Supporting Families of Mentally Ill Children and Teens, Part 1

Principle Considerations for Clinicians

Expert Interview Working With Children and Families Lee Combrinck-Graham, MDParent-reported information from the 2011-12 National Survey of Children’s Health showed that one out of seven U.S. children aged two to eight years had a diagnosed mental, behavioral, or developmental disorder (MBDD).

Approximately one in five youth aged 13–18 (21.4%) experiences a severe mental disorder at some point during their life. Further, research has shown that half of cases of lifetime mental illness begin by the age of 14, with current studies suggesting that changes in neurology that lead to mental illness may start much earlier.

No parent is ready for this situation. No parents look at their newborn and think to themselves that they and their child are going to have to manage significant mental health challenges. When children do start showing symptoms, it’s not at all unusual for the parents to feel responsible.

“What did I do or not do?” is a common question when they begin to look for help.

Historically, mental health professionals have only exacerbated their distress. It’s not so long ago that parents were blamed for their children’s mental illness. In the 1940s, Leo Kanner (credited as one of the first to explore autism) suggested autism might be related to a “genuine lack of maternal warmth” and that fathers were often no better.

Although he modified his view somewhat in his later years, Kanner never fully repudiated his early thinking.

In 1944, Bruno Bettleheim stated that some children needed a “parentectomy.”  Bettleheim falsified his credentials for years. Nonetheless, the notion of schizophrenia being the consequence of parental dysfunction and emotional neglect became widely accepted.

Psychological treatment, therefore, included a great deal of exploration of the patients’ relationship with their parents.

Fortunately, research has discredited much of that thinking. Yes, it is undoubtedly true that abuse and/or neglect by parents is a potential cause for trauma and the later surfacing of psychological difficulties. But it has been found that the majority of children and teens with significant mental illness have parents who love them and who do their best to manage the impact of the illness on the whole family.

The parents, their mentally ill child, and the siblings of that ill child are usually caught in a painful and confusing loop as they respond to the consequences of the illness and to each other’s responses to it.

Family activities and routines are often disrupted. Planning or participating in social activities becomes extremely difficult. Leisure time gets taken up with appointments to doctors, counselors, schools and specialists. Friends and extended family members sometimes distance themselves, leaving the parents without important emotional support.

Often, the effort to find care for their child is frustrating and demoralizing. It’s not unusual for the resources a family does find to be beyond their financial means.

Such parents need information, support and treatment to weather the many challenges that go with a child’s mental illness. It is not sufficient to treat the child without actively providing parent care. As we talk with parents in distress because of their child’s illness and behavior, it’s important to remember these basic principles:

Basic Principles in Family Care

This list is intended as a friendly reminder to clinicians who are treating a mentally ill child or adolescent and their family. I’m sure it isn’t new information. But sometimes parents present so confidently that it is difficult to remember that they are often struggling mightily to cope.

Parents are grieving: They are grieving the child they imagined they would have and the shattering of their expectations for a “normal” family life while their kids are young. They are grieving for the future they thought they and their child would enjoy. Yes, most adapt to their reality. But it is often accompanied by a profound sense of loss. That grief can be expressed in any number of ways – from profound sadness to anger to numbness to false optimism. Often parents cycle through Elizabeth Kubler Ross’ stages of grief multiple times.

Parents are probably not to blame. It is likely that the mental illness is because of some combination of biology, medical issues, external traumatic events and, yes, perhaps the reactions of family and society to the child’s or teen’s behavior. Research shows that most parents do provide affectionate support, tolerance for disruptive (sometimes outrageous) behavior, and acceptance of the illness.

Parents often feel guilty: They may worry that they have passed along a gene that made their child mentally ill. They may feel guilty that they don’t know what to do. They may feel guilty that they feel angry with their child and resentful that they have to deal with the child’s needs. They feel guilty for all the times they have to ask their other children to understand when the parents have to focus on the ill child at the expense of siblings’ activities and events.

Parents are often embarrassed: The parents may be dealing with property damage in the neighborhood, at school, and in the larger world. Their child may act up in public. If the child engages in antisocial behavior as he or she moves into adolescence, the parents may withdraw from their neighbors and extended family because of shame. This reaction is particularly true if there is police and court involvement.

Many parents are frightened: If aggression and property destruction are symptoms of the child’s mental illness, the risk of harm to family members increases as the child becomes bigger and older. Many parents are reluctant to admit to themselves or to treaters that they are scared of their own child.

Parents are often bewildered and confused by the systems of care. Few parents are aware of their rights as they deal with agencies, hospitals, the legal system and the school system. Often they find themselves in unfamiliar territory that they may experience as unhelpful, even hostile, as they work to get services for their child.

Sometimes, the various experts they consult with give conflicting diagnoses and advice. They need patience and support as they work to sort out what they are told by various experts and what is in Service Plans  or Individual Education Plans (IEP) that are presented to them.

Parents are conflicted about letting go: All parents struggle with the tension between keeping kids safe and yet granting increasing independence. This tension only gets exacerbated when mental illness is part of the picture. Every usual milestone toward more autonomy is fraught with worry and what-ifs.

As mental health counselors, it falls on us not to forget parental pain and involvement when we are asked to treat a mentally distressed child or adolescent. Young people live in the context of their families. Providing the child’s parents with a place where they can safely work out their frustrations, fears and distress as well as get good practical information is often a key factor in healing everyone in the family.

Related articles:

Meeting the needs of special needs kids

Advocating for Your Child within the School System

Why Friends Disappear when Crisis Turns Chronic


Supporting Families of Mentally Ill Children and Teens, Part 1

Marie Hartwell-Walker, EdD

Marie Hartwell-Walker, Ed.D. is an author, licensed psychologist, and a marriage and family therapist who has been in practice for more than 35 years. She is a regular contributor to Psych Central and one of the therapists who answer questions at Ask the Therapist.


APA Reference
Hartwell-Walker, M. (2018). Supporting Families of Mentally Ill Children and Teens, Part 1. Psych Central. Retrieved on October 27, 2020, from


Scientifically Reviewed
Last updated: 25 May 2018
Last reviewed: By John M. Grohol, Psy.D. on 25 May 2018
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