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A Survey of Contact With Offspring

and Assistance With Child Care Among


Parents With Psychotic Disorders
Jenny Hearle, B.A., B.Soc.W.
Karen Plant, M.Clin.Psych.
Linda Jenner, R.N., B.H.Sc.
Joanne Barkla, M.B.B.S., F.R.A.N.Z.C.P.
John McGrath, Ph.D., F.R.A.N.Z.C.P.

To help improve services for par-


ents with psychotic disorders, pa-
tients with such disorders in three
B efore new services are developed
for families with a parent who has
a psychotic disorder, several key
chotic disorders who were in contact
with health services, and to assess the
amount of contact between parents
treatment agencies in Queens- questions need to be addressed. How and their offspring. Child care use
land, Australia, were surveyed many patients with psychotic disor- and barriers to gaining access to child
about whether they were parents, ders are parents? How much contact care services were explored.
how much contact they had with do those parents have with their chil-
their offspring, and who provided dren? What child care and family ser- Methods
assistance with child care. Of the vices have the parents used, and are During 1997 and 1998 participants
342 individuals with psychotic there barriers to gaining access to ex- were drawn from two community
disorders who participated in the isting services? mental health services and an extend-
study, 124 were parents. Forty- Few empirical studies have exam- ed-care psychiatric hospital in Queens-
eight parents in the study had ined these questions. In a recent land, Australia. Individuals with a
children under age 16, and 20 of study in which 50 mentally ill parents chart diagnosis of a psychotic disorder
these parents (42 percent) had with dependent children were inter- (schizophrenia, schizophreniform
their children living with them. viewed, it was found that offspring of psychosis, delusional disorder, bipolar
Most parents relied on relatives 25 percent of the families had been affective disorder, depression with
or friends for assistance with placed in institutions or foster care psychotic features, schizoaffective
child care. Barriers to child care and that 40 percent of the families disorder, or atypical psychosis) were
services identified by parents had never received professional help identified. The relevant institutional
were inability to pay, lack of local related to their children (1). In addi- ethics committees approved the
services, and fear of losing cus- tion, 33 percent of the parents ex- study, and all participants gave writ-
tody of children. (Psychiatric Ser- pressed a need for support that was ten informed consent. Further details
vices 50:1354–1356, 1999). not received, and many stated that of the sampling strategy and the
they did not know where to go for means used to confirm participants’
help or would not be comfortable ask- diagnoses are provided in a related
ing for help. Themes that emerged paper that compares the fertility and
The authors are affiliated with the from a qualitative study of parents fecundity of patients with psychotic
Queensland Centre for Schizophrenia Re- with mental illness included the diffi- disorders and their unaffected same-
search. Ms. Hearle is also a project offi- culties of dealing with general day-to- sex siblings (3).
cer in the mental health branch of day parenting and the fear of losing A structured questionnaire was
Queensland Health in Australia. Send contact with children (2). There is a used to obtain demographic data and
correspondence to Dr. McGrath at the
marked lack of data on the experi- information about the patient’s ill-
Queensland Centre for Schizophrenia Re-
ences and needs of fathers with men- ness, parental status, and child care
search, Wolston Park Hospital, Wacol,
Q4076, Australia (e-mail, jjm@brain. tal illness. arrangements. Participants were
wph.uq.edu.au). Parts of this paper were To help in service planning, this de- asked if they had any children or had
presented at the Winter Workshop on scriptive study aimed to identify the ever been a parent. For those who
Schizophrenia Research held February prevalence of parenthood in a repre- identified themselves as a parent, we
7–13, 1998, in Davos, Switzerland. sentative sample of patients with psy- used a semistructured questionnaire
1354 PSYCHIATRIC SERVICES ♦ October 1999 Vol. 50 No. 10
Table 1
Selected characteristics of parents and nonparents in a sample of 342 individuals with a psychotic disorder

Parents Nonparents
(N=124) (N=218)
Test
Characteristic N % N % statistic df p

Gender χ2=36.58 1 <.001


Male 59 48 173 79
Female 65 52 45 21
Age (mean±SD years) 50.9±13.5 40.9±12.9 t=6.76 340 <.001
Years of education (mean±SD) 9.8±2.1 10.4±1.7 t=–2.48 335 .01
Marital status χ2=181.74 2 <.001
Married 45 36 8 4
Divorced 58 47 14 6
Never married 21 17 196 90
Accommodations χ2=8.56 7 .29
Hostel 22 18 50 23
Boarding house 4 3 9 4
Group home 2 2 6 3
Hospital ward 25 20 56 26
House or apartment (owned) 28 23 35 16
House or apartment (rented) 22 18 34 16
Public housing 19 15 28 13
Other 2 2 0 —
Diagnosis1 χ2=7.48 1 .006
Affective psychosis 31 25 29 13
Nonaffective psychosis 93 75 189 87
Age at first psychiatric admission
(mean±SD years) 29.4±9.7 23.6±8.4 t=5.90 324 <.001
1 Affective psychoses included bipolar affective psychosis, mania with psychosis, depression with psychosis, and schizoaffective disorder. Nonaffective
psychoses included schizophrenia, schizophreniform psychosis, delusional disorder, and atypical psychosis.

