Children of parents with mental illness (COPMI) are often referred to in the literature as invisible given the lack of services dedicated to this large population at increased risk for a multitude of psychosocial difficulties. Of the services available, few have been empirically validated. This study undertook a qualitative evaluation of Kids in Control, a psycho-education and support program intended to enhance the resilience of children of mentally ill parents. The goals of this study were to: determine whether the program was beneficial to the participants, identify the critical program elements deemed helpful/unhelpful by the participants, determine whether program objectives were being met, and to provide insight on how to improve the program to better meet the needs of this population. It is ultimately hoped that this research will give children of parents with mental illness a voice, thereby boosting their visibility and contributing to their psychosocial well being. Flanagan’s (1954) critical incident technique (CIT) was employed to determine the participants’ perceptions of helpful and unhelpful aspects of the program. Twelve participants (10 boys, 2 girls) ranging in age from 8-12 were recruited from 4 groups held in the Lower Mainland of British Columbia. Semi-structured interviews were conducted, followed by telephone interviews to discuss and verify the information shared. Participants reported a total of 121 critical incidents, which were classified into 8 helpful categories (105 incidents) and 2 unhelpful categories (16 incidents). The eight helpful categories were: identifying, communicating and managing feelings; learning about mental illness; helpful messages about responsibility, control, and empowerment; effective facilitator group management skills; having fun; connecting with other children experiencing parental mental illness; learning about stigma; and identifying supports. The unhelpful categories were: ineffective facilitation skills, and disruptive behaviour exhibited by other group members. Participants recommended improvements related to the areas of group instruction, time management, and group management. In addition, a 10-point rating scale was administered to determine the participants’ overall perception of program helpfulness. A mean rating of 7.63 was obtained which corresponds to very helpful on the scale. A comparison of incident categories with program objectives indicated a high degree of consistency, with a few exceptions. Implications for program improvements, wider program dissemination, and counselling practice are discussed. In addition, methodological issues related to using the critical incident technique with children are outlined.

Children of parents with mental illness (COPMI) are often referred to in the literature as invisible given the lack of services dedicated to this large population at increased risk for a multitude of psychosocial difficulties. Of the services available, few have been empirically validated. This study undertook a qualitative evaluation of Kids in Control, a psycho-education and support program intended to enhance the resilience of children of mentally ill parents. The goals of this study were to: determine whether the program was beneficial to the participants, identify the critical program elements deemed helpful/unhelpful by the participants, determine whether program objectives were being met, and to provide insight on how to improve the program to better meet the needs of this population. It is ultimately hoped that this research will give children of parents with mental illness a voice, thereby boosting their visibility and contributing to their psychosocial well being. Flanagan’s (1954) critical incident technique (CIT) was employed to determine the participants’ perceptions of helpful and unhelpful aspects of the program. Twelve participants (10 boys, 2 girls) ranging in age from 8-12 were recruited from 4 groups held in the Lower Mainland of British Columbia. Semi-structured interviews were conducted, followed by telephone interviews to discuss and verify the information shared. Participants reported a total of 121 critical incidents, which were classified into 8 helpful categories (105 incidents) and 2 unhelpful categories (16 incidents). The eight helpful categories were: identifying, communicating and managing feelings; learning about mental illness; helpful messages about responsibility, control, and empowerment; effective facilitator group management skills; having fun; connecting with other children experiencing parental mental illness; learning about stigma; and identifying supports. The unhelpful categories were: ineffective facilitation skills, and disruptive behaviour exhibited by other group members. Participants recommended improvements related to the areas of group instruction, time management, and group management. In addition, a 10-point rating scale was administered to determine the participants’ overall perception of program helpfulness. A mean rating of 7.63 was obtained which corresponds to very helpful on the scale. A comparison of incident categories with program objectives indicated a high degree of consistency, with a few exceptions. Implications for program improvements, wider program dissemination, and counselling practice are discussed. In addition, methodological issues related to using the critical incident technique with children are outlined.

