What’s the idea?
Perinatal mental health difficulties can impact on all children in the family. Older children may not understand what is happening and may not feel able to tell their parents about their distress.
Why implement it?
- Children of parents with a mental health disorder experience poorer quality interactions with their parents and are at higher risk of developing psychological difficulties themselves [ref. 42].
- Children may experience problems including:
- difficulties understanding what is happening to their mother
- witnessing distressing behaviour
- separation from their mother (e.g. inpatient admission)
- being expected to take on additional household duties and caring responsibilities for their mother and/or other siblings
- missing school or impact on academic work
- managing the double demand of a new sibling and an unwell mother
- behavioural changes as a way of communicating their own distress.
- The difficulties experienced by these children may be an additional source of stress for parents, who might feel guilty, struggle to manage the children’s needs, and increase their perception that they are not a good parent.
- Some children face additional challenges because both parents have a mental health disorder, or their unwell mother is a single parent.
- Those who become young carers report worries about the health and behaviour of the person they are caring for, their own health, and who will look after them in the future [ref. 43].
Actions to consider
- Identify any older children in the family/household and record their details (full name, date of birth, address, education provision).
- Remember that the needs of other children may be ‘hidden’ from perinatal mental health services. This could be due to:
- the child not being present (e.g. in childcare, school)
- their needs being minimised by the parent (e.g. due to fears of being seen as a bad parent, social care involvement, or lack of insight into the impact of a perinatal mental health disorder on older children).
- Find out about local services that can support older children (e.g. Children and Young People’s Mental Health Services, young carers groups) and liaise with them as appropriate.
- Support the family to consider whether they need to let the nursery/school know about the mother’s situation, to help them support the child’s needs.
- Consider ways in which the children can be involved in their mother’s care, and whether the clinical setting is welcoming for them (see Idea #9: Family-focused environments).
- Give older children the opportunity to talk with a professional who understands their mother’s difficulties and to ask questions.
- Where possible, support parents to have conversations about their mental health with their child(ren). This might involve considering age-appropriate methods of communication, what is appropriate to share, and helping the parent to anticipate and manage the child’s reactions and responses.
- Find out what knowledge and skills exist in the MDT to support parents with the needs of other children.
- Provide advice to families about ways that children can keep in contact with their mother while she is an inpatient e.g. phone calls, letters, video chats.
Practice example: Supporting siblings and young carers
Community Perinatal Mental Health Service & Yorkshire and Humber MBU, Leeds & York Partnership NHS Foundation Trust
The Leeds, Yorkshire and Humber specialist perinatal mental health teams recognise the importance of supporting the wider family across the MBU, community, and outreach team. They identified a clinical need among the older children of mothers accessing care, especially the siblings of babies admitted with their mothers.
The team design and facilitate activities with the support of a social worker who has experience of direct working with children and with a nursery nurse.
Activities are individualised and based on the age and needs of the children. Activities aim to provide fun ways of considering emotional wellbeing. These have included: a one-off pizza night to provide a space for peer support and information for children of a similar age; reading a book about a young person with a huge bag of worries [ref. 44], then making ‘worry bags’ (as a strategy to manage their concerns and anxieties); and completing the ‘safety hand’ activity (identifying five people they can share things with) [ref. 45].
Practice tips: box 11
Asking about the needs of other children
As you start to build a relationship with the family, ask about any older children (see Idea #1: Mapping the family).
Frame conversations in terms of offering support and thinking about the whole family, so that parents feel able to be open about strengths and difficulties:
- how is X doing/ how are they getting on at school? are you worried about anything regarding X?
- what does X understand about how you are feeling at the moment?
- is there anything that feels more difficult with parenting X?
- is X aware that you are in hospital?
- are school/nursery aware that you are unwell at the moment?
- who is available to support X at the moment?
- is there anything else we could be doing as a service to support you as a family?