Dalton Louise J, de Cassan Simone, Ilyas Athif, Dunn Abby, Rapa Elizabeth
Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom.
Oxford Health National Health Service (NHS) Foundation Trust, Oxford, United Kingdom.
Front Psychiatry. 2024 Oct 23;15:1463823. doi: 10.3389/fpsyt.2024.1463823. eCollection 2024.
Many parents with a mental illness report a desire for both recognition of their parental role and support for themselves and their children. However, parents are often fearful of negative judgements from professionals about their ability to be a parent, which inhibits raising concerns about their children with clinical teams. Consequently, an essential first step to supporting families is for professionals to proactively identify which patients are parents, although evidence indicates this is not consistently part of services. Professionals could play a pivotal role in guiding parents about how to talk to their children about their mental illness; this in turn can facilitate family functioning and enable children to access evidence-based interventions. This approach is crucial for mitigating the well-documented intergenerational risk of poorer outcomes and mental illness in children of affected parents. This study aimed to explore adult mental healthcare professionals' beliefs and experiences of talking with patients about: i) their role as parents ii) communication with their children about mental illness.
Semi-structured qualitative interviews were conducted with 19 adult mental healthcare professionals with 4-30 years' experience of working with adult patients under the care of NHS adult mental healthcare services in England. Audio recordings were transcribed verbatim and analysed using an inductive coding approach following the principles of thematic analysis.
All participants recognised their responsibility to identify patients' children through routine safeguarding protocols, but supporting patients around telling their children the diagnosis was less common. Many participants expressed concerns that raising the topic of children with patients could conflict with other parts of their professional role or would not be welcomed. Obstacles to these conversations were identified, across individual, environmental and organisational factors. Potential facilitators included specific staff training and resources for clinical teams and families around how to tell children about mental illness.
Adult mental healthcare professionals would benefit from enhanced training on the importance and methods of guiding parents to communicate with their children about mental illness. This should include routine identification of which patients are parents and recognition of the impact of an adult's mental illness on the wider family system.
许多患有精神疾病的父母表示，他们既希望自己的父母角色得到认可，也希望自己和孩子能得到支持。然而，父母往往担心专业人员对他们为人父母能力的负面评价，这使得他们不敢向临床团队表达对孩子的担忧。因此，支持家庭的关键第一步是专业人员主动识别哪些患者是父母，尽管有证据表明这并非服务中始终包含的内容。专业人员在指导父母如何与孩子谈论自己的精神疾病方面可以发挥关键作用；这反过来又可以促进家庭功能，并使孩子能够获得循证干预措施。这种方法对于减轻有充分记录的受影响父母的子女出现较差结果和精神疾病的代际风险至关重要。本研究旨在探讨成年精神卫生保健专业人员在与患者谈论以下方面的信念和经验：i）他们作为父母的角色；ii）与孩子谈论精神疾病的沟通情况。
对19名成年精神卫生保健专业人员进行了半结构化定性访谈，这些专业人员在英国国民健康服务体系（NHS）成人精神卫生保健服务机构的照护下，有4至30年与成年患者打交道的经验。对录音进行逐字转录，并按照主题分析原则采用归纳编码方法进行分析。
所有参与者都认识到他们有责任通过常规保障协议识别患者的子女，但在支持患者告知孩子诊断结果方面做得较少。许多参与者表示担心，与患者提及孩子的话题可能与他们专业角色的其他部分相冲突，或者不会受到欢迎。在个人、环境和组织因素方面都发现了这些谈话的障碍。潜在的促进因素包括针对临床团队和家庭的关于如何告知孩子精神疾病的特定员工培训和资源。
成年精神卫生保健专业人员将受益于关于指导父母与孩子谈论精神疾病的重要性和方法的强化培训。这应该包括常规识别哪些患者是父母，以及认识到成年人的精神疾病对更广泛家庭系统的影响。
