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Whether you are a service provider, educator, caregiver, or family member, we have all seen how the mental illness of a child can impact the functioning of an entire family. Despite this powerful firsthand experience, we often find ourselves in situations where treatment focuses on the struggles of the young person without considering the whole family dynamic.
When I say “whole families,” I mean multiple siblings, caregivers, extended family members, and non-biological kin who live in one or many households, which are important to the general functioning of the unit. I fully acknowledge that every case is different and it is not always appropriate to include parents and other family members in a child’s treatment. However, after a decade of research and practice in psychology, it has been my experience that parents and family members are often not directly included when it would actually benefit treatment.
So, to acknowledge Mental Illness Awareness Week (#MIAW2018 #kidscantwait), I have prepared a short list highlighting the reasons why whole families should be included in child mental health treatment.
1. Young people are developing in a family context
All parents know that the most important environmental influences on children in the early years arise from the family. Many therapists (including folks like me who practice “family therapy”) would argue that these factors should be at the center of all treatment across the lifespan. That being said, it remains the case that the guiding frameworks for most mental health services have been individual-focused (e.g., psychology literally translates to the study of the soul, breath, or spirit). Despite the considerable expansion of models of care that include caregivers, it remains the case that these services have substantial wait times and are often hard to access. Moreover, there is a significant need to expand and study treatment services that include whole families.
2. Mental health problems are highly familial
The expansion of a scientific field called “behavioral genetics” in the 1970s and 1980s provided irrefutable scientific evidence for what people had observed for ages: Mental health symptoms run in families due to genetic influences. Fast forward a few decades, and molecular genetics is now providing further support for these claims at the DNA level (though there is still a ways to go until we understand how these forces work). Our understanding in this area continues to be refined, and now researchers are increasingly interested in how some people may be more susceptible (i.e., influenced by) the sorts of stressors that arise in the family that can trigger mental health symptoms.
3. Therapy is often just one hour a week
Therapists who work in outpatient settings typically see their clients for an hour a week at maximum. (A colleague of mine just reminded me that many publicly funded settings have less frequency, such as once every two or three weeks.). For weekly treatment, that leaves 167 other hours in which families coexist, cohabit, and co-influence. Obviously, it is the nature of these hours (not the single hour in session) that determines whether or not people get better. For kids, this means that the strategies and techniques they are learning in therapy must be regularly employed at home, which requires substantial caregiver support. That being said, caregivers may have their own mental health challenges, are working long hours to provide for their children, and face substantial stressors, themselves. A whole-family approach can help family units rally around a direction of change, where supports can be provided flexibly, when and where they are needed.
4. Even if caregivers are not involved, they are often responsible for services
Every child therapist has had examples of parents who want to drop their child off at treatment and do not see themselves as being actively involved. It’s not their fault and they are not being malicious. The primary view in society is that mental illness is an individual affair (see #1, above). Why would this differ for kids? Part of providing treatment to children and families is re-education (what therapists call “psychoeducation”) about how mental illness becomes embedded in our close relationships, including parent-child, sibling, intimate/marital, and whole-family relationships. At the end of the day, parents are often responsible for getting children to and from appointments and organizing fees. If parents are not on board, treatment suffers.
5. Whole-family services can influence many people with one intervention
My last point is that whole-family services are prudent. That is, multiple individuals can have their mental health needs addressed within a single clinician hour. In my home province of Ontario, Canada, children are often waiting over 18 months for services and adult services are not much better. As a result, emergency room visits for mental health crises have skyrocketed. While it’s obviously not the only solution to the mental health service problem, I propose that one element such an initiative will be the expansion of whole-family services in the form of family therapy for families of young children. Ideally, these services would be widely available and could be applied in a preventative fashion, in early life, in order to strengthen the developmental environments of children that promote health and wellness.
Now… off to find funding!
