Tuesday, 30 April 2013

Bounce back, baby!

Remember those weighted plastic toys that you could tip in all directions but would right themselves and be ready to be knocked again?  That is about the best analogy I can think of for the word resilience.  And applying this to people, it basically means the ability to 'bounce back' no matter what happens.  It does not mean that resilient people do not experience pain, loss, defeat, tragedy and trauma, but that they have the emotional maturity and psychological strength to recover from these setbacks.  It is a characteristic we would all want our children to develop because it is the basis of good mental health.

What can we do as parents, remembering that we are engaged in a long process that extends from babyhood to late adolescence (and beyond!)?
  • ensure good attachment by meeting the baby's needs for food, warmth, comfort and nurture promptly so the baby learns it can rely on you to meet its primary needs;
  • introduce the baby into the wider world by positive interactions with siblings, grandparents, extended family and friends;
  • as the child grows start to incorporate awareness of their own feelings, helping to name them and to find ways of experiencing them and then extending this to recognising feelings in other people;
  • teach children that anger, frustration, jealousy are part of life and that they can be experienced without aggression and tantrums;
  • teach children to negotiate with you and with each other;
  • allow children to build a positive view of themselves by breaking tasks into small parts and helping them recognise their achievements as they master each part;
  • allow children to experience difficulties and frustrations and helping them to use their previous experience and to develop new skills to overcome problems;
  • encourage children to be positive and optimistic, even when they experience set backs
  • maintain honest and open lines of communication with children, listening as well as speaking, so they know that they can raise anything with us;
  • support and encourage children and adolescents in making their own decisions.
What doesn't help is to:
  • set unrealistic goals for children to achieve;
  • never let them experience disappointment and difficulties;
  • protect and shield them from the difficulties of life: not every one can win a prize nor can we have everything we might want;
  • being rigid and inflexible in your expectations and communications.
The development of good mental health in children and young people is as important as their physical health and their intellectual development since we all want our babies to grow up into well rounded, optimistic adults who enjoy life and can tackle its challenges with a positive attitude and bounce back from the blows that life can bring.

There are many guides about developing resilience on the net and in parenting and childcare manuals.
Some easily accessible links are:
Resilience Guide for Parents and Teachers
KidsMatter  It is worth exploring many of the links given within this site.
A Guide to Promoting Resilience in Children I like the I HAVE I AM I CAN approach
Bonsai Parents Lenore Skenazy of Free Range Kids fame has come up with a new term to replace 'helicopter parenting'.

Tuesday, 23 April 2013

Children in families where a parent has a mental illness Part 2

Last week I introduced the topic of families where a parent has a mental illness. This week I want to look more specifically at the children in these families and what can be done to meet their needs.

One of the first things these children need is honesty about what is happening to their parent, in language they can understand and which re-assures them that:
  • their parent is ill;
  • they have done nothing to cause or worsen the illness;
  • they cannot 'catch' the illness;
  • their parent is receiving treatment, whether this is medication, hospitalisation, counselling or some combination of these.
Unfortunately, mental illness still has some degree of community stigma attached to it, and this often extends to keeping children in the dark about what is going on.  As a result, they may develop all sorts of strange explanations for themselves about what is happening.  Even toddlers can understand simple explanations like 'mummy (or daddy) is sick', and that 'the doctor (nurse, social worker) is helping mummy to get better'.  Older children need more information and they also need the information to ask questions.  These questions need to be taken seriously, even when they are strange or difficult as they often help sort out confusion and fears that they hold.  As they grow, more complex explanations and opportunities for questions are needed. It is important that all this is done in such a way that the children are supported and their respect for and relationship with the ill parent is maintained. 

These explanations are often best provided by some one the child already knows and trusts  like the well parent, a grandparent or other family member, but it may also be done by people involved in assisting the parent, particularly if he or she is a sole parent.  Nannies working in these families need to be informed of the situation and to discuss with the family what their role is in supporting the children with information and reassurance.  On line there are also information sheets and resources likes DVDs and books available for purchase which can help those providing information or to use with children as well as information in age appropraite language.

