«Many children are ashamed of their parents' mental illness»

Winterthur Social Paediatric Centre, first floor. Kurt Albermann's welcoming handshake is firm, his smile charming. With an inviting gesture, he leads the way into a meeting room and offers coffee. During the conversation, he bangs the table so hard several times that the drink threatens to spill out of the cup. «I'm a bit lively sometimes,» he then says and smiles.

Mr Albermann, in a study you call children who grow up with a mentally ill parent «forgotten children». Why?

Because these children often go unnoticed. They don't talk about how they are feeling and that their parents have a problem. So their needs are overlooked in the situation in which they live.

Isn't it rather the case that these children are often conspicuous in their behaviour?

Sometimes yes. But the connection that a parent has a mental illness is overlooked.

Can you name a case that shows the stress that children with a depressed mother or father suffer, for example?

I remember a fourteen-year-old girl with two younger siblings who contacted our counselling centre. She had been looking after her mother and siblings for as long as she could remember.

What did your day actually look like?

The day before, she had already thought about what to have for lunch tomorrow and did the shopping. Her parents were divorced. At times, her mother could hardly get out of bed because she was so tired. That's why the girl woke up her younger siblings in the morning, helped them get dressed and made breakfast and snack. She barely made it to class because she still had to take her sister to nursery and her brother to the neighbours.

And what awaited the teenager after school?

At best, a «functioning» mother. But there were also times when the daughter had to call the paramedics because her mother refused to be woken up. There were packets of tablets on the bedside table. The constant insecurity and worry about her mother changed the hierarchy at home. The fourteen-year-old took on the role of the adult. She had to put her own needs aside from an early age. She was often sad herself. And angry.

With what consequences?

She hardly had any mates and was ashamed to bring anyone home. She was ostracised in class because she never had time and was sometimes weird. She didn't go to sport either. Nobody knew about her mum's problems, she would have been embarrassed to talk about them. She did well at school, although she often felt incredibly tired.

«I assume that up to 300,000 children are affected in Switzerland.»

Kurt Albermann, child psychiatrist

It is estimated that 20,000 to 50,000 children in Switzerland live with a mentally ill parent. Where does this figure come from?

It comes from a survey that we conducted in Winterthur ten years ago together with the University of Applied Sciences for Social Work and the Integrated Psychiatry Winterthur - Zürcher Unterland ipw. Personally, I think these figures are rather conservative. In Germany, it is estimated that a good three million children and adolescents are affected. Extrapolated to Switzerland, that would be around 300,000.

How does a mental disorder of the father or mother affect the health of the children?

Around a third also fall ill, a third have mental health problems from time to time and a third manage to stay healthy.

«Every third child of parents with mental disorders also falls ill.»

Kurt Albermann

So parental psychological stress is a risk factor for also falling ill?

Yes, with some illnesses more than others - and it is not possible to predict whether a child will actually fall ill. But the risk of developing depression, for example, is up to seven times higher if you have a depressive parent.

This means that profound or chronic stress experiences of the parents can be «passed on» to the next generation.

This is possible and is partly due to so-called epigenetic influences: Our cells change when we are under chronic stress. This stored information can be passed on to subsequent generations at a cellular level.

Without the parents concerned being able to do anything about it?

There are also factors that maintain health. If the mother is able to recognise the child's needs and respond to them in an age-appropriate manner despite mental illness, the risk of the child becoming ill is much lower than if they are neglected.

What disruptions are you most frequently confronted with in your day-to-day work?

For mothers it is depressive disorders, for fathers addictions. Often it is also anxiety or traumatic stress disorders, for example after a divorce. This is doubly difficult for children, as they themselves also suffer from the separation.

Do children of mentally ill parents often contact care centres themselves?

No. Depending on the illness and situation, a child grows up in such a «crazy», i.e. changed environment and knows nothing else. It is age-dependent and rather the exception that a child recognises that the father or mother has a problem.

Nevertheless, does such a child suffer from the behaviour of the sick parent?

Yes, children are ashamed or even feel guilty about their mother's or father's behaviour. So they don't talk about the fact that it is a burden for them if, for example, their mum is in bed for days on end. Mental illness is a taboo in our society, which is why parents often forbid their children to talk about it.

Also because you fear that your children will be taken away from you?

If a parent is mentally distressed, the child is not automatically taken away from them. There are many support options at home or facilities where children are only placed for a certain period of time. Here in Winterthur, Christine Gäumann and I have initiated such services with partner organisations under the name wikip: SOS childcare, foster families or parent groups. There are similar programmes elsewhere. During a counselling session, we look together at what support is needed.

«Young children perceive their parents' behaviour as normal - there are no comparisons.»

Kurt Albermann

Do children even understand what's going on with mum or dad?

