Parenthood and mental health: an intersection

Trust your instincts, observe patterns, and consult with healthcare professionals if you have concerns about your child's behaviour or emotional well-being.

Last month, a groundbreaking verdict in Michigan found Jennifer Crumbley, the mother of a 15-year-old mass shooter, guilty of involuntary manslaughter for her role in the deaths of four high school students. This decision marks a significant moment, suggesting potential implications for parental responsibility in such tragic events.

The incident in question, the deadliest school shooting in Michigan’s history, took place in north Detroit. In 2021, Ethan Crumbley, then 15, opened fire at Oxford High School, claiming the lives of four students and wounding seven individuals, including a teacher.

Photo: Mandi Wright/Detroit Free Press via AP, Pool

Jennifer Crumbley’s conviction is notable for being the first time a parent has been held criminally responsible for their child’s actions in a mass shooting. The case has sparked a broader conversation on accountability, especially focusing on the actions of Ethan’s parents.

The Journal consulted Malta’s Mental Health Association to shed light on how to develop more effective preventative measures, emphasising the importance of mental health support for both parents and children as a means of averting tragedies.

It’s crucial to clarify that our intention is to foster knowledge and understanding, and not to assign or in any way insinuate blame on parents and caregivers. Rather, our objective is to shed light on the nuances of mental health within family structures and its potential impact and devastating outcomes.

Reading the signs

Signs and symptoms of mental health issues in children and adolescents can vary depending on the condition and the individual. It’s important to note that experiencing one or more of these symptoms does not necessarily mean a child or adolescent has a mental health disorder, as some of these behaviours can be typical during certain developmental stages. However, if these symptoms persist or interfere significantly with daily functioning, it may be indicative of a mental health concern.

Signs of potential mental health concerns in children and adolescents include changes in mood or behaviour (such as sadness, irritability, or excessive worry), difficulty concentrating or poor school performance, changes in sleeping or eating habits, withdrawal from friends and activities, physical complaints without a clear medical cause, substance abuse, self-harm or suicidal thoughts, difficulty coping with stress, changes in energy levels, regression, aggressive or oppositional behaviour, and excessive perfectionism.

What is typical and what is not

Differentiating between typical developmental behaviours and potential mental health concerns in children involves comparing the typical behaviours with the current ones by considering factors such as the duration and persistence of the behaviour, its impact on functioning, developmental appropriateness, context and triggers, and patterns of behaviours.

The role of genetics

Genetic factors can predispose children to certain conditions, but environmental factors, such as family dynamics, upbringing, and exposure to stress or trauma, also play a crucial role. Positive environments can promote resilience, while adverse experiences can increase the risk of mental health issues. Understanding the interplay between genetics and environment is essential for promoting optimal mental health outcomes in children and adolescents, highlighting the importance of early intervention, supportive relationships, and creating healthy environments.

How to talk about it

When talking to your children about mental health, create a safe and supportive environment, initiate the conversation with openness, and normalise discussions around emotions. Active listening without judgment is key. Offer honest, age-appropriate information and share personal experiences if appropriate.

Reassurance, encouragement to seek help, and providing resources are important, along with ongoing support and follow-up conversations. By approaching these discussions with empathy and understanding, you can help their children feel supported and comfortable addressing their mental health.

What to do with suspicions of mental health issues in children

Trust your instincts, observe patterns, and consult with healthcare professionals if you have concerns about your child’s behaviour or emotional well-being. Early identification and intervention are important for addressing mental health issues and promoting overall well-being in children.

Consider seeking professional help for your child’s mental health if you observe persistent symptoms, sudden changes in behaviour, difficulty coping, impact on daily functioning, physical symptoms, social withdrawal, self- harm or suicidal thoughts, substance use, regression, or if they have a gut feeling that something is wrong.

Coping strategies that you can teach

You can teach your children effective coping strategies to manage stress, anxiety, or depression. These can include deep breathing, mindfulness, positive self-talk, physical activity, healthy lifestyle habits, creative outlets, social support, problem-solving skills, time management, and seeking professional help when needed. By teaching and modelling these strategies, you can empower their children to navigate difficult emotions and situations with resilience and confidence.

 Like parent, like child

The mental health of parents significantly affects the mental health and well-being of their children. Factors such as genetic predisposition, environmental influences, parenting practices, role modeling, attachment, stigma, and support all play a role. Children may inherit genetic risks and experience disruptions in family dynamics and emotional support when parents face mental health challenges. However, with appropriate support and intervention, children can develop resilience and coping skills to navigate these challenges effectively. Recognising and addressing parental mental health issues is crucial for promoting a healthier family environment and supporting children’s emotional development.

