COPMI research news – March 2016

View the latest research articles and news

Parenting with a mental illness:

Perinatal mental health:

Services for families where a parent has a mental illness:

Family Law

Child and family welfare services:

Parenting with a mental illness

Strategies for parenting by mothers and fathers with a mental illness

Introduction: Understanding of the problems of parents with mental illness is growing. Gaining insight into strategies for parenting, while taking the opportunities formulated by these parents themselves as a starting point is fairly new.

Question: What are the strategies of parents with a mental illness to be successful?

Method: Experiences of 19 mothers and eight fathers with a mental illness were explored with in-depth interviews. Data were content analysed, using qualitative methods.

Results: Next to feelings of inadequacy, interviewees also describe how children enrich and structure their lives and are not only a burden but serve as distraction from problems. Developing activities that interest both child and parent provides avenues for emerging strength. Mental illness constrains fathers, but also gives opportunities to develop a meaningful relation with their children.

Discussion: Strategies like being fully dedicated to the parental role, finding a balance between attention for one’s own life and parenting and finding adequate sources of support are found to be fundamental for recovery in the parent role.

Implications for practice: Peer groups can be of valuable help and mental health workers can support parents to set self-chosen parenting related goals.

Reference: van der Ende, P., van Busschbach, J., Nicholson, J., Korevaar, E., & van Weeghel , J. (2016). Strategies for parenting by mothers and fathers with a mental illness. Journal of Psychiatric Mental Health Nursing, 23(2): 86-97. doi: 10.1111/jpm.12283.

Paternal mental health: Why is it relevant?

Father’s mental health is an emerging area of interest that is beginning to be recognised in research, and to a lesser extent in clinical practice and society. Fathers are part of a parenting dyad with two partners who are responsible for their children’s emotional development. Similar to mothers, the risk for mental health problems increases once a male becomes a father, but there is limited research examining this issue.

The purpose of this review is to present the available literature on father’s mental health and its effect on child emotional health through various mechanisms.

In general, father’s mental health was found to be related to increased child internalising and externalising behaviors, but each disorder had different risk factors, and a unique effect on parenting behaviors and the child’s emotional health.

The most developed paternal mental health literature is focused on depression. However, key conceptual and methodological problems exist that may limit our understanding of paternal depression. Additionally, the focus on paternal depression may not accurately represent the largest risk for paternal psychopathology and the resultant child mental health outcomes because men have an increased likelihood of displaying externalising behaviors.

Implications for research, clinical practice, and policy are discussed.

Reference: Fisher, S. (2016). Paternal mental health: Why is it relevant? American Journal of Lifestyle Medicine, [Epub ahead of print]. doi: 10.1177/1559827616629895


Perinatal mental health

Depression and mental health in pregnant aboriginal women

Background: Depression is a major clinical and public health issue that carries serious consequences for wellbeing. In pregnant and postpartum women, the health consequences of depression also extend to the baby and other family members, making it an important maternal-child and family health concern. Chronic psychosocial stress is considered a prime risk factor.

Aboriginal populations in Canada experience health and social inequities relative to other Canadians. Many of the risk factors and health consequences associated with prenatal depression are more common among Aboriginal populations, suggesting that prenatal depression may be a concern. However, research on depression among pregnant Aboriginal women is limited. Given the unique historical and present-day societal context involved, it would be erroneous to assume that the results of studies in non-Aboriginal populations can be directly applied to Aboriginal populations. The societal context of Aboriginal women involves intersecting stressors from race and gender, social exclusion, and intergenerational trauma from residential schools and other legacies of colonization. Failure to consider the influence of societal context on health can result in the overlooking of key pathways to target for meaningful and enduring primary prevention, and in the investment of funds into ineffective programs that are inappropriate to the needs of the target group.

Key results: Chronic life stress and trauma were identified as key causes of depression, and were influenced by negative life events and circumstances, negative relationships, and socioeconomic factors. Driving these determinants were upstream, systemic factors related to historical and present day societal context (e.g., racism, sexism, social exclusion, and intergenerational trauma from residential schools and other occurrences of colonization).

Substance abuse was found to be a common coping mechanism for stress, trauma, and depression, indicating that mental health issues need to be addressed in order to effectively manage addictions. Social support and traditional Aboriginal healing practices were identified as protective, and thus may be key intervention strategies. While services in Calgary appear to be working well in certain ways, a need was identified for more culturally-appropriate services, better networking among agencies, and better training of service-providers to reduce stigma and enhance a safe and empowering healing environment for patients and clients.

Key recommendations: Aboriginal-specific prenatal and parenting programs are recommended – particularly those in group format that allow pregnant Aboriginal women to meet each other and develop supportive friendships. Additionally, programs that support Aboriginal fathers-to-be are warranted, to help them support their partner and children.