Children of parents with mental illness (COPMI) are often referred to in the literature as invisible given the lack of services dedicated to this large population at increased risk for a multitude of psychosocial difficulties. Of the services available, few have been empirically validated. This study undertook a qualitative evaluation of Kids in Control, a psycho-education and support program intended to enhance the resilience of children of mentally ill parents. The goals of this study were to: determine whether the program was beneficial to the participants, identify the critical program elements deemed helpful/unhelpful by the participants, determine whether program objectives were being met, and to provide insight on how to improve the program to better meet the needs of this population. It is ultimately hoped that this research will give children of parents with mental illness a voice, thereby boosting their visibility and contributing to their psychosocial well being. Flanagan’s (1954) critical incident technique (CIT) was employed to determine the participants’ perceptions of helpful and unhelpful aspects of the program. Twelve participants (10 boys, 2 girls) ranging in age from 8-12 were recruited from 4 groups held in the Lower Mainland of British Columbia. Semi-structured interviews were conducted, followed by telephone interviews to discuss and verify the information shared. Participants reported a total of 121 critical incidents, which were classified into 8 helpful categories (105 incidents) and 2 unhelpful categories (16 incidents). The eight helpful categories were: identifying, communicating and managing feelings; learning about mental illness; helpful messages about responsibility, control, and empowerment; effective facilitator group management skills; having fun; connecting with other children experiencing parental mental illness; learning about stigma; and identifying supports. The unhelpful categories were: ineffective facilitation skills, and disruptive behaviour exhibited by other group members. Participants recommended improvements related to the areas of group instruction, time management, and group management. In addition, a 10-point rating scale was administered to determine the participants’ overall perception of program helpfulness. A mean rating of 7.63 was obtained which corresponds to very helpful on the scale. A comparison of incident categories with program objectives indicated a high degree of consistency, with a few exceptions. Implications for program improvements, wider program dissemination, and counselling practice are discussed. In addition, methodological issues related to using the critical incident technique with children are outlined. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

This thesis investigated the experiences of children who have a parent with a mental illness, using qualitative methods. It is divided into three separate sections, the first two written as standalone journal papers. Paper 1 is a systematic review and synthesis of qualitative studies exploring children's experiences of having a parent with a mental illness. The review used specific databases, a search of qualitative journals and a general internet search to identify relevant studies, and the subsequent application of inclusion/exclusion criteria and a quality appraisal assessment. 14 studies meeting inclusion and quality criteria were identified exploring the experiences of 163 children and young people aged between 5 and 22 years, from a range of countries, with a variety of parental mental health diagnoses. The review then involved synthesising the findings of these studies to generate five overarching themes which were found to influence children's experiences. Children who had some knowledge and understanding of their parent's mental illness were more likely to use effective coping strategies, have a more positive relationship with their parent, and experience fewer negative effects on them as a child. Paper 2 is an original research study which explored the experiences of children who have a parent with bipolar disorder, to see how this might impact on the child's emotional wellbeing. This qualitative study used 'In My Shoes', a computer assisted interview tool, to explore the experiences of ten children from England aged between 4 and 10 years. Subsequent comparison with their parent's accounts enabled greater insight into family life. Child and parent interview data was analysed using thematic and content analyses. The four main themes that emerged from the child interviews were: knowledge and awareness of bipolar disorder; perception of parents; managing family life with a 'bipolar' parent; and living in a family with bipolar disorder. The study concluded that further research was needed to understand children's perspectives, which should be taken into account when developing appropriate services and interventions to support children and parents with mental illness, including bipolar disorder. Finally the third section of the thesis was a critical appraisal of the literature review, research study and research process as a whole, including methodological reflections, implications for future research and clinical practice, and the researcher's personal reflections in undertaking the research. The findings were deemed vitally important for the future of families in which a parent has bipolar disorder.

