Parents served by assertive community treatment: parenting needs, services, and attitudes.

Assertive Community Treatment (ACT) provides intensive, community-based treatment for individuals with severe mental illness (SMI) with a history of extensive use of mental health services and difficulties in independent living (Bond, Drake, Mueser, & Latimer, 2001). ACT has been shown to be effective in reducing hospitalizations, and increasing community functioning and overall quality of life (Bond et al., 2001; McGrew, Bond, Dietzen, & McKasson, 1995). Although ACT effectively addresses many areas of community living, the challenges associated with being a parent are not typically addressed within the ACT treatment model. Consequently, ACT research has tended to ignore parental status as an important variable. Though studies have investigated the impact of different variables (e.g., age, substance use) on outcomes, no study has explicitly examined the potential impact of parenting on treatment outcomes with ACT (Nicholson, Hinden, Biebel, Henry, & Katz-Leavy, 2007; Kortrijk, Mulder, Roosenschoon, & Wiersma, 2010). Studies show that a large percentage of people with SMI are parents, suggesting that numerous ACT consumers are likely parents. In fact, data from the National Comorbidity Survey indicates that parenting rates for the SMI population are similar to the general population, with 66.8% of women and 58% of men with severe affective disorders and 61.8% of women and 55.2% of men with psychotic disorders being parents, compared to 62.4% of females and 52.9% of males without a psychiatric disorder being parents (Nicholson, Biebel, Katz-Leavy, & Williams, 2004). Currently, the precise number of ACT consumers who are parents is unknown. The only study to assess prevalence identified 38% of ACT consumers as parents; however, the estimate was based on only four small ACT teams in Canada (Gewurtz, Krupa, Eastabrook, & Horgan, 2004). Because parenting tends to be overlooked as a critical area in the ACT model, ACT providers may be unaware of parental status of consumers and consumer needs in this area (Ackerson 2003; Gewurtz et al., 2004). This is problematic because parent consumers are a particularly vulnerable population and face many unique challenges and problems, tied to the dual demands of parenting and managing SMI (Ackerson 2003). For example, mothers with SMI are more likely to be divorced/separated, unemployed, and single mothers than mothers without mental illness and experience high levels of family strife, stigma, and victimization (Mowbray, Oyserman, Bybee, MacFarlane, & Rueda-Riedle, 2001; Nicholson, Sweeney, & Geller, 1998). Less than half of mothers with SMI receive child support or financial assistance from the other parent or a family member, and often raise their children below the poverty line (Mowbray et al., 2001). Moreover, mental illness symptoms and medication side effects sometimes impair abilities to support and care for children (Diaz-Caneja & Johnson, 2004; Nicholson et al., 1998) often resulting in children having to take care of the family during the parent’s acute episode(s) of SMI (Mechling, 2011). Loss of custody is another serious problem. Parents with SMI are about three times more likely than healthy parents to experience child protective services involvement and/or custody loss, with an estimated 60% to 80% of parents with SMI losing custody of at least one child (Diaz-Caneja & Johnson, 2004; Kundra & Alexander, 2009). Parents with SMI also report feeling tremendous self-blame, shame and guilt regarding symptoms and relapses, causing them to question their parenting abilities, hide their SMI diagnosis, and feel unfairly judged as bad parents (Ackerson 2003; Diaz-Caneja & Johnson, 2004). Although parents with SMI face difficult challenges, available treatment services do not adequately address these issues. When asked, parents express great interest in parent-related services, but report frustration with providers’ failure to recognize the impact that being a parent has on mental illness and recovery (Ackerson 2003; Boursnell 2007). They report wanting communication with providers about family issues and more emphasis on parenting in treatment planning and interventions (Diaz-Caneja & Johnson, 2004). This failure to incorporate parenthood into treatment services is a missed opportunity because parents with SMI highly value their role as parents (Gerwurtz et al. 2004; Oyserman, Bybee, Mowbray, & Kyoung Kahng, 2004). They describe parenthood as a chance to feel successful and efficacious in a valued social role and a source of purpose in life, self-esteem, and motivation to adhere to treatment (Oyserman et al., 2004). As noted above, ACT serves people with the most severe mental illnesses, many of whom are likely parents and in need of parent-related services and support. However, little information exists regarding the needs and experiences of parents served by ACT. Accordingly, the current study utilized structured interviews to examine the attitudes, thoughts, and experiences of parent consumers of ACT. Specific areas covered included the parenting role, custody, parenting needs, ACT parenting/family services, and suggestions for improved ACT services.