Further research is required into ways that accessibility to services might be improved; possible solutions might be longer hours of operation, drop-in services instead of appointments, and availability of childcare. Better systems of referrals and communication between different services and organizations are required, to ensure continuity and comprehensiveness in care. Additionally, there is a need for more culturally-appropriate services for Aboriginal patients and clients, as well as better training of service-providing professionals on how to create safe, stigma-free, and respectful service environments for patients and clients. Finally, there is a critical need for programs, services, and policies that better address the social determinants of health, racism, sexism, domestic violence, addictions, personal trauma and mental health concerns, and the intergenerational effects of residential school trauma.

Reference: Roy, A., Thurston, W. E., & the Voices and PHACES Study Team. (2015). Depression and mental health in pregnant Aboriginal women: Key results and recommendations from the Voices and PHACES study (Final report). Calgary, AB: University of Calgary.


Services for families where a parents has a mental illness

An Emotional Awareness Based Parenting Group for Parents with Mental Illness: A Mixed Methods Feasibility Study of Community Mental Health Nurse Facilitation (*Australian research*)

There has been limited examination of the use of relationship based structured parenting programs that focus on emotional interactions in the parent-child dyad in families where a parent has a mental illness. There is also a lack of awareness of the practicalities of providing such interventions within adult mental health services.

This study explores the process and outcomes of a nurse-led emotional awareness based parenting program for adult clients of a mental health service. Participants demonstrated a significant reduction in difficult parenting moments and associated stress and distress as well as promising improvements in overall distress and emotional awareness.

Reference: Isobel, S., Meehan, F., & Pretty, D. (2016). An Emotional Awareness Based Parenting Group for Parents with Mental Illness: A Mixed Methods Feasibility Study of Community Mental Health Nurse Facilitation. Archives of Psychiatric Nursing, 30(1), 35-40. Doi:

Practicing attachment in the real world: improving maternal insightfulness and dyadic emotional availability at an outpatient community mental health clinic

The purpose of the study was to examine the efficacy of an attachment-based intervention program practiced at an outpatient clinic.

Changes in parental insightfulness and dyadic emotional availability were assessed in 32 mother–child dyads from pre- to post-intervention. At both data collection points, mothers were interviewed with the Insightfulness Assessment and the mother–child dyad was observed in play sessions coded with the Emotional Availability Scales.

Findings revealed a strong association between maternal insightfulness and dyadic emotional availability, both before and after treatment. In terms of intervention efficacy, positive gains were observed in both insightfulness and dyadic emotional availability from pre- to post-intervention.

Mothers who changed their classifications from non-insightful to insightful following the intervention showed the greatest gains in emotional availability. These findings have important implications for the type of interventions and service delivery model that could work in real world clinical settings.

Reference: Ziv, Y., Kaplan, B., & Venza, J. (2016). Practicing attachment in the real world: improving maternal insightfulness and dyadic emotional availability at an outpatient community mental health clinic. Attachment & Human Development, [Epub ahead of print]. doi: 10.1080/14616734.2015.1135972

Psychopathology in families: an integral approach via the family outpatient clinic (*Article in Dutch*)

Background: Psychiatric disorders run in families. To bridge the gap between child and youth psychiatry and adult psychiatry, GGZ inGeest has started screening parents of new registered children for psychopathology – and if indicated – offers parents treatment in the same department as their children.

Aim: To examine the feasibility and usefulness of this procedure, to investigate how many parents agree to screening, further diagnostics and treatment, and to find out how many parents have in fact suffered from recent psychiatric problems.

Method: Prior to the children’s first appointment, the parents were asked to complete a questionnaire, the Adult Self Report (ASR), about their own problems. If these scores were (sub)clinical, parents were invited to participate in a telephonic interview. This consisted of the Composite International Diagnostic Interview (CIDI) and Conners’ Adult ADHD Rating Scales (CAARS). If the results indicate psychopathology, further psychiatric assessment and, if necessary, treatment is offered.

Results: The first response was 55.7% and, if indicated, most of the parents agreed on further diagnostics. On the ASR 2 out of 5 mothers (42.1%) and 1 out of 5 fathers (21.8%) reported problems that could point to a psychiatric disorder. According to the ASR, within this high-risk group 37% of the mothers met the criteria for an axis I diagnosis (less than one month earlier) compared to 70.6% of the fathers. A mood disorder was the primary diagnosis for women, whereas men most often suffered from an anxiety disorder. In total, 19.1% of the parents screened were suffering from recent psychopathology and 75% of this group agreed to receive mental health care (treatment at the family outpatient clinic or referred to another clinic).

Conclusion: Implementation of the family outpatient clinic scheme is feasible. However, further efforts are needed in order to reach a larger group of parents, particularly fathers. The family outpatient clinic is useful because parents who suffer from psychopathology do not always receive mental health care. However, a randomised control trial is needed to determine whether parallel treatment of parents and children can improve the treatment outcome for children.

