What is it like to raise a schizophrenic child?
When mom is confused ...
Every third adult in Germany will develop a mental illness within a year. International studies for other western industrialized nations report comparable prevalence rates. German Health Survey (DEGS), module "Mental Health", 2013
Mental illness always affects the entire family; relatives - parents, partners - are always affected. In the meantime, the relatives have organized themselves and, not least, have drawn attention to their painful life situation. The experience that relatives are not perpetrators but victims of a dynamic that often makes everyone involved sick and that mental illness often creates conditions that lead to extreme stress in the environment has led to a new way of dealing with relatives in psychiatry. Associated with this is the right to individual help for the families.
So far, the children of mentally ill people have not benefited sufficiently from this. They are not included in the work with relatives, but rather deliberately excluded. In this way, a social as well as an intra-family mechanism, namely the tabooing of a parent's mental illness, is re-established by psychiatry.
According to conservative estimates, around 500,000 underage children and adolescents have at least one mentally ill parent. You are at an increased risk of developing mental health problems yourself; this has been proven by studies (high-risk research, genetic studies). A genetic component could be demonstrated in both schizophrenic and affective psychoses: While the lifetime risk of developing schizophrenia is one percent, the probability of children with a schizophrenic parent is more than tenfold. If both parents have schizophrenia, the probability is as high as 40 percent. However, this also means that more than half of the children affected do not develop any corresponding symptoms - certainly a starting point for further research needs regarding the protective factors of development.
In addition, there is often psychosocial stress, i.e. the children of mentally ill parents often grow up under living conditions that are in some ways more difficult than with many other children.
What problems do the families concerned have?
Most families have at the top what can be summed up in the following sentence: "We have to do it alone, because once it becomes clear that we need help, we will only be torn apart." This fear is not entirely unjustified, because the time when people with mental illnesses were denied the right to have children and to raise them is not long ago. Possible consequences: Parents do not go to the doctor or hospital in time, or do not go to the doctor in time - and they do not get support in good time with problems with their children or in everyday life.
The children do not turn their concerns to outsiders; they don't confide in anyone for fear of betraying the family and their secrets. Even if the children grow in their responsibility, there is still a great feeling of loneliness, which all children who are now grown up report about.
A long-standing mental illness in one of the parents usually leads to a deterioration in general living conditions for the entire family. Keywords for this are: unemployment, financial problems, poor living conditions, isolation, stressed relationships within families. In addition, the proportion of single-parent families is high. Research results have made it clear that this bundle of problems generally affects the psychological development of children more than the mental illness itself.
On the effects of the parental illness on the mental development of children
The children experience their parents over a longer period of time or repeatedly in extreme emotional states that they cannot understand. They feel that their mother is imprisoned in an often threatening inner world from which they are excluded or should be closely involved. They can be exposed to an often unreasonable use of time, money, nutrition, etc. They experience separations through hospital stays and often changing care. They are loyal to their parents and find themselves in a conflict between the “family” and the “outside” world, the needs of their parents and their own.
Children are often the first to be confronted with a mental crisis and are asked to organize help. It is they who spend most of their time with a sick mother, for example, and all too often they have to take on tasks and responsibilities from and for her. This life situation creates fear in small children, and often anger in larger children, which in turn leads to feelings of guilt. Anger also has its roots in the social situation of children. Making a mental illness taboo is not just an intra-family phenomenon, but also a social one. For a mentally ill mother you feel ashamed as a child and it is best to keep silent about it.
How can children and their families who are under such stress be helped?
The first step is to be educated. The main problem here is how to reach these mostly inconspicuous and well-adjusted children and adolescents. Age-appropriate information for children as relatives of the mentally ill should become routine in all psychiatric work. This applies to both inpatient and outpatient areas. The prerequisite for this, however, is to first develop an awareness of the problem among the professionals working there.
In addition, all those groups of people who can become contact persons for affected children - e.g. teachers, educators, family doctors and paediatricians - must be made familiar with this matter. If this succeeds in breaking the taboo, a new atmosphere for discussion can arise, which brings great relief for the families.
In addition, there are serious problems and deficits in the offers of help for the children and their families. One reason for this is that, in view of the complex problems, the experts lack the competence to really see families as a unit. For example, adult psychiatrists tend to forget the children or use them as a kind of auxiliary therapist. The necessary psychiatric skills are often lacking in youth welfare institutions and services. Existing offers of help relate only to part of the family system; the possibilities for help and funding channels are fragmented; And communication between the various supply systems is insufficient - not to mention cooperation or networking.
What to do?
Children and their families need low-threshold help tailored to their individual needs. This should be complemented by an appropriate, structured support system.