As I mentioned last week, some children may take on a care taking role with their parent, often described as 'parenting their parent.'  To help reduce the unfair burden that this can place on children, it is important treatment plans are set up in such a way that the parent or another adult takes responsibility for ensuring that the parent's needs are met.  For this reason, it is important that those involved in supporting and treating a mentally ill person know that that patient is a parent with the care of dependent children, and that the children's needs are considered in the case planning.

All children need consistency and stability, and thus a degree of predictability in their environments to maintain their own development.  For children with a mentally ill parent, it is important that as far as possible these needs are met by the well parent and the broader family network.  Signs that the children are under stress include 'acting out' with impulsive or attention seeking behaviours (eg aggression, tantrums) or signs of anxiety like bed wetting, thumb sucking, or moodiness and withdrawal.  Where nannies are working with these children they need to be alert to these behaviours and not take them personally.  Useful strategies include maintaining the usual behavioural management techniques and consistency along with lots of reassurance, warmth and opportunities to find more positive ways for children to express their feelings.  The parents should also be informed of these behaviours and the strategies being used to meet them, ensuring good communication is maintained.

If a parent is separated from a child for an extended period, children become distressed, hence the slow process introducing children to childcare and school, so it is not surprising that if a parent is hospitalised because of physical or mental illness there will be an effect on the child, especially as this often happens suddenly.  In the case of mental illness this may follow a sudden episode when the parent has been acting in a way that the child finds unusual or strange.  Ideally the child would continue to live at home, with the well parent's care supported by known and trusted family and friends.  A nanny may be introduced to the family in these circumstances, and so the child is faced with coping with the temporary loss of a parent and a new person at the same time, which is likely to produce some of the behaviours mentioned above.  of course, where there is no extended family and the family does not have the means to employ a nanny, the child may face the even greater disruption of being placed in out of home care eg foster care, and consequently even more profound reactions may take place and professional help may be needed to assist their recovery.

Like all other children, those with a parent with a mental illness need time, space, love, nurture, understanding to grow into healthy resilient adults who can engage positively with the world and those who care for them need commonsense, good communication skills, a sense of humour and boundless patience. 

Next week I will look look further at issues I have touched on before about raising resilient children.

Tuesday, 16 April 2013

Children in families where a parent has a mental illness, Part 1

Today I want to look at a situation that is much more common than is generally recognised: children who are raised in families where a parent has a mental illness.

Recent statistics suggest that almost half of the Australian population will suffer some form of mental illness during the course of their adult life, and about one in five during any one year.  This includes illnesses like severe depression, anxiety disorders, substance abuse, psychotic illnesses (eg schizophrenia) and other conditions including senile dementia.  About 3% will suffer severely from illnesses like schizophrenia (1%) and bipolar disorder, previously known as manic depression (2%).  This is not a picture of a country with robust mental health, and certainly suggests that;
  • many children are raised in families where the mental health of a parent is an issue
  • we need to be concerned with raising all children to be resilient and thus more able to withstand the pressures of modern life.
 In the "old days" people with severe mental illnesses were confined in institutions, often for most of their lives as drug and other therapies were not effective in treating their conditions.  This meant that children would continue to live with the well parent, or if necessary be placed in care.  In these more enlightened times, and with far better treatment, this situation has changed, with patients living in the community and engaging in everyday life.  They can work, form relationships, marry, have children, drive, buy houses...just like everybody else. Some, however, may be so severely disabled that their lives are permanently damaged and they are unable to live so well in the community eg some 80% of the homeless have a mental illness.

With this degree of prevalence, there is no excuse for prejudice: we all probably know someone within our immediate circle of family and friends.  Nor is there any reason for the persistence of myths like people with schizophrenia having two personalities, that the mentally ill are violent and a danger to society, particularly children.  As a community and as individuals we need to be informed not ignorant, sympathetic and caring not blaming or avoiding, but we also need to be realistic and recognise that many people at times, have an enormous struggle to keep well and functioning appropriately.