Reference: van Veen, S., Batelaan, N., Wesseldijk, L., Rozeboom, J., & Middeldorp, C. (2016). Psychopathology in families: an integral approach via the family outpatient clinic. Tijdschr Psychiatr., 58(2): 95-104.

Occupational Therapists’ Perceptions of How They Support the Parenting Role of Mental Health Service Users Who Have Children

This study explored occupational therapists’ (OTs’) perceptions of how they support the parenting role of mental health clients. Qualitative data were provided by eight OTs in the United Kingdom, five in a focus group and three in individual interviews. Framework Analysis of the data generated four themes:

  1. ‘OT practice’
  2. ‘uncertainty about the role of adult mental health workers’
  3. ‘fitting into the health and social care network’
  4. ‘uncertainty about the necessity to be an expert on parenting’

There was uncertainty about what support should include and whether adult mental health OTs can give it. Recommendations were made to change guidelines and training.

Reference: Hackett, E., & Cook, S. (2016). Occupational Therapists’ Perceptions of How They Support the Parenting Role of Mental Health Service Users Who Have Children. Occupational Therapy in Mental Health, 32(1): 32-49. doi: 10.1080/0164212X.2015.1091280


Family law

View from the Bench: Parental Mental Health and Child Custody

Family courts are confronted with an increasing number of custody or visitation disputes where a parent suffers from a mental illness. In fact, when making a custody determination, most state statutes include parental mental health as a factor to consider in a best interests analysis.

This article presents best practices from the perspective of a family court judge when it comes to handling cases involving parental mental health and custody, including a discussion of the nexus between parental mental health and the parent’s relationship to the child and the weight given to custody or forensic evaluations.

Key Points for the Family Court Community:

  • In determining the best interests of the child, the family court judge must evaluate the parent–child relationship, parenting capacity, and parenting skills.
  • Most state statutes authorize judges to consider parental mental health as one of many factors in a best interests analysis.
  • The judge must weigh all of the evidence and determine whether a parent’s mental illness impacts the best interests of the child.
  • In making this determination, the judge can rely on the custody evaluation, the child’s attorney or guardian ad litem, and personal observations, among other sources.

Reference: Dane, E. & Rosen, J. (2016). View from the Bench: Parental Mental Health and Child Custody. Family Court Review, 54(1), 10-17. doi: 10.1111/fcre.12199


Child and family welfare services

The Evaluation of the Protecting and Nurturing Children: Building Capacity, Building Bridges Initiative (*Australian report*)

In 2010, the then Department of Families, Housing, Community Services and Indigenous Affairs (now the
Department of Social Services) funded the Australian Centre for Child Protection (ACCP) to develop and deliver
Protecting and Nurturing Children: Building Capacity Building Bridges (BCBB) over three years as an integral initiative supporting the National Framework for Protecting Australia’s Children 2009-2020: Protecting Children is Everyone’s Business. The Framework espouses a public health approach which seeks greater involvement of a range of professionals and others to enhance the variety of systems that are available to protect children (COAG,

BCBB was tasked with transforming the goals of the National Framework into action that made an impact within communities, including recognition that beyond mandatory reporting protecting children is the collective responsibility of all of our sectors and community members.

In particular, BCBB had two main foci: the first being to enhance the knowledge and skills of practitioners in child and family focused and adult focused services to support parents to meet the needs of children in their care (building capacity). The second was to strengthen collaboration between adult focused and child and family focused services to improve the way that families with multiple needs experience the service system (building bridges).

This report outlines the formative evaluation of BCBB and the learnings from this innovative initiative. The ongoing evaluation of BCBB was a key part of quality improvement, organisational learning and program development, conducted throughout the life of the project. The report draws upon information from program documentation, and surveys and interviews held throughout the course of the initiative.

Reference: Gibson, C., Francis, H., McDougall, S., Arney, F., Grauwelman-Smith, M., & Parkinson, S. (2016). The Evaluation of the Protecting and Nurturing Children: Building Capacity, Building Bridges Initiative. Adelaide: Australian Centre for Child Protection, University of South Australia.

Trauma-informed care in child/family welfare services (*Australian report*)

This paper aims to define and clarify what trauma-informed service delivery means in the context of delivering child/family welfare services in Australia.

Exposure to traumatic life events such as child abuse, neglect and domestic violence is a driver of service need. Policies and service providers must respond appropriately to people who are dealing with trauma and its effects in order to ensure best outcomes for individuals and families using these services. In addition to evidence-based programs or clinical interventions that are specific to addressing trauma symptoms, such as trauma-focused cognitive behaviour therapy, there is a need for broader organisational- or service-level systems of care that respond to the needs of clients with a lived experience of trauma that go beyond a clinical response.

Some of the challenges identified in implementing and embedding trauma-informed care across services and systems are discussed.

Reference: Wall, L., Higgins, D., & Hunter, C. (2016). Trauma-informed care in child/family welfare services (CFCA Paper No. 37). Melbourne: Australian Institute of Family Studies.


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