Background: Parents with a serious mental illness (SMI), compared to parents who do not have a mental illness, have a greater likelihood of having contact with child protective services and afterwards, of experiencing negative outcomes such as loss of custody. Child protective service (CPS) workers may be able to connect parents with an SMI with services and resources to help address mental health, parenting, and other needs. The purpose of this dissertation was to gain a better understanding of factors that contribute to the provision of services and referrals by the child welfare system for parents with an SMI. Aims: The specific aims were as follows: 1) Determine whether child welfare agencies’ structure, policies, and climate are related to CPS workers providing or referring parents with an SMI to mental health and parenting services. 2) Determine child protective service workers’ knowledge of and attitudes towards serious mental illness. 3) Determine child protective service workers’ perceptions about providing or referring parents with an SMI to mental health and parenting services. 4) Determine whether child protective service workers’ knowledge, attitudes, and perceptions (as specified in Aims 2 and 3) vary between parents with major depression and parents with schizophrenia. Methods: Secondary analysis of the second National Survey of Child and Adolescent Well-Being (NSCAW II) was conducted to see how child welfare agencies’ structure, policies, and climate are related to workers’ provision of services or referrals to parents with a serious mental illness. Aims 2-4 were addressed by the development and dissemination of a survey to child welfare workers. As there are no existing measures of child welfare workers’ attitudes related to serious mental illness and perceptions around working with parents with a serious mental, some survey items were adapted from existing measures and questionnaires. These included measures of mental health stigma and knowledge given to healthcare professionals. Other survey items were developed based on existing literature in parental mental illness and child welfare. Results: For Aim 1, no factors were statistically significantly related to an agency’s rate of provision of mental health services and referrals. Only percent of the county in poverty, percent of the county that was White, and an agency having one caseworker from the beginning to the end of a case were statistically significantly related to an agency’s rate of provision of parenting skills training services and referrals. The survey for Aims 2-4 had an overall sample size of 456 participants. For Aim 2, participants were knowledgeable about both major depression and schizophrenia. They had relatively low levels of stigmatizing attitudes towards parents with a serious mental illness although many undervalued the benefits of parenthood for people with an SMI. For Aim 3, participants identified mental health treatment, emotional support from family and friends, and practical resources as the three most important needs of parents with an SMI. Participants rated their capability in supporting parents’ non-mental health needs more highly than supporting their mental health needs. Participants identified possible barriers to the provision of services and referrals including caseloads and leadership support. Participants strongly supported child welfare agencies providing parents with an SMI with services and referrals. Conclusion: This dissertation expands our understanding of factors impacting the provision of services and referrals by the child welfare system to parents with an SMI. It highlights the importance of workers having the time and resources to work with parents with an SMI and identifies areas in need of improvement. / Public Health

Researchers have extensively studied the experiences and potential consequences of being a child whose parent has a mental illness (COPMI). However, there is no consensus on the best way to support these children, in general or in schools. The purpose of this quantitative study was to examine the effects of parental mental illness on children by using an ecological approach. Researchers have used ecological theory to illustrate the importance of internal characteristics, skills, and supports for children to enhance resiliency. This study looked at whether COPMI differed significantly from the children of parents of parents with no current or past mental illness (NonCOPMI) on the Developmental Assets Profile (DAP). The study also looked at whether there was a significant difference in the change in DAP scores for the COPMI compared to the NonCOPMI over time. A secondary data analysis of DAP survey results was performed and SPSS v.23.0 (IBM, 2015) software was used to complete one-way and two-way repeated measures ANOVA on DAP scores. COPMI reported lower DAP levels than NonCOPMI, and this difference was statistically significant in some areas of Internal Assets and Social and Community contexts. These findings suggest that COPMI may be challenged in these areas and are in line with previous findings regarding the challenges that COPMI may face and supports the continued use of ecological theory. By utilizing the DAP survey, specific areas where COPMI may benefit from additional supports can help professionals promote resilience among children. Proactive efforts like this, especially in schools, where increasing attention is being paid to mental health education, may contribute to positive social change.

