«I did something wrong, that's why mum is sad»

Mr Kupferschmid, children of mentally ill parents often blame themselves for their parents' illness. What counteracts the children's feelings of guilt?

Children have their own logic to explain their parents' illness. The classic idea is: I did something wrong, that's why mum is sad. With education about mental illness, children can move away from this idea. For pre-school children, it makes sense to use aids. In the book «Mummy's Monster» (see tips in the article «When Mummy is always sad»), for example, an emotional monster is to blame for Mummy's depression. It steals her feelings. In this way, children can free themselves from their feelings of guilt. But sometimes books also reach their limits. Then it can be helpful if parents and children create a shared metaphor. An alcoholic mother and her nine-year-old girl, for example, used the image of a fork in the road that leads out of the downward spiral. Both were able to hold on to it.

Who talks to the children in a meaningful way?

Depending on the situation, this may be the mother, a healthy family member or a specialist. Often a conversation with the doctor treating the sick parent helps the child to better understand the illness. However, the majority of parents want to talk to the child themselves. We offer group therapy where stressed parents can practise such conversations. The programme is available in Berne, Winterthur and soon also in Zurich. The stressed parents meet six times to share their experiences.

How can outsiders help if you realise that the child doesn't want to talk about the parent's illness?

The educational counselling service is a good point of contact. There are also groups for children of mentally distressed parents that offer the children space to talk about their family problems. However, the focus is on activities with peers, as children of mentally stressed parents are often isolated. Sponsorships that allow children to experience normal everyday life are also helpful. Compared to their friends from healthy parents, children of mentally disturbed parents often experience a different normality; for example, if a child's main carer suffers from psychosis, the child has experiences that other children do not have.

Children of mentally ill parents take on a lot of responsibility at home. How much of this can a child take?

Responsibility is a resource. However, too much of it can overwhelm a child. If they take on responsibility that is inappropriate for their age and development, this is known as parentification. For example, it is inappropriate for a 9-year-old child to be solely responsible for the entire household or for a 13-year-old child to take their father's medication. Overburdened children are unable to take the necessary developmental steps. In everyday clinical practice, we often observe the phenomenon of parentification in single or helpless parents, for example if they suffer from depression or addiction. There is also often a reversal of hierarchy: children and parents swap roles. Instead of taking responsibility away from the children completely, it can be helpful to transfer it to another area. For example, the child could take on a role in the sports club. This builds up strengths instead of minimising deficits.

How do I recognise that a child of mentally ill parents is under stress?

Children react in different ways: some become aggressive and wild, others quiet and introverted, others very well-adjusted. There are no universal characteristics. However, it is known that psychological stress on the part of the parent increases the likelihood of all psychological problems occurring in the children. Prevention is therefore very important. However, there is still a gap in our system: Health insurance pays for treatments. For prevention, on the other hand, foundations or the parents themselves often have to step in. Prevention not only benefits the child and the parents, but is also more cost-effective for the state in the long term.

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Read more:

• When mum is always sad. A story about children of mentally ill parents, what the illness does to them and why it is so important to involve them more in their parents' therapy.