to collect the relevant information. Twenty-seven fathers and 21 moth- pants, or 61 percent) described them-
The instrument is available from the ers had children under age 16, and selves as happy with the current level
authors. within this group, 20 parents (42 per- of contact, and ten participants (27
cent) had their children living with percent) said they preferred more
Results them. Among the 323 offspring, 75 contact. One participant preferred to
A total of 342 individuals with a psy- (23 percent) were under age 16. Thir- have less contact.
chotic disorder participated in the ty-four of these children resided with Of the 248 offspring over age 16,
study. Table 1 presents information the study participant, and 24 resided 145 lived independent of the study
about participants and comparisons with the other parent. In many cases, participant, 22 lived with the study
between parents and nonparents. A the children resided with the well participant, 17 lived with the other
total of 257 patients—182 men and parent after the parents separated. parent, ten resided with relatives oth-
75 women—met DSM-III-R criteria Four children lived with relatives oth- er than their parents, and six were in
for schizophrenia. Sixty patients—38 er than the patients’ partners or for- foster care or had been adopted. The
men and 22 women—had affective mer partners, and five children were whereabouts of 13 offspring were un-
psychoses, which included bipolar af- in permanent foster care or had been known, and data were missing for
fective psychosis, mania with psy- adopted. The whereabouts of three nine offspring. Twenty-six offspring
chosis, depression with psychosis, and children were unknown, and data had died.
schizoaffective disorder. The remain- were missing for five offspring. A total of 111 of the 124 parents
ing 25 patients had either a delusion- For children under age 16 who provided information about child
al disorder or atypical psychosis. were not residing with the study par- care. Of these, most parents who re-
Of the 342 participants, 124 (36 ticipant, data indicated that 11 chil- sponded to this question (N=97, or 87
percent) were parents who had a total dren were seen by the participant at percent) reported that they had relied
of 323 offspring. More than half of least weekly, 11 were seen at least on relatives for assistance. Twenty-
the women in the sample were moth- several times a year, and 16 had not seven parents (24 percent) relied on
ers (65, or 59 percent). Only a quarter been seen for more than year. The 28 friends. Other forms of child care re-
of the men were fathers (59, or 25 parents in this subgroup were asked ported included foster care (15 par-
percent). Eleven of the parents (9 about their overall level of satisfaction ents, or 14 percent), day care (three
percent) had a partner with a serious with the amount of contact with their parents, or 4 percent), family-based
mental illness. offspring. More than half (17 partici- child care (three parents, or 4 per-
PSYCHIATRIC SERVICES ♦ October 1999 Vol. 50 No. 10 1355
cent), and emergency respite care (six study reported past child care inter- tody of children—require consumer
parents, or 5 percent). Five children ventions that had been carried out education and practical demonstra-
(5 percent) had been permanently against their will, and nearly a third of tions that services will respect the
adopted. the parents stated that they were re- needs of parents with psychotic ill-
The child care assistance or inter- luctant to seek help with child care nesses.
ventions that parents reported using because they feared that their chil- Currently in Australia, there is a
were organized by a variety of agen- dren would be removed from them. lack of integration of the services re-
cies, including the state government The study provides insights into quired by families with a mentally ill
statutory child protection agency (19 patterns of child care use among par- parent. In many instances, the focus
parents, or 18 percent), mental health ents with a psychotic disorder. Clear- is on the adult and the mental health
clinics (14 parents, or 13 percent), ly, such parents often rely on the sup- problem or on the children and their
church groups (11 parents, or 10 per- port of family and friends. Providing needs for care and protection. Service
cent), psychiatric hospitals (nine par- timely and practical support to these philosophies that focus on the func-
ents, or 8 percent), general communi- individuals in the area of child care, as tioning and maintenance of the fami-
ty agencies (nine parents, or 8.3 per- well as supporting the parents, may ly unit are vital to maintaining intact
cent), legal aid services (six parents, serve to keep such support networks families and promoting positive out-
or 6 percent), maternity hospitals (six comes for both parents and children
parents, or 6 percent), family courts (4,6–9). ♦
(five parents, or 5 percent), and eth-
nic services (one parent, or 1 per- Acknowledgments
cent). Four parents (4 percent) en- Nearly This project was supported by a research
dorsed the “other” category for the and development grant from the Queens-
land Health Promotion Fund.
question about agency type. a third of
Thirteen parents (11 percent of the References
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policies and programs that address the
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for but not received help (13 parents, that a supportive social support net- sector. Hospital and Community Psychiatry
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Discussion and conclusions This study found that many parents Mothers with severe mental illness caring
for children. Journal of Nervous and Men-
The survey of 342 individuals with a with psychoses acknowledged that tal Disease 183:398–403, 1995
psychotic disorder found that more they needed support but were unable
8. Cohler BJ, Stott FM, Musick JS: Distressed
than a third (36 percent) were par- to find it for various reasons. To im- parents and their young children: interven-
ents. The lack of participants from prove outcomes for the current gen- tions for families at risk, in Parental Psychi-
the private sector and the absence of eration of parents with psychotic dis- atric Disorders: Distressed Parents and
Their Families. Edited by Göpfert M,
a control group limit interpretation of orders, it is hoped that service plan- Webster J, Seeman MV. Cambridge, Eng-
the results. However, it is noteworthy ners can address barriers such as lack land, Cambridge University Press, 1996
that of the 48 parents in the study of affordable local services. Other fac- 9. Seeman MV: The mother with schizophre-
with children under age 16, only 20 tors found in the study that impeded nia, ibid
had their children living with them. access to optimal child care—such as
In addition, 13 of the parents in the embarrassment or fear of losing cus-
1356 PSYCHIATRIC SERVICES ♦ October 1999 Vol. 50 No. 10