The present study aims to contribute to knowledge about the psychosocial health inworking life after growing up with a parent with a mental illness. The study also wants toinvestigate what impact from society is needed in order to support a positive developmentfor this group of children. Theoretical perspectives used were the Socio-ecological modeland Attachment theory. A qualitative method with semi structured interviews was used.Six informants from a purposive sampling group participated in the study. The collectedmaterial was transcribed, and thematic analysis was carried out. The results mainlyshowed that security seeking, low self-esteem, insecurity, pronounced sense ofresponsibility, a great need for adaption and control, and a striving for acceptance fromthe environment was important. The results also show the importance of support and helpfrom the environment. Growing up with a mentally ill parent does not necessarily have anegative effect on a person’s occupational health, but several experiences in working lifewere reported, that could be related to childhood conditions in a family with mentalillness

<p>Barn till psykisk sjuka kan ha ökad risk för psykisk ohälsa men detta kan uppvägas av tillgängliga skyddsfaktorer. Barn har blivit mer uppmärksammade inom vuxenpsykiatrin på senare år. Beardslees familjeintervention implementeras sedan 2008 i Sverige. Studien undersökte hur vuxenpsykiatrin stödjer barn till psykisk sjuka, speciellt angående interventionen. Tio anställda, utbildade i interventionen, från sju psykiatriska kliniker i Stockholm intervjuades. Materialet analyserades abduktivt. Barns reaktioner och behov visade sig påverkas av föräldrafunktionen och risk- och skyddsfaktorer hos barnet, i omgivningen och situationen. Interventionen upplevdes bli ett sätt att uppmärksamma barn och skapa dialog inom familjen. Samtidigt upplevde deltagarna bristande kunskap om hur man kommunicerar med barn. För att stödja barn som mår dåligt skulle ett samarbete med BUP behövas. Ingen barnpolicy på avdelningsnivå finns och barns delaktighet ansågs låg. Preventivt arbete kan minska riskfaktorerna, men fokus måste också vara att öka barns möjlighet att hantera vardagssituationen, vilken kan förändras av omständigheterna och över tid.</p> / <p>Children of mentally ill parents have a higher risk to develop psychiatric problems but this risk can be reduced by protective factors. In recent years children of mentally ill have received more attention within adult psychiatry. The Beardslee family intervention has been implemented in Sweden since 2008. This study examines how adult psychiatry supports children of mentally ill, with focusing specifically on this intervention.  Ten professionals, educated in the intervention, from seven psychiatric hospitals in Stockholm, were interviewed and data analyzed abductive. Children's reactions and needs was shown to be influenced by the parenting skills and factors of risk and protection within the child, the environment and the situation. The intervention was perceived as a way of paying attention to the child and to create a dialogue within the family. At the same time the participants experienced a lack of knowledge about how to communicate with children. In order to support children cooperation with child psychiatry is required. No policy of how to handle children was available at the hospital units and the participation of children is considered to be low. Prevention may decrease the risk factors but there must also be a focus on increasing the possibility for the child to cope with the everyday situation. This situation may also change depending on circumstances and over time.</p>

Bakgrund: Barn som lever med en förälder som har psykisk ohälsa glöms ofta bort av både familj och vårdpersonal bakom förälderns ohälsa. Detta kan utgöra en konsekvens för isoleraring och ensamhet. Samtidigt löper dessa barn en stor risk för att själva drabbas av negativa konsekvenser. Syfte: Beskriva barns upplevelser av att leva med en förälder med psykisk ohälsa. Metod: Syftet besvarades genom en allmän litteraturstudie baserat på 11 vetenskapliga artiklar med kvalitativ ansats. Resultat: Resultatet tematiserades under fyra huvudteman med subteman därtill. Huvudteman som framkom var I skuggan av psykisk ohälsa, Ett stort ansvar för ett litet barn, Den känslostyrda vardagen samt Bristande kommunikation. Slutsats: Av studiens resultat framkommer det att den psykiska ohälsan hos föräldern påverkar barnen på flertal olika sätt både i ung och vuxen ålder. För att hälso- och sjukvårdspersonal ska kunna ge stöd och uppmärksamma dessa barn finns ett behov av adekvat utbildning. Klinisk betydelse: Resultatet kan genom en ökad kunskap om barns upplevelse av att leva med en förälder med psykisk ohälsa bidra till en bättre förståelse för sjuksköterskor och därmed involvera barnen i vården. Den bristfälliga kunskapen som visas kan bidra till att relevant utbildning ges för hälso-och sjukvårdspersonal för en förbättrad kommunikationsstrategi. / Background: Children who are living with a parent who have mental illness are often forgotten behind the parent's illness by family and professionals. That can be a consequence for isolation and loneliness. These children are also are at great risk to also suffer from negative consequences. Aim: To describe the children's experiences of living with a parent with a mental illness. Method: The aim was answered by a general literature study based in 11 scientific articles with qualitative approach. Result: The result thematized four main themes with corresponding subthemes. The main themes that emerged were In the shadow of mental illness, A huge responsibility for a little child, The controlled emotional living and also Lack of communication. Conclusion: From the study’s result is revealed that the parental mental illness affect the child in multiple ways both at young and adult age. The need of education is important so the healthcare can give support and recognize these children. Clinical significance: The result can contribute an increased knowledge about children’s experiences of living with a mentally ill parent and add a better understanding in healthcare that will also involve the children. The lack of knowledge that is exposed today can contribute to relevant educations for nurses to an improved communication strategy.