Inledning: Globalt sett beräknas det att en av fyra familjer har minst en medlem med psykisk störning och de anhöriga är ofta de som är de främsta vårdarna. En majoritet av personer med psykisk sjukdom är eller kommer att bli föräldrar. Forskning visar på ett starkt samband mellan psykisk sjukdom hos föräldrarna och psykisk ohälsa hos barn. Syfte: Att identifiera riskfaktorer respektive friskfaktorer som uppträder hos barn som växer upp med en psykiskt sjuk förälder. Metod: En litteraturstudie där 15 artiklar både kvantitativa och kvalitativa ingick. Analysering av artiklarna har skett enligt en tematisk analysmetod. Resultat: Barn till föräldrar med psykisk sjukdom utgör en högriskgrupp för att själva utveckla beteendemässiga, känslomässiga och psykiatriska problem. Det finns ett starkt samband mellan förälderns psykiska sjukdom och stigmatisering samt bristande skolgång. Skyddande faktorer inbegriper stöd, kunskap om förälderns tillstånd, en aktiv coping strategi och en familjefokuserad vård, vilket kan öka familjens och barnens resiliens. Diskussion: Det finns stora behov av tidiga insatser för att stödja barn. Många gånger missas barnen då fokus på vården enbart är riktad till den psykiskt sjuka föräldern. Studien visar att stöd och information till barnen inte är implementerat eller är bristfällig i många fall. / Introduction: Globally, it is estimated that one in four families has at least one family member with a mental disorder and relatives are often the primary caregivers. A majority of people with mental illness are or will be parents. Research shows a significant association between parental mental illness and mental illness in children. Purpose: The purpose of this systematic literature review was to identify the risk factors and the protective factors of the health of children living with a mentally ill parent. Method: A literature study involving 15 articles both quantitative and qualitative. Analysis of the articles has been done according to a thematic analysis method. Result: Children of parents with mental illness constitute a high-risk group for developing problems such as behavioural, emotional and psychiatric disorders. There is a strong relation between the parent's mental illness and stigmatization as well as lack of school attendance. Protective factors include social support, knowledge of the parent's illness, having an active coping strategy and a family-focused care that can enhance the family and children's resilience. Discussion: There is a great need of early efforts and interventions to support children. Many times, the focus from health care is only on the mentally ill parent and many children's needs are missed. This study shows that support and information to the children in many cases is not implemented or inadequate.

Multiple studies show that growing up with a mentally ill parent affects children in many ways. In recent years many children ́s picturebooks about mental illness have been published, making it an accessible subject for the youngest readers. The aim of this study is to examine how children’s experiences of parental mental illness is described in picturebooks on the topic, and if these books can be helpful in increasing children's sense of coherence. The study is based on an analysis of eight Swedish picturebooks dealing with different types of mental illness directed to children in the age group 3-6 years. The books’ descriptions of children’s experiences of parental mental illness are mapped and the content is analyzed using Antonovsky’s theory Sense of Coherence, SOC. The study shows that children’s experiences of parental mental illness as described in the books, are relatively consistent with descriptions found in interview studies with children with experiences of parental mental illness. Furthermore, the study shows that the picturebooks can be helpful for children with experiences of parental mental illness, especially in combination with the presence of an adult whom the child trusts to talk to. Finally, the study shows that the picturebooks offer answers to children’s frequently asked questions about parental mental illness. / Flertalet studier visar att barn på olika sätt påverkas av att växa upp med en psykiskt sjuk förälder. De senaste åren har flera bilderböcker på ämnet psykisk ohälsa givits ut, vilket gör det till ett ämne som även de yngsta läsarna kommer i kontakt med. Syftet med studien är att undersöka hur barns upplevelser av föräldrars psykiska ohälsa beskrivs i bilderböcker på ämnet, och om böcker av detta slag kan vara en hjälp i att öka barns känsla av sammanhang. Studien bygger på en analys av åtta svenska bilderböcker som berör olika typer av psykisk ohälsa riktade till barn i åldersgruppen 3–6 år. Böckernas beskrivningar av barns upplevelser av föräldrars psykiska ohälsa kartläggs och innehållet analyseras utifrån Antonovskys teori Känsla av Sammanhang, KASAM. Studien visar att bilderböckernas beskrivningar av barnens upplevelser av förälderns psykiska ohälsa stämmer relativt väl med de beskrivningar som återfinns i intervjustudier med barn med erfarenhet av att växa upp med en förälder med psykisk ohälsa. Vidare visar studien att bilderböckerna kan vara en hjälp till barn med egna erfarenheter av att leva med en psykiskt sjuk förälder, speciellt i kombination med att en vuxen finns tillgänglig för samtal med barnet om bokens innehåll. Till sist visar studien att bilderböckerna erbjuder svar på vanliga frågor barn har om föräldrars psykiska ohälsa.