Young children often perceive this behaviour as normal - after all, they have nothing to compare it to. But by the time they start nursery school at the latest, they realise that things are different in other families. Then the pressure of suffering increases. You can't take mates home with you like the others. Because the schizophrenic father has boarded up all the windows. Or because the mother has an obsessive-compulsive disorder and is afraid of other people's dirt.

But there is another parent...

The mothers affected are often single parents. If there is another parent present to support the children, they can compensate for the burden. Incidentally, it also happens from time to time that children do not perceive the illness of the parent as such an extreme burden, but actually find it a good thing at certain times.

Excuse me?

A colleague of mine wrote a book about his childhood with a father with bipolar disorder, whose mood and behaviour fluctuated uncontrollably between manic and depressive phases. He thought it was great at times as a child. In good phases, he had the best father ever, who took his son on outings and showered him with gifts. In depressive phases, he would lie in bed and drink and his son would simply stay away from his father.

It sounds like having a mentally ill parent is sometimes not so bad?

Of course, this is not true. Dangerous situations occur time and again, especially with bipolar disorders. In a manic phase, you speed down the motorway at 200 km/h with your child in the next seat. Or you go completely into debt because you bought your child a horse.

Are you talking about cases from your own practice?

Not mine, but a colleague had a patient who suddenly turned up with a horse and «deposited» it on the porch. Such anecdotes are funny to tell, but in everyday life they are not funny for the families.

«Reporting to the KESB is tricky. But we also have a duty to look after each other.»

Kurt Albermann, Medical Director of the Institut Kinderseele Schweiz

For example, what should I do as a neighbour if I have the feeling that children with a mentally ill mother are living next door?

First speak to the person concerned. If I'm still very worried after a conversation, I can file a risk report with the KESB. That's tricky and an invasion of privacy. But we live in a community and have a duty to look out for each other.

If a mother like this receives psychiatric treatment, what happens to the children?

I am committed to ensuring that parents automatically receive competent and professional counselling and support in such cases, which unfortunately is far from being the case everywhere. It is important to make an emergency plan: What should the child do if the mother collapses? Who can they turn to?

As a parent, this requires you to talk to your children about your own mental disorder.

That is extremely important. As an adult, you have to have the courage to admit to the children that you are not feeling well at the moment. You should ask how the children are feeling and answer their questions. This works best in a counselling environment, for example together with a psychologist.

Should a mental illness be communicated in the children's environment - school, parents, friends?

In principle, this does not have to be the case. If it is important for understanding, for example because the child cannot concentrate at school, you can also say in a conversation with the teacher that you are currently in a difficult situation without going into the specific diagnosis. However, if there is a relationship of trust, open communication can also be helpful and contribute to understanding.

What happens if the parent concerned is unable to care for their children?

An attempt is then made to find a joint solution. If he or she does not agree, a risk report is made to the KESB in an emergency. It has the task of looking into the current stress and support options.

«It's important that children know that they are not to blame for their mum or dad's behaviour.»

Dr Kurt Albermann

If withdrawal occurs - how do you explain this to a child?

With younger children, we like to do this with picture books. For example, there is one about a fox family. Whenever Father Fox wears his green coat, he's funny. Then he can't look after his children. But he's still the dad. Of course, you can explain things differently to young people. It is important that the children know that they are not to blame for the behaviour or illness of mummy or daddy.

But there are also mentally ill parents who actually endanger their children...

Yes, I have seen children who were literally slammed against the wall by their severely overburdened mother. Or a boy whose mother slashed his wrists during a severe schizophrenic episode. There's no time to waste, the children must be taken away from their parents immediately. Later, you can analyse the situation and see how the relationship can continue.

With respect - but a mother who slits her son's wrists must never see him again...

The case happened ten years ago. The mother's psychiatrists said that she needed contact with her son in order to get better. The boy was afraid that he would not survive a reunion with his mother! This shows that even specialists are often overwhelmed. I know a mentally ill father who threw his young children out of the window in an extreme situation. The man was in therapy, continues to take medication and today has a cordial relationship with his children.

Is it possible to lead a normal family life as an affected family?

If we assume that one in two people will suffer from a mental illness at some point in their lives and that around one in ten will have a mental disorder, it must be possible.

«Family life can also be more harmonious than before the illness.»

Kurt Albermann, child psychiatrist

What does family life look like after an illness and therapy?

This depends on the illness and the possible consequences. Parents are often plagued by feelings of guilt. This is understandable, but not very helpful. If the family succeeds in understanding the history of the illness and adapting the framework conditions - providing sufficient relief and the necessary support - family life can be more harmonious than before the illness.

Read more:

• Mamis Schatten auf der Seele: Das Porträt einer starken Jugendlichen, die die psychische Krankheit und den Selbstmord ihrer Mutter überstanden hat.
• Wenn Mami immer traurig ist: Eine Reportage über eine Familie, in der die Mutter an Depressionen leidet