This research sets out to discover what impact parental schizophrenia makes on a child’s life. It focuses on the daily life and experiences of children. Their health, education, family and leisure activities are examined. Contact with helping agencies and their unmet needs are investigated. The sample was drawn from the children of patients attending the mental health services in South West Dublin. They were matched with a control group of children of well parents. The majority of children who have one parent with schizophrenia had similar profiles to the children of well parents in the areas of physical health, positive family feelings, friendships, hobbies and household tasks. In a number of other areas, however, differences were found. Sample children had more psychiatric disturbance, more problems associated with school, less contact with relatives and spent more time at home. The children had little access to services and were upset by hospital visiting. The need for an educational programme and support for these children was demonstrated. It is recommended that a more co-ordinated approach is required by both adult and child mental health services in order to meet their needs.

Schizophrenia: The Impact of Parental Illness on Children

Psychosocial issues and interventions
play a very important role in the aetiology,
course and prognosis of several child psychiatric disorders.
Psychosocial problems in a child and adolescent
psychiatric clinic population in Nigeria were documented
as a preliminary step towards the planning and
development of this new facility. A standardised
assessment procedure was integrated into the routine
at the clinic when services commenced. Psychosocial
stressors and life events were measured using the
interview method so that in–depth information could be
obtained. Over the 3-year period of study, 79
(62.2%) of the 127 new referrals to the clinic had significant
psychosocial stressors in the year preceding presentation.
Problems with primary support, such as separation
from parents to live with relatives, disruption of
the family, abandonment by mother, psychiatric illness
in a parent and sexual/physical abuse, occurred in 50
(39.4%) of the subjects. Problems with social environment
occurred in 11 (8.7 %), 39 (30.7 %) had educational
problems, 5 (3.9%) had economic problems and 15
(11.8%) of the children had ‘other’ psychosocial stressors.
Significantly more children and adolescents with
disruptive behaviour disorders and disorders like
enuresis, separation anxiety and suicidal behaviour had
psychosocial stressors when compared to children with
psychotic conditions, autistic disorder and epilepsy
(χ2 = 9.6; p = 0.048). The importance of the
psychosocial diagnostic dimension in routine practice is
illustrated in this study. Some psychosocial factors identified
are cultural practices. The effects of these practices
on child mental health require further study.

Psychosocial issues in a child and adolescent psychiatric clinic population in Nigeria

Government policy and organizational factors influence family-focused practice (FFP) in adult mental health services. However, how these aspects shape psychiatric nurses' practice with parents who have mental illness, their dependent children, and families is less well understood. Drawing on the findings of a qualitative study, this article explores the way in which Irish policy and organizational factors might influence psychiatric nurses' FFP, and whether (and how) FFP might be further promoted. A purposive sample of 14 psychiatric nurses from eight mental health services completed semi-structured interviews. The analysis was inductive and presented as thematic networks. Both groups described how policies and organizational culture enabled and/or hindered FFP, with differences between community and acute participants seen. This study indicates a need for policies and organizational supports, including child and family skills training, to promote a whole family approach in adult mental health services.

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The Impact of Organizational Factors and Government Policy on Psychiatric Nurses’ Family-Focused Practice With Parents Who Have Mental Illness, Their Dependent Children, and Families in Ireland

Stigma is a pervasive social mechanism with negative ramifications for people who experience mental illness. Less is known about the stigma experiences of families where a parent has a mental illness. This review aims to identify and synthesize evidence on the concept of stigma and stigma-related experiences and outcomes reported by parents and children living with parental mental illness. An integrative review method was employed, with PRISMA (Preferred Reporting Items of Systematic Review and Meta-Analyses) guidelines to search and select literature and extract and analyse data. This approach allows for inclusion of theoretical and empirical literature and for concept definition. Fifty-eight papers, mostly from the USA, Australia, and the UK, met the inclusion criteria. Stigma was primarily conceptualized in families as a marked difference that was negatively appraised, and which could be internalized. Some articles examined how underpinning assumptions could shape the behaviour of individuals and groups and be embedded within social institutions and structures. For parents, mental illness stigma was interconnected with stigma relating to perceived violations of social and cultural norms related to parenting. Children's experience of stigma resulted in bullying, embarrassment, guilt and social isolation, and efforts to conceal their parent's mental illness. One outcome was that stigma prevented children and parents from seeking much needed supports. Public health policies and campaigns that focus exclusively on promoting open disclosure of mental illness to foster community education outcomes are unlikely to be effective without additional strategies aimed at preventing and redressing the structural impacts of stigma for all family members.

Stigma in relation to families living with parental mental illness: An integrative review

This paper addresses Tier 4 services for children and young people whose needs require highly specialised services, and describes the range of provision which is currently available for this group. Although the evidence base is in its infancy, what is known about clinical outcomes, cost effectiveness and the views of users is summarised. The current shortfalls in tier 4 provision are highlighted, the drivers for change are identified and recommendations are made for future service improvements.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1475-3588.2007.00481.x

Tier 4 Child and Adolescent Mental Health Services (CAMHS) - Inpatient Care, Day Services and Alternatives: An Overview of Tier 4 CAMHS Provision in the UK.