Untreated and under-treated mental illness not only makes life difficult for the person but also for those around them, and those who are closest, particularly family members can be seriously affected.
  • It is very hard work for example to be the partner of someone so affected by depression that getting out of bed is too hard, whose thoughts and ideas are all negative, who may talk of death or wanting to die.  
  • It is hard as an adult to be confronted by someone you love who is hearing voices telling them to do all sorts of strange things; or who suddenly believes you are the devil or some other enemy; or that they have superpowers.
Imagine how much harder it is for a child to be confronted with this.  Then imagine that your parent has no partner, that you and your siblings are the only ones who see and hear this.  You might have to look after yourself, get your own meals, wash and keep yourself clean as best you can, get yourself to and from school.  Most children are aware of what is OK and what is not OK, they may find it exciting to go on expeditions with a parent at all hours of the night, but they also know at another level that this is not what their friends do.  Children, like most of us, don't want to stand out as different so they often cover up what is happening at home, and it often takes crisis signs like frequently having no lunch, being dirty or absent from school to bring the family situation to the attention of adults who can intervene.

It is also not uncommon, for children, not only to have to care for themselves but to take on a caring role for their parents, making them food, reminding them when to take medication, or attend appointments, or even ringing mental health services to get help.  They may also take on extra responsibility for younger siblings.  They can grow up before their time, losing their childhood and becoming overly responsible.  In extreme cases, they may even believe that they are in some way to blame for their parent's current episode.

Reading this, you may be struck how sad this is, and be angry that the parents don't make an effort to look after their children, but remember, the parents are ill, and if they are aware of what is happening, they often are ashamed and this just adds to their negative self talk.  If they are unaware of what is happening, when they have been treated and told of what has happened, again they can be overwhelmed by shame.  Just because parents are mentally ill, it does not mean they don't love and care for their children.

Of course the situation should be much easier if the mentally ill parent has a partner, but often the load on this partner to be the wage earner, and to care for their partner and children is very heavy.  Family and friends are not always as helpful as we like to think we would be.  They all might be worn out from caring.  Unfortunately, too, if the person had a chronic physical illness or even a terminal illness, our attitudes and those of the general community would often be different.

It has not been my intention this week to stigmatise those with a mental illness or their families;  they are doing the best the can under very difficult circumstances.  I have wanted to point out some of the issues that such families face as from time to time we come across these issues in the families that contact the agency looking for a nanny.

Next week I want to look at some of the ways children in these families can be helped, and what can be done to strengthen the resilience of children in our care.

Helpful links:
Sane Australia
Children of Parents with a Mental Illness
Mind Matters
Better Health Victoria

Monday, 8 April 2013

In praise of grandparents!

As you may have realised, I have reached the stage in life when I am a proud grandmother and step grandmother.  I love:
  • to see the young ones;
  • to have news of them;
  • to have them to stay;
  • to have fun with them;
  • to receive their confidences;
  • to spoil them.
But today I'm not writing about the joy, amusement and occasional heartache I have from the experience of being a grandmother, but rather about the role grandparents play in families and in society.

If, like me, you have been watching Call the Midwife, you will have seen one of the traditional  roles of grandparents, to attend their daughters as they give birth.  While this is less common now in our western, medicalised births, in traditional cultures this was what it was all about.  They would then care for the young family as the mother recovered after birth.  I particularly like the Vietnamese tradition where the mother is tended for 30 days after the birth, so that her only role is to feed and look after the newborn.  What a wonderful time for rest and bonding! 

In multigenerational households, grandparents are there to be closely involved in the life of the young ones every step of the way, supporting, giving advice and often taking on the care of the children as the parents work.  I don't want to over romanticise this: I am very aware that grandparents can rule with a rod of iron, undermine the daughters in law that come into the family, interfere between parents and children, prevent or make very difficult the introduction of change and create factions within the wider family.  There are, however, many younger Australians who have been raised in this style of household and who look back and see its benefits as well as the difficulties, and who remember fondly the close relationship they had with their grandparents. 
 A friend recently told me of his experience of an Anglo-Saxon version of this, when as an only child raised in a rural city, he had both sets of grandparents as well as many members of his extended family living in surrounding streets and moved from one to another for food, attention and fun!  Perhaps this represents the best of both worlds, but in this day and age families are dispersed across vast tracts of suburbia, interstate or even overseas and such easily accessed family support is not necessarily available.

