|Contact||Dr Alan Cooklin, Consultant in Family Psychiatry, Camden and Islington NHS Foundation Trust|
|Telephone||0203 317 6428|
|Address||St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE|
This service aims to promote resilience of children and young people in Camden and Islington, supporting them to cope with the emotional and behavioural impacts of a parent’s mental illness.
For every 1000 children and young people aged 5 to 18 years, between 110 and 220 of them will be affected by a parent suffering from mental illness (Parrott 2008). Aggregated studies suggest that 70 per cent of these children will show some level of morbidity – manifested mainly as poor school attendance, lowered attainment, social isolation, anxiety and depression.
Much recent attention has been given to young carers support services. Generally these are for all categories of young carers and will commonly focus on the negative effects of, and the need for support with, the caring role. Less attention has been given to the specific effects on children’s development and on distressed family relationships when living and growing up with the emotional and behavioural impacts of a parent’s mental illness.
There is good research evidence that children’s resilience to adversities of all kinds can be improved if the child can understand the source of the adversity. There is also some specific evidence that having a good understanding of a parent’s mental illness can improve the psychological development of affected children. The Finnish Adoption (Tienari et al., 1994, 2004) study and earlier work by Rutter et al Rutter M., 1996, 2004 has demonstrated that when the relationships in a child’s environment are improved – or even when the child and family can discuss the parent’s illness – then the child’s future resilience to mental illnesses, even those which carry a genetic vulnerability, can be enhanced.
Developing understandable explanations of parental mental illness and promoting family discussion
Constraints against this approach can include potential concerns about patient confidentiality, which can in turn lead to poor communication from mental health to children’s services. Overload in children’s services and poor understanding of mental illness by workers in children’s’ services can be a further limitation, as can insufficient liaison of both services with voluntary services for young carers. In addition many of these children are not known to children’s services as they become adept at concealing family problems.
The Kidstime approach
Camden and Islington CCGs’ Kidstime team have pioneered an approach which both addresses explanations that are acceptable to both the parent and child and encourages less anxious discussions within the family. This is illustrated in the films ‘Being Seen and Heard’ Royal College of Psychiatrists 2004 and 2006 and the online film for children ‘When a parent has a mental illness’ (Kidstime foundation Royal College of Psychiatrists, and YouTube). The collaborative nature of the approach diminishes inter-agency misunderstanding and addresses the fragmentation of service complained about by parents and their children. In addition, the fact that professionals from different agencies and professions jointly run the programme leads to a widening of perspectives from all the participating professionals.
Kidstime is a multi-family project for the children and families who are affected by mental illness. It began in 1999 as a response to the lack of attention to how children are affected by parental mental illness. Kidstime was first set up in Camden and Islington in London. The groups meet monthly after school and may be attended by up to 10 families or more at a time.
What are the groups for?
Kidstime is very explicitly defined as not therapy, as this definition would be a deterrent to participation by many children. Kidstime is simply a developmental and educative forum which aims to help children, young people and their families find ways of talking about mental illness that can be acceptable to them. This opens up the possibility of sharing information and understanding, and allows distressing events to be named and discussed.
Explanations to the child about the parent’s illness help to allay the child’s anxiety. Often children will have heard negative comments about mental illness such as ‘It runs in the family’. Such remarks commonly compound the child’s fears by suggesting that they are at risk of inheriting a similar illness. Kidstime groups provide a space to address such fears and confusions caused by negative stigmas.
The workshop groups
Kidstime workshop groups begin with a short seminar for the children and parents together where some aspect of mental illness or questions about it are discussed or demonstrated. The combined seminar runs for approximately 10 to 30 minutes depending how much interest and attention it generates in the children. This is followed by separate group discussions for the children and for the parents.
The children’s group starts with games and warm-up exercises. Then the children tell stories about family life, commonly including aspects of living with mental illness prompted by the seminar. They are helped to dramatise these stories and the resulting plays are filmed. Parents and children then gather as a single group to eat pizza while the parents report on the topic of their discussion and all watch the filmed plays.
The workshop concludes with a whole group discussion of what the children have produced and also issues raised in the parents’ group. The discussion may be very brief or it may become very intense. The aim is not to hear about each individual family’s problems but to help the children and their parents to think and act differently in response to the parent’s illness.
Factors which make it work
- Kidstime runs as a close and integrated collaboration between the Mental Health Foundation Trust, Family Action, the Multi- agency Liaison team (Camden) and the children’s services of both Camden and Islington. This broadens the perspective of both professionals and family members who see the co- operation of different agencies in the service of helping them improve the quality of family life.
- The multi-family structure prevents parents or children from feeling overexposed or scrutinised and ensures adequate safeguarding of the children. The multi-family structure encourages mutual support between parents and children as well as intergenerational alliances.
- The focus on drama and play promotes parental pride and counteracts parental shame. This is a very important factor in encouraging parental engagement.
Contacts for more information
- Dr Alan Cooklin, Consultant in Family Psychiatry, Camden and Islington NHS Foundation Trust 07966373256 or 0203 317 6428 firstname.lastname@example.org
- Rebecca Taylor, Senior Family and Outreach Worker, and Kidstime Coordinator, Family Action Islington and Camden Young Carer’s Service. 0207 272 6933
- Sabbi Jones, Senior Practitioner, Camden Multi Agency Liaison Team (CAMHS) 0207 974 3165
- Parrott L., Jacobs G., and Roberts D., (2008) SCIE Research briefing 23: Stress and resilience factors in parents with mental health problems and their children, London, SCIE
- Tienari P, Wynne LC, Moring J, et al (1994) The Finnish adoptive family study of schizophrenia. Implications for family research. British Journal of Psychiatry 164 (suppl 23): 20–6
- Tienari P, Wynne LC, Sorri A, et al (2004) Genotype– environment interaction in schizophrenia-spectrum disorder. Long-term followup study of Finnish adoptees. British Journal of Psychiatry 184: 216–22
- Rutter, M. (1966) Children of sick parents: An environmental and psychiatric study. Oxford University Press, Oxford
- Rutter M (1990) Psychosocial resilience and protective mechanisms. In Risk and Protective Factors in the Development of Psychopathology (eds J Rolf, AS Masten, D Cicchetti et al): pp 181–214. Cambridge University Press