Treatment sometimes absent for children of mothers with mental illness

Children who have a mother diagnosed with a mental illness are at risk of psychiatric and behavioral problems, yet these children often fail to receive needed services, a new University of Michigan study indicates.

“These high-risk children do not necessarily get the services they may need to improve their lives, even though their parent is receiving treatment for mental health problems,” said Carol Mowbray, a U-M social work professor.

One factor might involve the mother’s mental health care provider, who neglects to ask if she is a parent, she said.

Mowbray served as lead author for the paper, “Children of mothers diagnosed with serious mental illness: Patterns and predictors of service use.” Published recently in the journal, Mental Health Services Research, the paper’s other a uthors were Lisa Lewandowski, a research associate at the U-M Institute for Social Research, Daphna Oyserman, a professor in the School of Social Work, and Deborah Bybee, an adjunct professor of psychology at Michigan State University.

The study was part of a National Institute of Mental Health-funded, longitudinal investigation and included mothers’ descriptions of their children’s problems, service use and predictors of service use. The study involved 506 children of 252 mothers diagnosed with serious mental illnesses such as schizophrenia, bipolar disorder or major depression.

Individuals were involved in the study over a five-year period. Mothers were recruited from 12 community mental health centers and from inpatient psychiatric units of three hospitals in southeastern Michigan. Women were between 18 and 55 years of age, had primary care responsibilities for at least one child aged 4 to16, and had a diagnosis of mental illness persisting for at least one year and causing functional limitations.

About two-thirds of children in the risk category do not receive services from school or mental health agencies in their lifetimes, Mowbray said. As with other children, their service use was predicted by demographic characteristics (being male, non-African American and older).

As might be expected, given their mothers’ serious mental illness, children’s service use was also predicted by maternal psychiatric variables, the researchers said. But even on top of these factors, the children’s social context played a significant role in getting mental health services.

"What is most surprising is that there continues to be a limited understanding of service use for high risk children," Lewandowski said. "Future research is needed to better clarify the processes that facilitate or inhibit service use for these children."

Future research should also answer questions about the causes for children to be in services and if mothers avoid these services, fearing custody loss or having a distrust of professionals. “In spite of decades of service provision, it is not yet clear to us as researchers and service providers what actually is being done when a service is provided and to what extent the service provided actually helps or is even relevant,” Oyserman said. Additional research must determine what happens to these high-risk children—those who receive mental health services and those who don't—during their adult lives, researchers said.

“While we know that these children are at risk, we also know that many adults whose parents have serious psychiatric disorders are resilient and successful. We should be investigating the keys to their success, not just the basis for pathology,” Mowbray said.