The purpose of this essay was to investigate social workers' work with children who have mentally ill parents in order to gain a better understanding of their work and how it affects the children. Mental illness is today a growing public health problem. The proportion of Sweden's population suffering from some form of mental illness is increasing. Mental illness is both psychiatric conditions and mental disorders. It causes suffering for the individual themself, but it can also affect the individual's surroundings. A parent's mental illness affects the child through an increased risk that the child themself may develop a mental and physical illness as a young adult. Research shows that children who have mentally ill parents are an "invisible" group due to the fact that social workers often target the parents without attending to care for the children. Furthermore, research shows that there is a need for these children to be identified in order for them to receive support and that there is a lack of knowledge about care provision in Sweden.  The method used in this essay is a qualitative method and the data was collected by qualitative interviews. Our collected material has been analyzed through meaning categorization which includes coding. The conclusion that was made in this essay is that the social work with children who have a parent with mental illness is very diverse. There’s different ways a social worker can help the children and there are also factors that can hinder the work. However, it can be seen that the work contributes to the child feeling better and developing positively.

The effectiveness of psychoeducation and peer support programs for children of mentally ill parents is frequently measured by demonstrating children’s ability to meet program goals according to pre-defined categories determined by adults. Little is known about how children respond to these goals, whether they share them, and how, or if, their needs are met. I conducted an ethnographic study of one such group for school-aged children. I examined how specific discourses framed the content of the program manual designed to educate and support children and I observed how children responded to the program. My study is rooted in Goffman’s (1959) dramaturgical analyses of the reciprocal influence individuals have on one another in face-to-face encounters. From a critical dramaturgical perspective the participants were expected to conform to behavioural expectations of the setting, itself framed by broader arenas of interaction in which shared institutionalized meanings govern (often idealized) presentations of self. Data collection included: 1. a critical discourse analysis of the program manual; 2. participant observation of interactions during the eight-week program; and 3. children’s evaluations of the program in a separate group interview. Being identified as “as all in the same boat” was meaningful and consequential for children who were expected to learn mental health/illness information because, “knowledge is power”, and to express difficult feelings about being a child of a mentally ill parent. Children could be said to have achieved the goals of the program because they developed a mutual understanding about how to interpret and give meaning to their circumstances; “recognizing” unpredictable behaviours as signs of illness and becoming responsible for managing only how “their own story would go”. Children were not expected to care for ill parents, even when they wanted some responsibility, and were strongly discouraged from turning to friends for support. Children strategized to negotiate and resist group expectations and challenge assumptions about being “all in the same boat”. Suggestions are made for determining what constitutes “good” mental health literacy based on children’s preferences for explaining their circumstances in ways they find relevant and for supporting children’s competencies to manage relationships that are important to them.

The effectiveness of psychoeducation and peer support programs for children of mentally ill parents is frequently measured by demonstrating children’s ability to meet program goals according to pre-defined categories determined by adults. Little is known about how children respond to these goals, whether they share them, and how, or if, their needs are met. I conducted an ethnographic study of one such group for school-aged children. I examined how specific discourses framed the content of the program manual designed to educate and support children and I observed how children responded to the program. My study is rooted in Goffman’s (1959) dramaturgical analyses of the reciprocal influence individuals have on one another in face-to-face encounters. From a critical dramaturgical perspective the participants were expected to conform to behavioural expectations of the setting, itself framed by broader arenas of interaction in which shared institutionalized meanings govern (often idealized) presentations of self. Data collection included: 1. a critical discourse analysis of the program manual; 2. participant observation of interactions during the eight-week program; and 3. children’s evaluations of the program in a separate group interview. Being identified as “as all in the same boat” was meaningful and consequential for children who were expected to learn mental health/illness information because, “knowledge is power”, and to express difficult feelings about being a child of a mentally ill parent. Children could be said to have achieved the goals of the program because they developed a mutual understanding about how to interpret and give meaning to their circumstances; “recognizing” unpredictable behaviours as signs of illness and becoming responsible for managing only how “their own story would go”. Children were not expected to care for ill parents, even when they wanted some responsibility, and were strongly discouraged from turning to friends for support. Children strategized to negotiate and resist group expectations and challenge assumptions about being “all in the same boat”. Suggestions are made for determining what constitutes “good” mental health literacy based on children’s preferences for explaining their circumstances in ways they find relevant and for supporting children’s competencies to manage relationships that are important to them.