Background There is no published research on attitudes of psychiatrists towards children visiting parents who are acutely-unwell and inpatients in psychiatric hospitals. Nor is there information on facilities available for such visits. Objectives (I) To assess the attitudes of Irish psychiatrists towards children visiting. (II) To determine the availability of child-friendly facilities within admission units. Method A questionnaire was posted to every consultant psychiatrist accepting acute adult admissions in the Republic of Ireland and Northern Ireland. Results The response rate was 69%. Ninty-seven per cent were in favour of children visiting. Almost half felt that decisions on visits should depend on the particular situation, considering the child, parent, ward, etc. However, only 11% of units had a room/area designated for children visiting. 90% had no facilities they considered child-friendly on their unit. A majority felt that arrangements for children visiting were inadequate. Conclusions This topic is of interest to psychiatrists, and can be contentious, particularly when considering supervision of, and legal responsibility for, children visiting. Guidance on these issues would aid psychiatrists and hospital management. Poor facilities and infrequent visits may be a factor in the early development of stigma towards mental illness. Further research, improvements in facilities and staff training in liaison with children are needed.

Attitudes to visits by children to parents hospitalised with acute psychiatric illness.

Objectives: This study focused on measuring symptomatology and self-esteem in children admitted to an inpatient child psychiatric unit.Method: Twenty-six children consecutively admitted to a child psychiatric unit were assessed using the Rutter Parent Interview, the Birleson Depression Scale and the Harter Self Perception Profile for Children. Children were followed up at three and 15 months post-discharge and the same measures administered.Results: A stay in the unit was linked with a significant reduction in overall symptomatology and this was particularly so for emotional-type symptoms at both follow-up points and for hyperactive-inattentive symptoms at 15-month follow-up. The unit did not appear to be successful at reducing conduct symptoms at either followup. Nor did self-esteem change significantly following an inpatient episode. Children with depressive symptoms especially appeared to benefit both in the short- and longterm and this benefit extended to self-esteem.Conclusions: When analysing the benefits of an inpatient admission it is crucial to consider outcome and therefore efficacy on a long-term basis. Efficacy needs to take into account longer-term outcomes. The impact of an inpatient episode on a child's psychosocial adjustment will for some children take time. These ‘sleeper effects’ need further study.

A 15 month follow-up study of children admitted to a child psychiatric inpatient unit

Identical twins encounter unique psychological and maturational difficulties alien to the experiences of single children. A brief review of the literature on these points is presented, emphasising both the tormenting and gratifying aspects of a twin who has in the outside world another identical self that the world notices and confuses with him. Such aspects need to be taken into consideration when engaging an identical twin in analytical psychotherapy. ‘Fallout’ from psychotherapy can have repercussions on those close to the patient but in the case of identical twins the effects on the twin not in therapy can be disastrous. In particular, when psychotherapy-by-proxy ensues it appears possible for the co-twin to establish strong links to the analyst through his narcissistic relationship with his twin, which appear transferential in nature. A clinical vignette is presented which elaborates on the issues of twin transference and the fallout effects on the twin not in therapy. A question is put forward: whether it is realistic to analyse identical twins individually and not together when their narcissistic dependency and defensive hostility are paramount to internal processes. The author takes the view that a psychoanalytical orientation to the psychotherapy of an identical twin is the most recommended but cautions against individual psychoanalytical psychotherapy where the real drive is the assassination of the internal and external twin-object as a means to individuation from the twinship. The nature of this object - whether selfobject or transformational object - is tentatively discussed.

Fundamental Considerations in the Psychotherapy of an Identical Twin

Objectives: To determine the frequency with which abuse, parental separation and bereavement occur on their own or together in children attending child psychiatry services and to assess the relationship between these traumas and attendance and outcome. Method: A review of all case notes over a 12 month period (n = 435) was conducted and a proforma completed. Information was gathered on clinical presentation, rate of attendance, the presence of sexual abuse, non-sexual abuse including bullying, bereavement and parental separation and a measurement of outcome by subjective assessment was made. Results: Fifty-nine per cent of the children had experienced at least one of the specified traumas; 13% had experienced two and 2.5% had experienced three. The children who had been abused or bereaved were more likely to require fairly long-term work; those who were adjusting to parental separation required less intervention over time. The children who had been sexually abused had, relatively, the poorest outcome in contrast to those adjusting to bereavement where 87% were considered to have made significant improvement. Conclusions: Bereavement, abuse and parental separation are common in children referred to the child psychiatric services and these children often require long-term intervention. Increased resources will be required in order to continue to provide adequate intervention and treatment for these children.

Dyads and triads of abuse, bereavement and separation: a survey in children attending a child and family centre

Objective: An audit was carried out to evaluate the performance of a telephone consultancy service in adolescent psychiatry. Its objective was to answer the following questions: What does a telephone consultancy service actually do? Is it worth having? If so, how can we improve it? Method: Proforma data sheets on 69 consecutive calls to the Telephone Consultancy Service over a 16-month period were analysed. Results: Seventy-seven percent of enquirers used the service to request a referral or to ask about the appropriateness of referral but only 46% of enquiries were responded to in this way. Twenty-two percent of enquiries were given counselling or advice on how to proceed with the cases themselves. Almost 50% of calls came from the social work department and they enquired principally about conduct problems (27% of their calls) and sexual abuse victims (18% of their calls). General practitioners infrequently used the service (7 calls over a 16-month period). Conclusions: These findings appear to indicate that a telephone consultancy service can provide a counselling service and highlight community resources that may be overlooked by other agencies. However, infrequent use of the service by general practitioners suggests that there has been poor dissemination of information about the service – therefore it is important to bolster awareness of the service itself on a periodic basis amongst potential users.

Declan Sheerin

Papers

Attitudes to visits by children to parents hospitalised with acute psychiatric illness.

A 15 month follow-up study of children admitted to a child psychiatric inpatient unit

Fundamental Considerations in the Psychotherapy of an Identical Twin

Dyads and triads of abuse, bereavement and separation: a survey in children attending a child and family centre

Telephone consultancy in adolescent psychiatry: an audit