Child psychotherapist Joanna Fortune says most parents with a serious but well-managed mental illness can continue to provide safe and secure loving care for their children. “When the illness is carefully managed, the children will go on to thrive but that’s not to say that the illness won’t have an impact on them,” she says.
“Children thrive on predictability, and a parent with a mental illness can be unpredictable. This can be unsettling for children. If a parent has to go into hospital for a while, their care becomes fragmented.
“If a mother has depression when her baby is young and she can’t respond to and delight in the baby, that baby’s emotional development will be impacted. School-aged children are impacted differently by a parent’s mental illness. Generally speaking, girls become mini-carers and boys act out, becoming more impulsive or aggressive.”
Aware, the support group for people with depression and other mood disorders, is hosting a public conference on the future of depression and bipolar disorder on Saturday, October 12th, and Fortune will speak at the conference (see awareconference.com) in UCD on how families cope when a family member has a serious mental illness.
When children becomes carers, they can take on “pseudo-mature behaviour”, according to Fortune, while developing strong independence skills. However, what often happens is that, in the process, they lose their sense of childishness and childhood playfulness.
She says that the most important thing within a family is to talk about the illness in an age-appropriate way. “It’s important to keep the lines of communication open, demystify the illness and take the scariness out. Remember, you are still their mum or dad, which means everything to them,” says Fortune, who recommends families read the illustrated book The Black Dog by Levi Pinfold, a clever tale about confronting your fears.
Some children might not want to bring friends home because their parent behaves differently, but if they have the language to explain the illness, this will help them cope better. So, if a child is being teased about a parent arriving late for a school pick-up, the child can learn to say “my dad has depression and sometimes he feels too sad to come out. This empowers the child to have a narrative and not feel ashamed by a parent not turning up at the school gate.”
For parents suffering with depression or bipolar disorder, Fortune says it’s important to consider what they can do rather than what they can’t. “There are always opportunities for shared joy, and children will remember times when a parent braided their hair, arm-wrestled with them, played ‘row, row, row the boat’ with them or made popcorn and watched a movie with them.”
Sharing stories from their own childhood is another way for parents to connect with children if they aren’t well enough to get down and play on the floor with their children. Also, it’s important for a parent to be able to say to their children if he/she is having a bad day.
“I recommend all families keep a hopefulness jar filled with post-it notes with suggested things to do to make everyone feel better. Then, if you are having a bad day, you can take one out and do the activity. It might be as simple as going to the park to play Frisbee. And then, if you’re having a day that you need to lie down, don’t just disappear or retreat to your room, tell your child you need to lie down. If you don’t, they will think they did something to upset you.”
Dr Andreas Higgins, clinical psychologist and clinical director of Aware, will speak at the conference about the importance of family carers looking after themselves.
“Mothers, fathers, brothers and sisters can experience a lot of stress from looking after [or living with] someone with depression or bipolar disorder,” she says. “Often, those closest to the person with the illness can really see what’s going on, when the person isolates him/herself, when they are harder to reach or when they reject support.”
Often carers of people with depression have the caring role thrust upon them. “Some people might not even recognise themselves as carers but they need to do so to acknowledge their own needs,” adds Higgins. Aware offers programmes for relative and friends and carers can also attend the life skills programmes that the organisation offers people suffering from depression and other mood disorders.
PREGNANCY AND POSTNATAL DEPRESSION
Ten to 15 per cent of women suffer from depression in pregnancy or postnatally. Prof John Sheehan, perinatal psychiatrist at the Rotunda Hospital in Dublin, will speak at the Aware conference about managing depression in pregnancy and after the baby is born.
He says that while most people acknowledge the existence of post-natal depression, many people don’t realise that the same amount of women – 10-15 per cent – suffer from depression in pregnancy as those who are depressed following the birth of their baby.
“The average age of women having their first baby is now 31 or 32, and many of them will have worked very hard, have a good job and be financially independent when they become pregnant. Also, 50 per cent of pregnancies in Ireland are unplanned and it might not be the right time for them to have a baby even if they go ahead with the pregnancy,” says Prof Sheehan.
He says that every woman is now asked about their mental health at their first hospital appointment during their pregnancy. “Fifty per cent of women who are depressed in pregnancy or after the birth of their baby will respond well to psycho-social measures such as counselling, social support, information and education. However, for those with moderate to severe depression, medication will also be needed,” he says.
Prof Sheehan says that there are certain anti-depressant medications that are suitable to take during pregnancy and while breastfeeding. Depression in pregnancy is associated with low-birth-weight babies, premature delivery and a higher rate of instrumental deliveries, so keeping a woman well in pregnancy has benefits for her, for the baby and for all the family,” he says.
Public health nurses who attend women after their babies are born will also screen for depression and organise so-called “listening visits” for women who need to talk about their difficulties coping with a new baby in the house.