Written evidence submitted by Our Time (CYP0100)

Our Time is a charity formed in 2000, which supports the children of parents with a mental illness (COPMI) and their families through workshops, school programmes, training professionals, and advocacy.

Summary:

Reforming the UK mental health system towards early intervention and prevention approaches, and specifically recognising COPMI in mental health policy, would help mitigate the immediate challenges facing COPMI, reduce their risk of developing future mental health problems, and decrease the financial strain of costly ‘late’ intervention strategies to the public purse.

‘Late’ interventions and COPMI:

The mental health of children is closely related to the mental health of their parents. Parental mental illness can negatively impact all aspects of a child’s development, with COPMI facing a 70% chance of developing a preventable mental health issue themselves, and 40% requiring treatment by the age of 20[1]. Parental mental illness is associated with a higher risk of mental illness for their child across the spectrum of diagnosable disorders[2]. This is a widespread problem. In the UK, over 2.9 million children live with a parent with anxiety or depression alone[3]. Covid-19 has likely increased the prevalence of COPMI, with nearly 40% of the UK’s population reporting high anxiety in March 2020[4], an increase from 21% in 2019, and parents and carers reporting higher levels of stress and anxiety than population averages[5]. Contracting the virus or experiencing financial or psychological hardship associated with the pandemic, could exacerbate existing mental illness. The pandemic may also result in mental illness going unidentified and untreated[6].

Untreated childhood psychosocial adversity can lead to severe adult health outcomes. For example, childhood adversities have been associated with heightened risk of both physical and mental adult chronic conditions[7]. Adults who have experienced four or more Adverse Childhood Experiences (ACEs) (parental mental illness is often a root cause of many ACEs) are 37.5 times more likely to have attempted suicide than those who have experienced none[8]. 

There are significant costs to the healthcare system if this intergenerational cycle of ill health is not addressed early in life. Prior to the pandemic, £17 billion per year was spent in England and Wales by the state on ‘late’ intervention – equivalent to £287 per person[9]. Some of the largest costs relate to child and family adversity; the Children’s Commissioner’s Office estimate that the average public expenditure on mental health and well-being was around £24,000 per child receiving support in 2017[10]. These costs can reasonably be expected to have grown during the pandemic.

Early intervention and prevention approaches:

Early interventions can reduce the effects of adversity on children and adolescents[11], as well as their family. Our Time has found success in low-cost, community-based, multifamily interventions, known as ‘KidsTime Workshops’, which have continued remotely throughout the pandemic. These are for families where a parent has a mental illness and are non-treatment sessions, offering a fun protected space, where young people can express themselves, build their confidence and resilience, and learn about mental illness; while their parents have the opportunity to share experiences and discuss their role as parents, rather than patients, in an informal and intimate space. There are many testimonials which demonstrate the workshop’s efficacy[12]. One child constantly worried about her mother with a bipolar disorder when she was not by her side. After attending the workshops, she became “quite comfortable being away from Mum” and “is much more settled at school”, which has had a “hugely positive impact on her education” as well as improving their relationship[13].

Our Time also runs ‘Who Cares?’ schools programmes, which equip staff with simple but powerful skills to respond to the needs of COPMI, and create an environment where stigma is reduced and students who have an unwell parent are supported positively. It also provides practical help for affected children.

Best practice examples:

The UK should follow the positive examples set by countries such as Norway and Australia, which have produced early intervention policies targeted at supporting COPMI. In 2006, the Australian government introduced a new early intervention service called Headspace, which specifically identified the need for support and early intervention for target audiences with high needs, including children of parents with a mental illness[14]. Headspace grew from 10 centres to over 110 by 2018 and is now accessed by over 100,000 young people each year[15]. Independent evaluations have found it to be accessible to a range of people with high levels of psychological distress, including vulnerable groups[16]. Additionally, the Norwegian government established the ‘BarnsBeste’ network in 2007, which initially aimed solely to support children of patients with either mental illness or substance abuse, before being further expanded[17]. In 2010, a new provision (section10a) in Norway’s Health Personal Act obligated health personnel to identify and follow-up patients’ children[18]. Since its introduction, health professionals in Norway have reported high levels of knowledge and confidence in working with families and children, and there have been substantial increases in the recognition of children in parent’s health records.[19] Mental health services in California also screen children experiencing adverse life events[20].