Beardslee directs the Judge Baker Children's Center 10-Year Preventive Intervention Project, funded by the National Institute of Mental Health. The intervention project has studied 100 families in which one or both parents have experienced serious affective disorder and who were exposed to two forms of cognitive, psychoeducational, preventive interventions: either clinician-facilitated and/or lecture discussion group interventions. Beardslee and colleagues have found both interventions to be safe and feasible and are following the children to determine preventive effects over time.
One of the treatment outcomes must be a return to being a functional parent, Beardslee said. Rather than counting symptoms, psychiatrists need to focus on removing enough impairment so that patients can connect with their children.
Nicholson, director of the Program of Research on Parents with Mental Illness and their Families at University of Massachusetts Medical Center, agrees. A woman with severe depression, for example, needs to learn to explain to her child that her crying is part of a biologically based illness, not the result of something the child did.
Psychiatrists in private practice may worry that they do not have the expertise or skills to address parenting issues with their patients, Nicholson said, so it is important to remember that parents have a great deal in common with one another. The challenges that a psychiatrist faces as a parent can help in relating to the problems that a patient experiences in terms of the day-to-day stress and challenges. The compromises to functioning brought on by mental illness are similar to the challenges faced by a parent with heart disease or diabetes. The illness raises a number of potential complications and concerns around hospitalization, medication and genetic transmission.
When a psychiatrist is treating an adult with children, Beardslee said, it is important to ask how the children are doing and to share information about the risks involved for them. A father with a severe anxiety disorder, for example, will need to know those risks so that he can identify problems early on and seek treatment for the child if they occur.
Depression and other mental illnesses are terribly misunderstood, Beardslee explained. Both the patient and family members tend to blame themselves for the illness, and doctors need to use an educational approach to confront this and other misconceptions. The illness must be placed outside the context of guilt and blame, he said, by explaining the biological nature of the illness and what the patient can do about it.
According to Southern, children of parents with mental illness should be provided support and information regarding the illness and what to expect from the parent during times when symptoms are more prevalent. They should be told that the illness is treatable, in order to dispel any fears they may have. Not all children of parents with mental illness will develop their own mental health problems, but they may be at risk for certain types of mental illness, including mood disorders, alcoholism and personality disorders. Beardslee pointed out that parents should be reminded that children can do well in spite of the parent's illness. Mental illness in a parent does convey an increased risk to children, but it is far from being a one-to-one correspondence. Genetic determinism is not inevitable, and a lot can be done to prevent it. "I think if anything, parents overemphasize the inevitability," he told PT.