Grandparents have always had a role in passing on the culture of their society.  As well as telling stories of their past, they passed on songs, dances, traditional rhymes and stories, games, foods and how to prepare them, handicrafts and activities.  This has not just been the role of grandmothers...grandfathers, as elders, also had an important role.  This, I think, is one of the roles that many grandparents fill today, and while Play School, Sesame Street and the rest might introduce modern versions, often the ones that children are exposed to first are the traditional ones that grandparents learnt as children, and used to their children.

Perhaps the most important role grandparents have today is providing care for their children, for working parents, or during school holidays or, sadly, where parents no longer have the care of their children.  This last situation, in particular, is a growing area as welfare departments, when looking for carers, usually start with the family network.  It is a huge commitment as it is not easy to take on the care of children, especially at an age when you may well have been starting to think about planning your retirement, when you might be starting to experience the odd twinge in the joints, when your contemporaries are becoming grey nomads.  Parents know only too well that it is hard work caring for children and that dealing with adolescents can frequently demand high levels of emotional energy, but generally their friends are facing these issues at the same time and are available for mutual support.  It's much, much harder caring for your grandchildren going through these stages especially as their issues are often complicated because of their past life experiences.  Financially too, the costs can eat into retirement savings, and although there are various government allowances available they are generally inadequate.  Grandparents Australia is an excellent organisation advocating on behalf of all grandparents but especially grandparent caregivers.

I would be interested to hear your experiences of having grandparents in your life, either as a child or as a parent with children, and of course from other grandparents!

Tuesday, 2 April 2013

Don't make school holidays hard work!

As one of my earlier posts was titled, I love holidays and when i was a mother of young children, I loved school holidays:
  • no waking to the alarm
  • no making school lunches
  • set routines out the window
  • time to do things together with the children
  • time to visit other families. 
And yet for as long as I can remember the media warns of school holidays as if parents, and mothers in particular needed to be prepared to have a horrible time with their children at home.  It was almost as if children were little monsters who needed to be at school to protect their long-suffering parents.

Now, with more mothers in the workforce, I acknowledge that school holidays can bring issues:
  • supervision of children when parents are at work
  • the cost of school holiday programs
  • the difficulty getting employers to have flexible leave problems for working parents
  • the frequent assumption that it is the mother who will take annual leave to care for the children...dads are parents too!
I know that I grew up in less affluent, more innocent times, but we were lucky to have one special treat during the holidays: maybe a trip to the movies to see the latest Disney production, or a trip into the city to go to the museum. The rest of our time was spent playing, inside and outside, reading, going around to a friend's place or perhaps when we were older an outing with friends to the city without parental supervision, a time to try the lipsticks in the department stores, have a milkshake or a hamburger and chips, look at clothes, and of course admire any groups of boys we saw, giggling for all we were worth.  Maybe my children expected more than this, but apart from the odd swimming class or football clinic, their holidays were rather like mine except watching TV was thrown into the mix.

I am surprised today though, that some children and families don't seem to have a down time, that school holidays are jammed full of activities, classes, outings.  There doesn't seem to be time to just hang, to play alone or with friends.  I'm not sure what drives this need to fill every minute.  Is it that parents don't want to spend time with their children?  Or is it a sign of how much you care for your children that you want to take advantage of every minute for enrichment and stimulation?

It certainly seems to me that the result is children who cannot amuse themselves or find things to do. I think too that they are becoming restless unless they are constantly stimulated or entertained.  My answer to "I'm bored" used to be, "Only boring people are bored" then I might explore with them what they would like to do so they didn't feel bored any longer, but the onus was on them to come up with the solutions, and the most successful ones usually involved some level of physical activity or involvement with other people.

It is important I think for children to learn that they can make changes in what they are doing that then change how they are feeling.  I'm not sure that they get this opportunity when their life is crowded by activity, often organised by adults.

So my advice, for what it's worth, is to enjoy holiday times with the children, have fun together and don't cram every minute with entertainment and activity!