FIG1 People with serious and
persistent mental illness often face unique issues surrounding their role as
parents, issues that should be addressed during psychiatric treatment,
according to a panel of Baltimore-area psychiatrists who spoke at APA's
Institute on Psychiatric Services in Atlanta in October.
Curtis Adams, M.D., sometimes prescribes dates for overburdened couples
who care for relatives with serious mental illness.
Some of these issues include losing custody due to repeated
hospitalizations, being unable to care for a child due to debilitating
psychiatric symptoms, or needing the support of family members to raise a
"In an opening dialogue with patients, we tend not to ask questions
about parenting," noted Ann Hackman, M.D., medical director of the
Programs for Assertive Community Treatment (PACT) team at the University of
Maryland Medical System in Baltimore.
Although questions such as "Have you ever had children?" often
come up during the initial assessment, she said, "we don't necessarily
get back to them." This is the case with both men and women patients,
Giving patients the opportunity to talk about their feelings about
parenting is important, she noted.
Clinicians should determine the level of the patient's involvement with his
or her child and address whether problems such as psychiatric symptoms,
homelessness, or substance use interfere with the parent-child
One of Hackman's patients told her she would have loved to have children,
but began experiencing symptoms of serious mental illness at age 17 and was
never able to maintain a relationship with a significant other. For that
reason, the woman never felt she could have children. "That's a loss
that merits discussion," Hackman said.
Hackman sometimes hears from patients that medication side effects or
psychiatric symptoms "impact dramatically on the ability to be the
parent they would have liked to be," she said.
Psychiatrists can help patients who are parents in other ways as well, such
as helping them manage visitation of their children or get involved in
parenting classes and peer support groups, such as a women's support group at
the University of Maryland Medical System.
In the group, Hackman noted, women may discuss "how to strengthen the
relationships they have with their children or how they were able to
successfully raise their children despite repeated
In addition, she said, some support-group members "talk for the first
time about the trauma of having their children taken away from
Theodora Balis, M.D., a member of the PACT team, said societal stigma"
may have led many to believe that parenting is not highly valued by
people with mental illness" and that "women with serious mental
illness have multiple partners and above-average fertility rates," which
all have been disproved by scientific literature.
The proportion of women with serious mental illness who lose custody of
their children ranges from 30 percent to 60 percent, depending on the study,
She quoted sociologist Erving Goffman, Ph.D., who in 1961 wrote that"
patients with serious mental illness are victimized twice as they first
experience a devastating neurobiological illness through no fault of their own
and then find themselves at risk for other losses including losing their
children.... They are viewed as permanently flawed and incapable of fulfilling
one of society's most cherished roles."
Balis noted that many psychiatric patients lose custody of their children
during hospitalization. Fear of losing custody of children for this reason may
keep many people with mental illness from seeking treatment, she said.
Clinicians need to be educated about the likelihood that women with serious
mental illness either have or may have children, and if they do have children,"
parenting should be an important part of treatment planning and case
management services," she said.
When people with serious mental illness become parents, it may become
necessary for members of their extended families to step in and take over many
of the roles the parent would normally assume, said Curtis Adams, M.D., an
assistant professor of psychiatry at the University of Maryland and a member
of the PACT team.
Parents or siblings of the person with mental illness may assume the role
of guidance counselor or confidante of the relative's child because the ill
relative may be unable to do so.
The family member may also need to educate the child about his or her
parent's mental illness and even serve as interpreter for the parent.
In his work with family members of people with serious mental illness,
Adams noted that "often a family is a tyranny ruled by its sickest
It is easy for family members to lose themselves in the responsibilities of
caring for the sick relative and his or her children, he noted.
In some families, it is a couple who assumes these responsibilities and
lose their lives together in the process of dealing with the relative's
illness, Adams said. To help them regain their lives, he said, "If they
haven't been on a date recently, I prescribe a date, and the next time I see
them, I ask them where they went."
"It is important that the relative's illness not dominate their
lives, and this can easily happen, especially where parenting issues are
concerned," he added. ▪