Barn till psykisk sjuka kan ha ökad risk för psykisk ohälsa men detta kan uppvägas av tillgängliga skyddsfaktorer. Barn har blivit mer uppmärksammade inom vuxenpsykiatrin på senare år. Beardslees familjeintervention implementeras sedan 2008 i Sverige. Studien undersökte hur vuxenpsykiatrin stödjer barn till psykisk sjuka, speciellt angående interventionen. Tio anställda, utbildade i interventionen, från sju psykiatriska kliniker i Stockholm intervjuades. Materialet analyserades abduktivt. Barns reaktioner och behov visade sig påverkas av föräldrafunktionen och risk- och skyddsfaktorer hos barnet, i omgivningen och situationen. Interventionen upplevdes bli ett sätt att uppmärksamma barn och skapa dialog inom familjen. Samtidigt upplevde deltagarna bristande kunskap om hur man kommunicerar med barn. För att stödja barn som mår dåligt skulle ett samarbete med BUP behövas. Ingen barnpolicy på avdelningsnivå finns och barns delaktighet ansågs låg. Preventivt arbete kan minska riskfaktorerna, men fokus måste också vara att öka barns möjlighet att hantera vardagssituationen, vilken kan förändras av omständigheterna och över tid. / Children of mentally ill parents have a higher risk to develop psychiatric problems but this risk can be reduced by protective factors. In recent years children of mentally ill have received more attention within adult psychiatry. The Beardslee family intervention has been implemented in Sweden since 2008. This study examines how adult psychiatry supports children of mentally ill, with focusing specifically on this intervention.  Ten professionals, educated in the intervention, from seven psychiatric hospitals in Stockholm, were interviewed and data analyzed abductive. Children's reactions and needs was shown to be influenced by the parenting skills and factors of risk and protection within the child, the environment and the situation. The intervention was perceived as a way of paying attention to the child and to create a dialogue within the family. At the same time the participants experienced a lack of knowledge about how to communicate with children. In order to support children cooperation with child psychiatry is required. No policy of how to handle children was available at the hospital units and the participation of children is considered to be low. Prevention may decrease the risk factors but there must also be a focus on increasing the possibility for the child to cope with the everyday situation. This situation may also change depending on circumstances and over time.

