Letter

Lifting the Veil: Reply

In Reply: More than five million children in the United States have a parent with a serious mental illness, such as schizophrenia, bipolar disorder, and major depression, and some of these parents have co-occurring addictions. It is estimated that 68% of women and 57% of men with a serious mental illness are parents ( 1 ) and that 73% of women and 68% of men with posttraumatic stress disorder are parents ( 2 ). Yet it remains common to find mental health professionals who are unaware of or unwilling to see the relevance of this topic to their work and to the success of the people they serve.

With this in mind, we strongly urge readers to consider the concrete recommendations in the letter from Dr. Heru and her colleagues. However, the scope of this dialogue and their recommendations should go further. Our key message is this: Just as we now recognize that employment is a viable option for people with mental illness, we need to recognize that parenting is also a viable life choice for these individuals, including those with illnesses regarded as severe and persistent. Supported parenting should be integrated into all adult mental health systems.

Training for mental health professionals should include an understanding of the benefits of working with families. Professionals should be aware of and make available the supportive resources needed to address consumer parents' deepest concerns for their children and thereby contribute to parent and family wellness. Strengthening parenting skills enhances familial attachment and motivates parents toward recovery while also addressing the developmental needs of their children. Data should be collected on the parenting status of people who use adult mental health systems in order to understand where supportive parenting resources can be incorporated. Resources to enhance psychoeducation for young family members exist and are being rapidly developed in the United States and abroad (the fall 2009 special issue of Psychiatric Rehabilitation Journal provides an overview). These resources can be used today while we develop a national infrastructure for supported parenting. The Substance Abuse and Mental Health Services Administration should publish materials for supportive education of children who have a parent with mental illness, as it has for children with addicted parents.

Furthermore, parents should not fear losing custody of their children when they disclose their personal health information to any authority, nor should adults who access mental health services be discouraged from having children if that is one of their life goals. For these reasons, mental health systems should partner with child and family services systems to support families.

Understanding the unique experiences of daughters and sons who have a parent with mental illness should be a goal of future research. Daughters and sons need access to information that identifies and normalizes their common experiences. Research should go beyond estimating the statistical likelihood of future mental illness among these children to encompass other aspects of this group's experience and demographic characteristics. Daughters and sons often report difficulty with identity formation and preoccupation with the belief that they will experience the same mental illness as their parents. Therefore, we urge that the recommendations in this letter be balanced with an understanding that the need to screen children for illnesses is small compared with the need to unveil fortifying messages of resilience and hope within the family.