The aim of this thesis is to study young people's views on support, knowledge and change. The eight participants in this interview study are between 14 and 19 years old and they share the experience of growing up in a family where a parent is a substance misuser or mentally ill. Childhood sociology has been used as a theoretical framework. The main finding is that emotional and practical support based on the young person's needs and knowledge based on the ideas of empowerment and agency promotes change. The four most important insights according to the young persons are: My parent has got a problem. It is not my problem. I choose my own life. I am not alone. The theoretical perspective of childhood sociology suggests that positive change is possible when the young persons are seen as competent and active participants in their own life and when their value as human beings is acknowledged by those who aim to support them.

The aim of this doctoral thesis is to – from a child perspective and with children as informants – describe and analyze childhood conditions for children whose parents suffer from severe mental illness. The method used is qualitative – 28 children, 10 boys and 18 girls, 7–18 years old, were interviewed about their parents’ mental disorder; the family situation and their own personal life – in school and during free time. The analyses are based on Sociology of Childhood and Family Sociology. Previous studies have, to a great extent, focused on the risk the children run of developing mental health- and social problems and what helps them to grow up healthy. The increased risk of mental health- and social problems has been well confirmed, but also that preventive interventions can contribute to resilience in the children. Although some studies have explored children’s experiences of their parents’ mental illness and the challenges they meet, research from a childhood perspective, has so far been scarce. The results of this study reveal different degrees of emotional, physical and social exposure for the children. Their childhood conditions were related to gender, relations, communication, problem load and social situation of the family. If the parent with a mental illness was a woman, the situation for the child was often more exposed than if it was the father – most likely due to parental roles and expectations on men and women in the Swedish society at that time. Girls seemed more emotionally involved in the parents’ problems than boys, especially if the parent with a mental illness was a father. Most of the parents were divorced or had never lived together. Parental conflicts complicated the life of the children, who were expected to have maintained relationships to both parents. Lack of communication about the parent’s mental disorder in - and outside the family - was common. The children were often uninformed about the parent’s problems.  If hindered to pass information between and outside their two homes, they were left to handle difficult, sometimes dangerous, situations with the mentally ill parent, alone. The home was not always the safe place for rest and recovery, as homes are expected to be. The heavier the total problem load of the family, the more exposed was the child. Most exposed were children whose both parents had severe problems – mental illness or addiction. They were often placed in out of home care, for longer or shorter periods. The kind and degree of exposure the children experienced varied. Four kinds of childhood sceneries could be recognized: (1) the well organized childhood, where the parent’s mental health problem was mainly an emotional burden for the children; (2) the complicated childhood, where the parents conflicts and inability to protect the child made the child either too involved or too lonely in handling the problems that the parent’s mental illness caused them; (3) the problematic childhood where the parent’s mental illness was not the only problem in the family, but factors like the other parent’s drinking, siblings’ problems, social and economical difficulties added to the burden and (4) the exposed childhood where none of the parents was able to take care of the child. Knowledge and openness, about the parents’ problems, seemed to increase competence and decrease feelings of guilt and responsibility for the parent. All of the children stood forward, not as passive victims, but as competent agents in their own lives – although often more or less powerless because of their dependence of their parents and other adults around them. It was clear, though, that there is a need for professionals in adult psychiatry, social services, school and preschool, to pay attention to the children of parents with mental health problems and see to that they get the information and support they need. Keywords: Children, childhood conditions, children as agents, parental mental illness/mental disorders, mental health knowledge, exposed life situations, competence.