Bakgrund: Det är få verksamheter inom vården som har de rutiner och den kunskap som krävs för att bemöta barn till föräldrar med psykisk sjukdom. Sjuksköterskornas brist på kunskap och beredskap att stödja dessa barn leder till att barnen blir osynliga och inte får den information och det stöd som de behöver. Syfte: Att beskriva barns upplevelser av att leva med förälder med psykisk sjukdom. Metod: Litteraturstudie av tio vetenskapliga artiklar med kvalitativ ansats. Resultat: Resultatet presenteras utifrån fyra huvudkategorier. Stöd och information var en av de viktigaste beståndsdelarna som barnen uttryckte. Att leva med en förälder med psykisk sjukdom påverkar barnen, de lever i oförutsägbarhet, upplever oro, rädsla, skuld och ökat ansvar för föräldern. Brist på information om förälderns sjukdom till barnen samt stöd från vården ledde till att barnens situation försvårades. Samtliga barn uttryckte en önskan om stöd från vården. Slutsats: Denna studie har visat att stöd är viktigt för barn till psykiskt sjuka föräldrar. Sjuksköterskor behöver mer kunskap och beredskap för att kunna synliggöra dessa barn och hjälpa dem till lämpliga stödinsatser. Klinisk betydelse: Genom att belysa barns upplevelser kan stöd, beredskap och utbildning för vårdpersonal utvecklas så att dessa barn får det stöd de behöver. / Background: There are few health care establishments who have the routines and the knowledge required to respond to the children with parents with mental illness. Nurses lack of knowledge and equipment to support these children leads to children becoming invisible and do not receive the information and support they need. Aim: To describe the children's experiences of living with a parent with a mental illness. Method: Literature review of ten scientific articles with an qualitative approach. Results: The results presented from the four main categories. Support and information was one of the key elements that the children expressed. Living with a parent with mental illness affects children, they live in unpredictability, experience anxiety, fear, guilt and responsibility for the parent. Lack of information about the parent's illness to the children and the support of health care led to the children's situation was complicated. All children expressed a desire for support from healthcare. Conclusion: This study has shown that aid is important for children of mentally ill parents. Nurses need more knowledge and equipment to make these invisible children visible and help them to appropriate support. Clinical significance: By illuminate children's experiences can support, equipment and education developed for caregivers so that these children receive the support they need.

This project investigated characteristics relating to family functioning and attitudes to mental illness, and caregiving, which distinguish families choosing to care for children of parents with mental illness (CPMI) from families who choose not to but do care for other children (NCPMI), and from families not involved in the adoptive care system (COMM). Welfare agencies seeking long term home based care for children of parents with mental illness (among other groups of children) report that potential caregivers are concerned about the child’s genetic risk, and the requirement that they facilitate access visits with the birth parent. Consequently it is more difficult to recruit caregivers to care for children of parents with mental illness. Previous studies found that families who adopt children with special needs had family systems that were flexible and able to adapt to changing needs, and in which family members felt close to one another. It was not known if the functioning of families who care for children of parents with mental illness would differ from other family groups. Nor was it known if these families would differ in motivation to be caregivers and attitudes to mental illness from other family groups. / Forty four families completed a questionnaire providing background information, and a family functioning questionnaire which included the FACES II measure (Family Adaptability and Cohesion Evaluation Scale) and questions assessing level of altruism, and tendency to respond in a socially desirable manner. Data from the FACES II measure was used to classify families according to the Circumplex Model of Marital and Family Systems. Q-methodology was used to assess participants’ attitudes to eight issues related to the research question: mental illness, children of parents with mental illness, parents having a mental illness, family environment, motivation to be caregivers, ongoing contact between child in care and parent, approval of others when deciding to be a caregiver, and flexibility in deciding to accept a certain child for placement. The Q-method required participants to rate 42 statements (a Q-set), concerning these issues, according to a fixed distribution, from statements with which they strongly agreed to statements with which they strongly disagreed. / Participants could also give open-ended responses to questions addressing the same issues in a semi-structured interview. The CPMI group were found to have a lower level of income and education than the other two groups, and were more likely to be full time caregivers. Both caregiver groups were unlikely to have children of their own. The profiles of the three groups on the cohesion and flexibility sub-scales of FACES II were similar. The classification of the family groups on the Circumplex model showed that the CPMI group were located in the balanced and mid-range levels of the model more so than the other two groups. Responses to the Q-sort and interview questions suggested that the CPMI families were more understanding of mental illness, and of the needs of the children and capacity of their parents. It is suggested that future studies increase the number of participants, and investigate in more detail the factors which motivate families who provide long term care for children of parents with mental illness.