It is often said that health professionals don’t just treat the child, but the parents too. Nowhere is this more evident than in child development. Optimal development in the early years depends so much on the quality of the caretaking environment provided by the parents — good nutrition, immunisation, a safe environment to reduce the risk of injuries and most importantly, warm, consistent and responsive parenting. The first three factors are relatively straightforward – there are concrete and specific interventions to ensure they are provided. The fourth one, parenting that promotes optimal development, is much more complex and impacted by a host of factors. This is an area where health professionals can make a difference.
When we speak of parent mental health it is important that we do not default to mental illness. Mental health and wellbeing exist on a continuum and can fluctuate from time to time. It is perfectly normal for parents to feel anxious, stressed, or overwhelmed at times — looking after young children can be challenging, and there is a host of external factors that can precipitate such feelings. For many parents, these feelings are transient and diminish as they draw upon their inner strength and resilience, or they receive timely and appropriate support from their partner, extended family, or friends. However, some parents do indeed have ongoing mental health issues — either a pre-existing illness, or where the challenge of parenting becomes persistently overwhelming.
Risk factors for parent mental health issues can be found in the child, in the parent(s), and both within and outside the immediate family environment. Some children are inherently more difficult to parent; this may be a function of their temperament, a disability or cognitive delay, foetal alcohol spectrum disorder, or a neurodevelopmental disorder. In these situations, parents, especially the mother, can be quite vulnerable. There are many issues that may increase parent vulnerability and pose a risk both to their parenting and to the optimal development of their child. These include pre-existing mental health problems (which can be amplified by the demands of parenting), substance abuse, parental disabilities, or social isolation and the lack of day-to-day support. Parent mental health can also be impacted by poverty and its associations — food insecurity, poor housing, loss of a job or chronic unemployment, and reliance on welfare.
Sometimes mental health and wellbeing can be impacted by an infant who is irritable and hard to settle, a toddler with sleep problems, or a pre-schooler having issues with self-regulation. In these common situations it is almost inevitable that parents lose confidence, start to doubt their competence as parents, and become anxious or depressed. But these are also the situations where timely and appropriate support can be the most beneficial; it is these situations where recognition and intervention by health professionals can be decisive.
Incorporating a rapid assessment of parent mental health is an important part of a routine health care delivery to children. Professionals may already know the parents and be aware of any risk factors and be able to intervene in situations where they are likely to impact on the health and development of the child. It is easy enough to elicit stresses and problems with a few simple questions and/or observations during the consultation.
A useful tool is the Children’s Wellbeing Continuum, which can be downloaded free of charge from https://www.rch.org.au/ccch/continuum/. While originally developed for use with children, it has also been useful to rate how parents are coping on a continuum – good/coping/struggling/overwhelmed. Professionals can ask parents how they would rate themselves, and their responses provide an opportunity to begin a conversation about any support or interventions that may be of benefit.
Supporting the mental health of parents is crucial for the optimal development of their children. Parents play a critical role in shaping their children's cognitive, emotional, social, and physical development. When parents experience mental health problems, it can impact their ability to provide the nurturing and supportive environment that children need to thrive. Providing adequate support and treatment for parents can help reduce the negative impact of mental health issues on the entire family, leading to better outcomes for children's development and well-being.
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Professor Frank Oberklaid, Co-Director, Policy Equity and Translation, Murdoch Children’s Research Institute
Professor Frank Oberklaid is a developmental/behavioural paediatrician with a distinguished academic career encompassing clinical work, teaching, research and public policy. His interests include early childhood development, community-based models of service delivery that focus on prevention and early intervention, and the translation of research so it informs policy, service delivery and clinical practice.
Photo: © UNICEF-Pancic