A sufficient number of mother-child units should be set up in the psychiatric clinics or on the psychiatric wards of the general hospitals. Using UK figures as a basis, it becomes necessary to have 9.6 beds per 1 million inhabitants. Converted to the population and birth rate in Germany, this results in around 750 beds for inpatient admission of mothers with their small children. The financing of the inpatient treatment of the child by the health insurance companies and / or the participation of the social welfare offices must be regulated.
Post-inpatient care areas for mentally ill mothers / parents with their children are also very rare. At present, this constellation is often a reason for exclusion from being accepted into existing institutions.
Development of childcare options close to home
This is not primarily about the creation of new institutions, but about the meaningful networking of existing offers from the areas of adult and child and adolescent psychiatry and youth welfare. This requires increased interdisciplinary cooperation, especially between the clinic, outpatient psychiatric facilities and youth welfare, both in the specific coordination of help in individual cases and in the planning of future care structures. It is absolutely necessary for this cooperation to include or intensify this topic in the training and further education of employees. The Children's Commission of the German Bundestag also last called in 2013 for this family to be given greater attention: both when it comes to helping children and psychiatric treatment for parents.
In addition, the public must be adequately informed in order to free the issue - and thus also the families concerned - from the burden of shameful concealment. For example, breaking down taboos on mental illness is perhaps the most difficult, but also the most important step in improving the situation of the children of mentally ill parents.
In conclusion, I would like to quote from a mother's letter: “Children and relatives are always affected, and that is worse for the sick than you think. But I resist making them sick. One should help those who want help. You have to support everyone. "
Notes for parents
If one of the parents in a family has psychological problems, it is first of all important to organize help for the sick mother or father. However, the disease affects the entire family, and the children also need attention.
Raising children is not easy. All parents sometimes wonder if they are doing it right. If one parent is mentally ill, it doesn't make things any easier. There are also new questions. If you are concerned about your children, talk about them: with family, friends, neighbors or professionals!
Ten practical tips
- Explain what is going on. Your child realizes that something is wrong. So you explain to him what exactly is going on. You can start doing this yourself or wait until your child asks. Some children do not want to sit down for a proper conversation. They prefer to talk while washing up or going to bed. Then they feel more comfortable.
- Be honest. Explain in your own words what is on your mind. And just to be sure, ask whether your child has understood you. Your child may be asking questions that you don't know how to answer. “I don't know,” can then be the most honest answer.
- Listen to your child. When you explain to your child what is going on, ask them every now and then for their impressions and opinions. And then listen carefully. Children feel more comfortable when you listen to them carefully and understand what they are trying to say. Talking to children means above all: listening to them.
- Watch your child. Children often show how they are doing through their behavior. If you behave conspicuously, it can be a sign that you are burdened by something: wetting yourself again, skipping school or running away from home - these are clear signals. But sometimes the changes aren't that obvious. This means that you have to pay close attention to your child in order to be able to detect even inconspicuous changes in their behavior.
- Stick to familiar habits. For children, regularity means peace and security. If problems arise in the family, the child can be given a feeling of security if certain things go on as usual: for example, if they have to do their homework as always, can continue to exercise in the sports club or pursue other hobbies.
- Do not ask yourself to have to do and cope with everything on your own. Include other adults too, such as family members, neighbors, teachers, or other parents. Also, consider seeking advice and help from professionals.
- Let the school know. If a parent in a family has to be admitted to a clinic, the school should be informed - especially if your child is so stressed that they can no longer take care of them in school. When the teacher knows what is going on, he or she can better support your child. Tell the child that you spoke to their teacher.
- Accept when your child confides in someone else. Many children feel the need to speak to an outsider - an uncle or an aunt, the neighbor or the teacher. You may not want to burden the parents with their worries. So for them it is not about telling something. There is no need to be suspicious or jealous when your child is talking to someone else.
- Get professional help when you need it. For some children, the stress becomes too great, despite everything. They don't speak to anyone, or the conversations don't seem to be helping them. Then you, as a parent, need to get support.
- Don't forget the most important things: a smile and a hug. Whatever the problem, the most important thing for your child is that you love them. Every father and mother express this in their own way: with friendly words, a smile or a hug. If you just show your love to the child, every day anew - that helps over a lot!
(taken from the brochure “How are the children then?” see below).
Mattejat, Fritz / Lisofsky, Beate (2014): Not from bad parents. Children of the mentally ill. Bonn: Psychiatrieverlag, 4th corrected and supplemented edition.
Information brochures on the subject for children, young people and parents can be found here.
Beate Lisofky, qualified journalist, press officer for the Federal Association of Members of the Mentally Ill BApK press office
Oppelner Str. 130
Tel .: 0228-71002404
Created on April 22nd, 2002, last changed on June 19th, 2015
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