons, J., Conroy, S. and Bell, C. (1995) Operating the Child Protection System: A Study of Child Protection Practices in English Local Authorities. London: HMSO. Gopfert, M., Webster, J. and Seeman, M.V (Eds.) (1996a) Parental Psychiatric
19
School Psychology International (2003), Vol. 24(3) Disorder. Distressed Parents and their Families. Cambridge.: Cambridge University Press. Gopfert, M., Webster, J., Pollard, J. and Nelki, J. (1996b) ‘The Assessment and Prediction of Parenting Capacity: A Community-Oriented Approach’, iIn M. Gopfert, J. Webster and M. Seeman (eds) Parental Psychiatric Disorder. Distressed Parents and Their Families. London: Cambridge University Press. Gray, P., Miller, A. and Noakes, J. (1994) Challenging Behaviour in Schools. Teacher Support, Practical Techniques and Policy Development. London: Routledge. Hetherington, R., Cooper, A., Smith, P. and Wilford, G. (1997) Protecting Children. Messages from Europe. London: Russel House. Hetherington, R. (2000) The Icarus Project. Professional Interventions for Mentally Ill Parents and Their Children: Building a European Model. (Executive Summary of the Final Report to the European Commission) London Jennings, C. and Kennedy C. (Eds.) (1996) The Reflective Practitioner in Education. Psychological Perspectives and Changing Contexts. London: Jessica Kingsley. Kendall-Tackett, K. (1996) ‘The Effects of Neglect on Academic Achievement and Disciplinary Problems: A Developmental Perspective’, Child Abuse and Neglect 20(3): 161–69. Lloyd, G. and Munn, P. (1999) ‘Educational Services for Children with Social, Emotional and Behavioural Difficulties’, in M. Hill (ed.) Effective Ways of Working with Children and Their Families, pp. 163–78. London: Jessica Kingsley. Madianos, M.G., Economou, M., Hatziandreou, M., Papageorgiou, A., Rogakou, E. (1999) ‘Changes in Public Attitudes Toward Mental Illness in the Athens Area (1979/80–1994)’, Acta Psychiatrica Scandinavica 99: 73–78. Manlove, E. (2001) ‘Learning to be a Child Care Teacher. Reflections from Long-Term Practitioners’, Child and Youth Care Forum 30(4): 209–29. McCay, D. and Pollard, J. (1996) ‘Community Support Networks in Education and Care Settings’, in M. Gopfert, J. Webster and M.V.Seeman (eds.) Parental Psychiatric Disorder. Distressed Parents and Their Families, pp. 152–61) Cambridge: Cambridge University Press. Motti-Stefanidi, F., Tsiantis, I. and Richardson, S. C. (1993) ‘Epidemiology of Behavioral and Emotional Problems of Primary Schoolchildren in Greece’, Journal of the American Academy of Child and Adolescent Psychiatry 2: 111–18. Mowbray, C. T., Oyserman, D., Bybee, D., MacFarlane, P. and Rueda-Riedle, A. (2001) ‘Life Circumstances of Mothers with Serious Mental Illnesses’, Psychiatric Rehabilitation Journal 25(2): 114–24. Nicholson, J., Sweeney, E. M. and Geller, J. L. (1998) ‘Mothers with Mental Illness. The Competing Demands of Parenting and Living with Mental Illness’, Psychiatric Services 49(5): 635–42. Olsen, R. (1996) ‘Young Carers: Challenging the Facts and Politics of Research into Children and Caring’, Disability and Society 11(1): 41–54. Parker, I., Georgaka, E., Harper, D., Mclaughlin, T. and Stowell-Smith (1995) Deconstructing Psychopathology. London: Sage. Peake, A. and Turner, J. (1999) ‘Helping Teachers to Help Children’, in M. C. Calder and J. Howarth (eds) Working for Children and the Child Protection Register: An Inter-Agency Practice Guide, pp 269–85. Hants: Ashgate Publishing Ltd.
20
Bibou-Nakou: Children Living with a Mentally Ill Parent Reder, P., McClure, M. and Jolley, A (eds) (2000) Family Matters. Interfaces between Child and Adult Mental Health. London: Routledge Rutter, M and Quinton, D. (1984) ‘Parental Psychiatric Disorder: Effects on Children’, Psychological Medicine 14: 853–80. Sanders, R., Jackson, S. and Thomas, N. (1996) ‘The Balance of Prevention, Investigation and Treatment in the Management of Child Protection Services’, Child Abuse and Neglect 20(10): 899–906. Stevenson, O. (1998) Neglected Children: Issues and Dilemmas. Oxford: Blackwell. Trowell, J., Jennings, C. and Burell, S. (1996) ‘Child Sexual Abuse. Can We Bear It? Training Perspectives in the Educational Context’, in C. Jennings and C. Kennedy (eds) The Reflective Practitioner in Education. Psychological Perspectives and Changing Contexts, pp 161–93. London: Jessica Kingsley. Vanharen, J., LaRoche, C., Hegman, M., Massabki, A. and Colle, L (1993) ‘Have the Invisible Children Become Visible? Canadian Journal of Psychiatry 38(10): 678–80. Weist, M. D., Lovie, J., Lever, N., Johnson,A. and Rowling, L. (2002) ‘Building an International Network for Mental Health in Schools’, The International Journal of Mental Health Promotion 4(2): 34–40. WHO (2002) Prevention and Promotion in Mental Health. Mental Health: Evidence and Research. Department of Mental Health and Substance Dependence. Geneva: WHO.
APPENDIX Case vignette Alexandra is a 32 year old, married woman, with two boys aged eight and six. Since 1998, she presented with an acute psychotic episode along with a mild mental retardation. At that time, she was admitted to the state psychiatric hospital. When she left the hospital, she was living with her husband. A health visitor was visiting Alexandra every month for her Depot medication. In October 1999, Panos, the oldest son of the family, presented difficulties at school, according to his teacher’s comments. He was helped by a special teacher who was very worried about Panos. She asked for some help from a community mental health service. After the teacher’s collaboration with the community service psychologist, Panos seemed to get better. In December 2000, the health visitor left for an educational leave for three months and she was not replaced. In February 2001, the teacher was again very concerned about Panos’ attendance at school. The other children would bully him and he was violent towards them. After a social worker’s visit at home, the mother was reported ‘not feeling well, sleeping a lot and crying a lot, too’. On the 1st March, Alexandra was admitted to the hospital with her compliance. Her husband accompanied her. The grandmother was informed about the situation and she moved into her daughter’s house during the period of her admission. 21
