LO: Discuss how living with a/ parents with mental illness affects Australian children’s occupational participation This is the outline of my presentation and there are three main parts: • The first part is Background and Issue description, Second is Background and Issue description and Lastly I will apply MOHO to explain Impact on the child’s occupational participation Before we start let’s • Think of yourself, what was your childhood like? Some may think of happiness, freedom, playful etc. However, there is a group of people in our society that their childhood feel confuse, fearful and lonely. And these are the common feeling of Children of a parent with mental illness Background • In Australia, One in five Australians is experiencing mental illness according to AIHW 2019. • and 41% of them are women compared with 28% of men (ABS, 2020) • Highest treatment rates were mood and affective disorders E.g., anxiety, depression and substance use disorders • All in all , mental illness causes ¼ the total disability burden (WHO, 2019) • This is also the Third leading cause of overall disease burden after cardiovascular diseases and cancer (AIHW, 2020) • Let’s zoom in to our population, With the high rate of mental illnesses occur in Australia, it can be deduced that children of parents with a mental is high as well •however, Not enough up-dated statistics >> This may also contain a sense that this population is sometimes ignored among our society. Still, the prevalence of this issue can be estimated by • First, ABS data (2007) showed that 23% of all Australian children lived in a family with a parental mental illness. • Second, Mental Health service-use data indicated that across Victoria, 20% of patients had an estimated 15, 000 children (AIHW, 2009) • Finally, a cross-sectional community study of NSW families found that 15% of children had a parent with a mental illness (Howe et al., 2009) • All these suggests that up to one in five young people live in families in which a parent has a mental illness (Reupert et al., 2013) • This high percentage shows that the issue should be coped with appropriately To unpack the issue, I will use of social model of health Individual lifestyle factors Unstable childhood and safety issues: Although not all the parents with mental health conditions can have direct negative outcomes to the child, Study have found that children living is such status may experience undernutrition and child neglect , which happens 1.2 time more than the mentally healthy mothers ( (Nguyen et al., 2013) 55% are being hit or mistreated (this is more likely if the parent substance abuse or has personality difficulties(Christie et al., 2019) disruptions in their relationship with their parents, especially the parents are suffering personality disorders This population is experiencing higher chance of family violence (45% compared to 17%) (NIFVS, 2018) The children may develop the same illness as some illnesses have higher tendency to be passed through genes, e.g., bipolar and schizophrenia. For example in this table shows that if both parents with the conditions and the chances are much more higher. Age and vulnerability Children at young age may not have the words to express how they feel, how they are treated, and may rely on behaviour to communicate >> harder to seek help from others (Children of parents with a mental illness [COPMI], 2020) The children may develop the same illness as some have higher tendency to be passed through genes, e.g., bipolar, schizophrenia (Cross-Disorder Group of the Psychiatric Genomics Consortium , 2017) Social and community networks- Midstream • Evidence suggests that higher prevalence of this population are exposed to the socioeconomic and sociocultural risk factors such as poverty (25% compared to 15%), inadequate housing, marginal social status, unsafe neighbourhood (from the graph you can notice that parent with poor mental health are more from lowest SES areas iDandenong and Frankston in Melbourne. • Social stigma and discrimination • Survey in Australia displayed that 72% of family where someone has mental illness may experience stigma that had discouraged them from socialising, making new friendships and performing activity with the community (Sane Australia, 2017) . • Other studies also highlighted that their child are stereotyped to have behavioural problems in their schools or among the neighbourhood Social and community networks- Midstream • Evidence suggests that higher prevalence of children of parent with mental illness are exposed to the socioeconomic and sociocultural risk factors such as poverty (25% compared to 15%), inadequate housing, marginal social status, Behavioural risk exposure (smoking, drinking and substance abuse) Substance use disorders co-occur at high prevalence with mental disorders, such as depression and bipolar disorder, (ADHD), psychotic illness etc (Conway et al., 2006) Parent are found to use illegal drug in their house with friends or relatives >> normalise the risky behaviour for the child and the child may feel unsafe or imitate these behaviours (AIHW, 2020) School education and quality Not any psychoeducation program or