Children of parents with mental illness: parental disclosure, children’s illness beliefs and the development of a shared understanding of mental illness in the family.

xiii Chapter One: Broad literature review and location of the present thesis. 1 1.1 Clarification of terms which are used frequently within this thesis . 1 1.2 The existence of COPMI . 2 1.3 Prevalence estimates of parents with mental illness and their children . 3 1.4 Effect of mental illness on parenting . 5 1.4.1 What the research says about parenting with mental illness . 5 1.4.2 What parents say about parenting with mental illness. 8 1.5 Effect of parental mental illness on children . 8 1.5. 1 Detrimental effects . 9 1.5. 2 Detrimental effects for adult children of parents with mental illness . 12 1.6 Resilience in children of parents with mental illness . 13 1.6. 1 Fixed protective factors . 14 1.6. 2 Protective factors amenable to intervention . 16 1.7 The experience of being the child of a parent with mental illness . 18 1.8 Children’s lack of understanding of mental illness . 19 1.9 The importance of educating children about their parent’s mental illness . 21 1.10 Educating children about parental mental illness; what do parents think? 24 1.11 Gaps in the literature . 25 1.12 Research questions . 26 1.13 Overview of thesis . 26 Chapter Two: Methodology . 29 2.1 Ethics approval. 30 2.2 Participants. 31 2.3 Recruitment . 31 2.4 Procedure . 32 2.4.1 Recruitment procedure . 32 2.4.2 Interview location . 34 2.4.3 Engagement . 34 2.4.4 Interviews with children . 36 2.4.5 Length of interviews. 37 viii 2.5 Sample characteristics . 37 2.5. 1 Parent demographic details. 37 2.5. 2 Child demographic details . 45 2.6 Interview schedule . 47 2.6. 1 The use of semi-structured interviews. 47 2.6. 2 The theoretical framework guiding the interview questions and analysis . 49 2.6. 3 The specific questions asked within the present study . 52 2.7 Data analysis . 53 2.7. 1 Data collected for this thesis which is not included. 59 2.8 Ethical considerations . 60 2.9 Motivation behind the current research . 62 Chapter Three: Study one – Parents’ ideas about disclosing mental illness to their children . 63 3.1 Parental view of educating children about mental illness, what is known so far. 63 3.2 What we know about parental views on explaining other sensitive topics . 65 3.3 The need for research into parental view of explaining mental illness . 68 3.4 Aim . 69 3.5 Method . 69 3.6 Analysis and Discussion Part I: The process of disclosure from the parent perspective . 71 3.6. 1 At what age should illness be explained? 71 3.6. 2 Beliefs about whether children know about their parent’s illness. 74 3.6. 3 Beliefs about who told children about their parent’s illness . 74 3.6. 4 How parents talked to children about parental mental illness . 89 3.7 Analysis and Discussion Part II: Parent perspectives on non-disclosure. 108 3.7. 1 Reluctance to tell due to child . 109 3.7. 2 Reluctance to tell due to parent . 119 3.7. 3 Resources to help disclose . 129 3.8 Summary . 145 Chapter Four: Review – Children’s understanding of mental illness . 149 4.1 Children’s understanding of physical illness . 149 4.2 Differences between mental and physical illness . 150 4.3 The need for synthesis . 151 4.4 Aim . 152 4.5 Parameters of the literature included . 152 4.6 Review structure . 154 4.7 Review . 155 4.7. 1 Identity of mental illness. 156 4.7. 2 Cause of mental illness . 162 4.7. 3 Treatment and consequence of mental illness. 168 ix 4.7. 4 Timeline of mental illness . 172 4.7. 5 How do children acquire their information? 174 4