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The Patient as Parent: Family Matters

The Patient as Parent: Family Matters

Today, a person diagnosed with mental illness is as likely as anyone to be a parent or plan on becoming one. Public perceptions and the mental health care system have not always kept up with this reality, however, and research shows that the impact of mental illness on the patient and family is rarely acknowledged in the clinical setting. Ignoring that aspect of a patient's life can undermine treatment.

Mental illness can have a significant impact on the family, resulting in higher divorce rates and problems with parent-child attachments. Depressed parents, for example, become less emotionally involved in their children's lives; and the children risk developing social, emotional and behavioral problems.

Psychiatrists who focus on codifying symptoms rather than looking at the central life tasks of a patient are missing an important opportunity, said William R. Beardslee, M.D., chair of the department of psychiatry and psychiatrist-in-chief at Children's Hospital in Boston. When a mother with depression says she needs help with her children, "That's where the manifestation of depression is for her. It interferes with her ability to take care of the kids. As a doctor, I need to attend to that."

A physician would never expect a patient with cancer or heart disease to get through the illness without additional support, Beardslee said in an interview with Psychiatric Times. "In the same way, we need to dignify the treatment of people with major mental illness." Psychiatrists need to ask about resources, supports and the people available to a patient in times of trouble.

Providers can help patients think prospectively about what they might need in the event of a crisis, such as who will take care of their children, said Joanne Nicholson, Ph.D., associate professor of psychiatry and family medicine at University of Massachusetts Medical School. Otherwise, patients may compromise their own treatment. If they have to go to the hospital but have no one to take care of their children, they will not go. Or, if they have to get up early, they may not take a medication that makes them feel lethargic.

"Oftentimes, our patients who are parents can appear to be noncompliant or resistant to our treatment suggestions, when in fact they're just trying to figure out how to make those suggestions work without compromising their role as parents," Nicholson told PT. The result is that parents with mental illness, like many parents, will prioritize their children's well-being in the short run and compromise their own well-being in the long run.

Studies that have examined record keeping and charts for people with mental illness have revealed that important information about the family is frequently left out, she said. It may be that the patient chooses not to give out that information, but more likely, the doctor is not asking the questions.

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