lessons targeted for children in Australia at the moment (Emerging Minds, 2020) Children do not understanding what is happening on their parents and feel guilt that that they are the cause for the illness (Emerging Minds, 2020) 3. Social stigma and discrimination • Survey in Australia displayed that 72% of these families may experience stigma that had discouraged them from socialising, making new friendships and performing activity with the community (Sane Australia, 2017) . • Other studies also highlighted that their child are stereotyped to have behavioural problems in their schools or among the neighbourhood • Children’s experience of stigma resulted in bullying, embarrassment, guilt and social isolation (Reupert et al., 2020) Upstream factors Inadequacy in the mental health services • approximately 75 per cent of Australian children with mental health concerns are not receiving support or treatment, which shows the picture of gap in Australian healthcare (AIHW, 2017) • Consideration of parental mental health status are not included in the clinical assessments of children >> which means it becomes harder to identify this population and their needs • Not enough intervention research and study regarding this population as I’ve mentaioned Education •Not any psychoeducation program or lessons targeted for children in Australia (Emerging Minds, 2020) Legislation, Policy and Act Although there is an Act to prevent disability individual from discrimination, the children population are not usually emphasised or being informed regarding discrimination issues Bullying Policy Although it provides some prevention guidelines to the school but there is no any compulsory action to prevent it happen. Moreover, bullying is illegal only it cause physical harm. Mental Health Act (2014) >> have not focused the role to cope with this population There is not enough policy and legal support, resources and facilities for Family inclusive practice and family therapy When integrating all the factors upon this population, we understand that they are usually living in an unsafe and non-protective manner, as well as without focused policy or Act to focus their right and allow them to seek help, therefore, it may affect their occupational participation and I will apply MOHO for further explanation. Volition: According to Erikson’s stage of psychosocial development (, children from 0 – 14 years old may value relationships with their parents, playing and learning as well as social participation. If these needs are not met and and in the graph you can see they may feel fearful, insecure, failure to build trust or self-identity Regarding Habituation: They may not form stable routine as their parent have sudden incidents like (e.g., going to hospital, self harm and suicidal attempt) (Christie et al., 2019) According to the Attachment theory: Insecure relationship with their parents may allow the child to feel unsafe about the world which turns them into survival mode instead of learning mode A children’s performance and skill development capacity are mainly dependent by their parent as a role model. Yet, Parents with mental illness may have disruption with communication with their child as well as they do not understand how to teach them appropriately, verbal abuse or child neglect may happen (Christie et al., 2019) . Environment: • I have talk that in the social model of health, Unsafe and unstable conditions, with socioeconomic disadvantage usually Combining the volition, habituation, performance and skill development, children of parent with mental illness may have issues in occupational participation such as productuy self care and leisure. First of all, Social stigma and insecure feeling to towards the world affect the child to participate in school. It may result in school disengagement as well as affecting the learning occupations (Dam et al., 2018) For self-care activity: Study shows that this popualtion become the caregivers for their parents and this role shift may result in lack of time to take care of themselves It may Interfere typical childhood behaviour or cause them to egrade themselves (Warren & Edwards 2017). Last;y, it has a huge impact on their Leisure and social participation • Play occupations are obstructed as they feel stressed about the world and may not want to explore interests • They may also have Difficulties in socialising with others because they have trust problem have not build up interpersonal skills since their childhood (Yamamoto & Keogh, 2018) • This figure conclude all the factors from downstream, midstream and upstream. as well as the occupational particaption problem like School disengagement, Shift their role of self-care to caregiver as well as Obstructions in play and socialisation In conclusion, Children of parent with mental illness may feel scared, worried and sad. They have difficulties in occupational participation and cannot meet their volitive requirement. Which can construct low self-esteem and cannot from a proper occupational identity. It is important to know that their parents are victims also and we should not blame them. 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