Proactive mental health care for children of parents with mental disorders called for
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A Queen’s University professor is the lead author of a new paper advocating for better mental health care for children of parents with severe mental illnesses.
Anne Duffy is a psychiatrist and professor in the university’s psychiatry department who has spent 25 years researching the genetic, biological, psychological and social factors involved with the link between children living with parents with mental illnesses such as depression, bipolar disorder and schizophrenia, and those children’s high risk for developing mental illness themselves.
Now, Duffy and her co-authors are using their latest published research, which points to decades of research data, to make recommendations on how to address what their paper describes as a “largely overlooked population” of children of parents with mental disorders who are “at high risk for reduced well-being and poor mental health.”
According to cited research, 55 per cent of youth whose parents suffer from a severe mental illness are at risk of developing a mental disorder before the age of 27, as well as facing “reduced well-being and increase psychosocial and academic problems.”
Duffy worked alongside scientists, clinicians and experts from 37 different countries to produce the paper, which was published on July 20 in the online journal Nature Mental Health.
“This is an international consortium of experts from complementary disciplines who got together, and we wrote this evidence-based review and call to action to advocate for proactive support and services for children at familial risk of severe mental illness,” Duffy told the Whig-Standard on Monday.
“One of the most robust risk factors for a mental disorder is having a family history, so having a parent with one of those disorders: major depression, bipolar disorder, schizophrenia,” Duffy said. “Currently, the way our system works is we take patients as individuals; we don’t base this on the family. If an adult comes in with schizophrenia, other than child-protection issues, we don’t ask routinely about the children and their mental health, and we don’t track them.”
Duffy said that currently in Canada and other places in the world, children would have to present as symptomatic themselves to access their own services.
“We’re sort of seeing this disconnect between the adult and the children services, and also, shouldn’t we be incorporating monitoring the mental health of these children at high risk as proactive prevention and health promotion, being mindful not to stigmatize or over-pathologize, because a lot of the kids are well?”
According to the paper, studies have been able to identify high-risk children of parents with severe mental illnesses who could benefit from proactive surveillance and early intervention efforts.
The many years of research that has led to Duffy and her co-authors’ paper has allowed them to formulate recommendations for policymakers, including Duffy’s 25-year-long Canadian Institutes of Health Research-funded study identified as Flourish, following children at risk of bipolar disorder due to having a parent with that disorder.
Duffy’s Canadian high-risk offspring bipolar study has worked to map biological and psychological risk factors and genetic determinants in the quest to understand the onset of bipolar disorder.
“It’s been a hugely successful study around the world,” Duffy said. “When I came to Queen’s, I was able to get a further grant, and we were able to improve individualized risk prediction looking at models of predicting for individuals based on their own family and personal history, what their risk wold be in the next one to five years. That wasn’t to scare anybody, but it was meant to empower families and patients, young people, so they can make good choices for themselves.”
Queen’s is launching a parallel research program for university students, looking at common mental disorders in post-secondary students.
That research and more has informed the recently published paper, as well as the recommendations that its authors are making to policymakers.
“We’ve reviewed the current evidence and we’ve distilled that into specific recommendations about a developmental approach,” Duffy said. “We advocated that the next steps would be through striking a working group, say through the (World Health Organization) or a similar organization, to organize a standard for supporting care for children at familial risk of severe mental illness. We’ve pretty much clarified from our perspective the next steps.”
The paper puts forward five recommendations, beginning with the creation of a task force of multidisciplinary experts, stakeholders and families on an international level to develop guidelines for supporting children’s well-being.
Further, the paper recommends that new training for psychiatrists and new mental health care pathways for children be developed, and then that academics, health-care providers, research communities, funding agencies and stakeholders be engaged to support both children and their parents through a number of initiatives and resources.
“If there was a recognized importance of asking about and tracking the mental health of children of these patients who are already identified in the adult psychiatric system, for example, that would be a really good starting place (and lead to) more collaborate work between adolescent and adult services in psychiatry (and) in community mental health,” Duffy said.
While faculty at universities like Queen’s have historically been well positioned to help inform the development of clinical practice, Duffy believes there is room for improvement.
“We certainly need to do more of that,” she said. “It’s getting the right people around the table. Hopefully, if this is an identified priority with those involved with planning out care, then hopefully they would invite us to the table. … We really do need to get back to the table. We’re currently not at the table, and I don’t know what’s happened. I think there was a different political philosophy in Ontario, and then there was COVID. We really need to have the experts around the table with the politicians in order to be pragmatic and translate the findings into evidence-based care, but also to show the cost-effectiveness of this to the taxpayer.”
Duffy said there are many things that can be done today to mitigate the risk for negative outcomes in young people.
“We’re negligent as a society if we continue to turn a blind eye to this,” she said.
After working with parents and their children for 25 years in her research, Duffy sees the need and the commitment to the issue on the part of families.
“What’s lacking is the commitment and willpower from the powers that be that organize care in this province and country,” she said.
“We arguably have the best data in the world … we’ve done really excellent work, like many Canadian research groups have, and sometimes these findings get more readily uptaken around the rest of the world than they do in Canada. I’m really passionate about this because I think we can make a difference in my own lifetime, and today, for young people.”
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