Take care of yourself too

To manage your own mental health while supporting your children, you should prioritise self-care, seek support when needed, set boundaries, and maintain healthy communication. They can practice stress management techniques, seek professional help if necessary, build supportive networks, and maintain healthy habits. Flexibility, mindfulness, and gratitude are also important for navigating parenting challenges while promoting overall well-being for both parents and children.

The types of help available 

Psychiatrists – medical doctors who specialise in the assessment, diagnosing and treating mental health disorders in children and adolescents.

Psychologists – trained in assessing and treating the mental, emotional, and behavioural issues of children and adolescents. They often provide therapy and counselling services to help children cope with challenges such as anxiety, depression, trauma, or behavioural disorders.

School counsellors – trained to provide support and guidance to students in school settings. They can help students navigate academic, social, and emotional challenges.

Family therapists – they assess family dynamics, communication, and relationships. They collaborate with families to develop tailored treatment plans, using a family systems perspective to address underlying issues. Family therapists facilitate communication, teach conflict resolution skills, and identify and change unhealthy patterns within the family. They also provide support, education, and coordination of care with other professionals involved in the child’s treatment. Ultimately, their goal is to promote healing within the family system to support the child’s mental health and well-being.

Social workers – they conduct assessments, provide crisis intervention, advocate for children’s rights, providing family support and education, refer to community resources, promote prevention and early intervention, and collaborate with multidisciplinary teams. Their focus is on addressing the social, emotional, and environmental needs of children and ensuring they have access to comprehensive care and support.

Occupational therapists – they assess functional abilities, set goals, and develop individualised intervention plans. They focus on skill development, sensory integration therapy, environmental modification, collaboration, education, and promotion of engagement and well-being. OTs work to improve the child’s independence, enhance participation in daily activities, and support overall well- being through a holistic approach tailored to the child’s needs and strengths.

Psychiatric nurses – they manage medications, implement therapeutic interventions, and offer crisis intervention when needed. Psychiatric nurses educate and support children and their families, collaborate with multidisciplinary teams, advocate for their needs, and ensure continuity of care.

Community resources for children and families

Perinatal mental health services – provides specialist care for women experiencing mental health problems within the first year post-partum. They also offer pre-conception counselling for women with mental illness.

Child and Young People’s Services (CYPS) at St Luke’s Hospital

Incredible Years –  An evidence-based program for School-Age BASIC Parent Training Programs (Ages 6-12 years) focuses on helping parents gain the skills to reduce challenging behaviours in children and increase their social emotional learning and self- control skills. The programmes have been found to be effective in strengthening parent management skills, improving children’s social emotional competence, emotion regulation, and school readiness, and reducing behaviour problems.

Cygnet – Cygnet is a group parenting support programme for parents and carers of children and young people aged 7-18 years with a diagnosis of autistic spectrum disorder. When a child receives a diagnosis of autism, their parents will often find it difficult to understand the condition and its impact on the child’s behaviour. As a result, parents are invited to seek help through this group to obtain a better understanding of autism and strategies to help them address these difficulties. The sessions last approximately 2.5 hours each and run on a weekly basis for five weeks.

Anger Management – The anger management group therapy is aimed at young people aged 8-18 years. The goal of the group is to equip children and adolescents with necessary skills to be able to better control their anger outbursts in different contexts. The professional carries out individual screening sessions with both child/adolescent and parents/caregivers. The parents/caregivers are invited to an information meeting in order to provide information regarding the programme and the skills used in order to further support the young person in controlling their anger. The group is commenced and weekly sessions are held for 7 weeks (1 hour per week).

CAPES (Child & Adolescent Psychiatric Emergency Services) is an emergency 24hr service 7 days a week at Mater Dei Hospital which offers assessments for young people aged 3 to 18 years presenting with acute mental disorders. This means that one’s mental state is severe enough to make the person feel that their life or the life of others may be at risk and therefore require immediate attention.

CHIT (Crisis Intervention and Home Treatment) teams is an assertive outreach team which offers an intensive intervention to young people who have either been recently discharged from in-patient care or else they have attended CAPES and require extra support to address their mental health needs within the community. This service’s intervention is offered for a maximum length of 4 weeks, after which the young person is referred to CYPS for follow up care.

Young People’s Unit (YPU) at Mount Carmel Hospital offers intensive treatment interventions for young people who are experiencing severe mental disorders with a risk to self or others. The YPU provides assessment and treatment for young people who have complex health, behavioural and emotional needs. This center offers a range of therapeutic educational, social and recreational facilities.

Access to these services is by referral from the child/young person’s doctor.

If you are going through a situation that requires guidance, please contact the Mental Health Association by emailing [email protected].

Main photo: cottonbro studio

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