Covid-19 and Families With Parental Mental Illness: Crisis and Opportunity

Abstract

The COVID-19 emergency has affected us all, but not equally. Families where parents have mental illness (PMI) are potentially at increased risk, but little is known about how they or their support services managed under lockdown/restrictions. We harnessed our existing partnerships with adult and child mental health services in the Republic of Ireland (RoI) and Northern Ireland (NI) to investigate the qualitative experiences of service users and families in coping during the first COVID-19 lockdown (March–May 2020), and how services were supporting them. Semi-structured phone/online interviews were conducted with 22 clinicians/managers (12 from RoI; 10 from NI) who provided information from their caseloads (~155 families with PMI). Sixteen family members (10 from RoI, 6 from NI) were also interviewed. Data were analysed using standard thematic analysis. Sixty percent of families reported improved mental health, primarily due to respite from daily stresses and the “normalisation” of mental distress in the general population. Approximately 30%, typically with more severe/enduring mental illness, reported additional challenges, and mental distress including: unmanageable child behaviours; fear of relapse/hospitalisation; financial difficulties; absence of child care; and a lack of routines. Service provision varied considerably across regions. The experiences within this case study highlight unique opportunities to address the multiple stresses of pre-emergency daily living. We also highlight how mental health services and governments might become more “pandemic ready” to more effectively support vulnerable families, including addressing service overload issues, optimising the use of digital technologies, and providing in-person contact and social supports where required.

The Family Talk Programme in Ireland: A Qualitative Analysis of the Experiences of Families With Parental Mental Illness

“…Additional delays/disruption in FT delivery due to the COVID-19 restrictions also led to some degree of disillusionment and disengagement from mental health services. This was more common in areas where mental health clinicians were partially redeployed to frontline COVID-19 duties and could only provide minimal telephone support to service users ( 41 ). Interestingly, those who disengaged from FT were almost twice as likely as “completers” to be lone parents (6/9 vs. 5/14)–suggesting that the stresses of lone parenting may also have been a barrier to engagement.…”

“…Thirdly, the COVID-19 lockdown restrictions had implications for the delivery of FT, including blended adaptation (both in-person and online sessions), as well as family disengagement following repeated delays to delivery. Notably, there was considerable variation in the capacity of sites to deliver FT during the lockdowns with some mental health staff partially redeployed to frontline COVID-19 duties and providing minimal phone support to patients while clinicians in other areas were able to continue home visits and outpatient clinics, following COVID-19 guidelines ( 41 ). Reassuringly however, it is likely that the future implementation of FT will be conducted in person in view of the >90% uptake of vaccination in the RoI ( 57 ).…”

“…These varied experiences highlight that each family member presents with a unique history and motivations and can present a range of challenges for clinicians when considering a family's readiness for FT. The COVID-19 pandemic restrictions have been shown to have had a considerable impact on population mental health and on those with pre-existing mental illness, both in Ireland and internationally (41)(42)(43)(44). Seven families in this study were interviewed during the COVID-19 emergency, with three reporting sustained benefits from FT and that they were coping well with pandemic stresses, while four families reported increased mental distress and challenging child misbehaviour as a result of the restrictions; two of these families had disengaged from FT due to stigma/relapse issues and two indicated that FT delivery had been suspended due to the restrictions.…”

A Family-Focused Intervention for Parental Mental Illness: A Practitioner Perspective

“…In addition, several clinicians indicated that negative past experiences of mental health/child protection services amongst some families, had led to their disengagement. Furthermore, some families dropped out following lengthy delays to FT delivery as a result of the COVID-19 pandemic restrictions in Ireland, and particularly in sites where mental health clinicians were redeployed to frontline COVID-19 duties ( 46 ). While involvement in the research promoted implementation and recruitment in some regards (as discussed earlier), being involved in a time-limited RCT also hindered recruitment to some degree.…”

An Evaluation of the Acceptability, Appropriateness, and Utility of a Bibliotherapy for Children of Parents With a Mental Illness

“…Many parents who have a mental illness may worry about their children's mental health and look for tools or psychosocial support services to help them cope ( 37 ). These families may face important additional challenges owing to the current pandemic and the limited capacity of mental health services to meet their needs ( 38 , 39 ); such challenges can include obstacles to accessing care and services (e.g., long waiting lists and the absence of dedicated care pathways and intervention tools adapted to their needs and family issues) ( 40 ). In this context, bibliotherapy like the one in this study could offer a useful form of support for children and families who are waiting for psychosocial services or hesitate to accept help from a professional.…”