Letter

Lifting the Veil

To the Editor: The Personal Accounts column by Maggie Jarry ( 1 ) in the December issue is a call to action for psychiatrists to pay attention to the needs of children whose parents have mental illness. Other developed countries, such as the United Kingdom and Australia, have extensive programs to support these children and young adults, but the United States lags substantially behind ( 2 ).

Young caregivers want to be respected, included, and acknowledged by the professionals treating their parent. They have a range of needs—from the child who is coping well and needs information to the child who needs support, treatment, and perhaps protection. The extent of a child's vulnerability depends on many factors, such as the developmental stage of the child and the degree of social isolation of the family.

Until the United States can develop a more comprehensive approach, each psychiatrist can make an individual effort to work with the children of parents with mental illness. We should include children in family meetings about the parent's illness. Parents may want to exclude children "to protect them" or out of fear that children will be removed if the parent is seen as unfit. However, children often have questions about the parent's illness and unfounded fears that are distressing and that distort their understanding of the situation, and children can benefit from support and education. When children visit the parent in the hospital, they can be given age-appropriate literature.

Psychiatrists should advocate for a broader vision of health and recognize that parenting is an essential human role and can be a significant rehabilitative factor in helping a person reach wellness. When a person with a mental illness is a parent, activities supporting his or her parenting should be discussed as part of recovery. Most important, children and other family members should be invited into the room.

There are many barriers to delivering comprehensive care to families. Prominent barriers include the lack of awareness among adult psychiatrists of the needs of these children and the lack of collaboration between child and adult psychiatric services, which keeps the needs of these children invisible. As noted above, parents' fears also conspire to keep children's needs hidden. Finally, perhaps the greatest barrier is a systemic practice in which one person is the identified patient and the needs of other family members remain unrecognized. For example, the current reimbursement system does not facilitate preventive screening of children who might be at risk.

Changes in policies and in health care delivery are needed. Recently it has been recommended that mothers of children with depression also be assessed and treated for maternal depression ( 3 ). Can we ask for the reciprocal: that children of parents with mental illness get assessed, and supported and treated if necessary? The Family Committee of the Group for the Advancement of Psychiatry is exploring ways to raise awareness of this issue and to develop interventions that might be accepted and easily incorporated into the clinical arena.