Study calls for ‘family-focused’ approach to mental health treatment

Almost a quarter of all Irish families have a parent who has suffered mental health issues, according to researchers seeking greater consideration of how this might affect children.

A study by the Maynooth University Centre for Mental Health and Community Research (CMHCR) has led to calls for the implementation of a family-focused approach to treatment when parental illness is identified.

While focusing on “Family Talk”, an American model of whole-family therapy, the work touches on a broader need to change culture and widen treatment responses beyond the individual.

According to the researchers, when the welfare of children is not taken into account, mental health services might not identify those who face a significant risk of becoming the next generation of users.

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The HSE-funded, five-year Primera research programme found the Family Talk method was “significantly beneficial” for two-thirds of families.

A randomised controlled trial looked at the experiences of 86 families (139 parents and 221 children) and compared their outcomes with those who received more routine services.

Families who received the intervention were found to have fewer child behavioural and emotional problems at follow-up sessions six months later, as well as better relationships and a better understanding to the impacts of mental health issues on children.

In-depth interviews conducted with a small subsection of the participants also found reduced stigma and increased wellbeing.

However, typical responses to treatment needs can be part of the problem: a lack of communication between adult and child services; crisis-oriented approaches to assessment; and confidentiality concerns all mean a potentially wider problem is not identified.

“It’s all about working with families in a holistic way, bringing them together and talking through some of the issues that they are experiencing,” said CMHCR director Prof Sinéad McGilloway, who explained that such interventions could help prevent children from internalising related trauma.

"It's incredible that it's not actually happening as a routine part of services in Ireland. "

International studies estimate that 25-68 per cent of adult mental health service users are parents. Between 35 and 60 per cent of children presenting at Child and Adolescent Mental Health Services have a parent with a mental illness.

As with physical health problems, children with parents suffering from poor mental health are far more likely to develop it themselves. Ireland has the third-highest incidence of adult mental illness across 36 countries in Europe.

Joint therapy

One of the parents involved in the study, who asked to be identified as David, explained how he and his young son entered joint therapy when his own childhood sexual abuse trauma began to resurface.

“I couldn’t imagine [the abuse] happening to my own child so I was reliving it worse,” he said. “He was in turmoil and I was in a spin.”

The pair entered the programme, completing it just before the first pandemic lockdown.

“It was so beneficial for him. He was caught in the middle where he was not at the right age to understand everything. I think it’s one of the biggest breakthroughs . . . I don’t see how it could be done any other way.”

Prof McGilloway and her team have recommended the Family Talk policy and practice be developed and incorporated as part of routine Adult and Child and Adolescent Mental Health Services in Ireland.

“We know that parental mental health can typically affect the entire family,” she said. “An estimated 23 per cent of all families have at least one parent who has or had a mental health disorder.”

In such cases, the needs of their children or partners should automatically be considered, she said.