Putting Prevention into Practice

PREVENTING MENTAL HEALTH PROBLEMS IN FAMILIES AFFECTED BY PARENTAL DEPRESSION

Nick Kowalenko Deputy Chair, AICAFMHA Senior Lecturer University of Sydney Chair, Faculty of Child & Adolescent Psychiatry, RANZCP

Depression and Families

1 million Australian children live with a parent who has depression(estimate)

Mental illness: 2-4 times higher40-70 %

Social, developmental, educational and emotional difficulties (Beardslee, Solantaus, Morgan, Gladstone & Kowalenko, 2012)

Paternal and Maternal Depression (Fletcher et al 2011)

PPEI Concepts

Ottowa Charteroften via family members & people who work with children, parents and families

through key partnerships that can influence local change

facilitating broad participation in the planning, development, implementation & evaluation of strategies

including development of accessible, high quality resources & guidance for organisations

especially as it relates to identification of strengths, needs & support for families.

Developing personal skills and

knowledge

Developing locally supportive

environments

Supporting community action

Reorientation of services

Influencing the development of

public policy

Developing personal skills and knowledge

Developing locally supportive environments

Supporting community action

Inclusion of People recovering from mental illness

and those that care for them (including

young people) in the development of guidelines, information, and workforce development resources within the COPMI national initiative

Reorientation of Services: Sustainable systems change

Children of Parents with a Mental illness. Systems Change in Australia Report Owen Educational Consultancy http://www.copmi.net.au/images/pdf/Research/final-report.pdf

Developing Quality Resources

Family Focus: Prevention in Practice

COPMI national initiativeFunded by Department of Health and

Ageing in 2010-2012 to develop:DVD – for families where a parent has

depression or anxietyelearning resource – to train mental

health clinicians in a preventive family intervention

Family Focus Origins

Studies on risk/resilience in COPMIBeardslee ‘Family Talk’ interventionPilot version developed in USARCT: Lecture material Vs clinician

facilitated intervention (Beardslee, 2008)

Outcomes of Family Focus

Child Diminished internalising

symptoms Increased understanding of the

parent’s illness increased recognition and

treatment of children with depression. 6 7

Parent/s increased understanding of

mental illness improved understanding of their

children felt assisted with child and illness

related concerns improved outlook for the family's

future. 4 6 8

Family increased family

communication about parental mental illness

increased positive family interactions

improved family functioning increased family problem-

solving regarding experiences of parental depression. 6 9

Mental health professional increased satisfaction and job

motivation at work improved collaborative

relationships with local organisations. 2

Child/Parent Family/Professional

Keeping families and children in mind

Family Focus DVDChildren Observe

Build parent awareness that mental illness is a family experience

Children make senseCommunicate with children about

mental illness to help them make sense of what it happening

Children respondSupport parents to recognise that they

can influence this response (and future outcomes)

Family Focus DVD

Parent only sectionLived experience interviewsFictional storylines (promote key

messages)

Family Focus DVD

Children’s sectionParents can show

children (8-12 year olds)

Starting point for communication about parent depression or anxiety

Family Focus: e - learningSix modules1 Working with us

Working with familiesWhy focus on families?PreventionDeterminantsRisks &protective factorsYour practiceMental health promotion...etc

2 Building understanding

3 Dialogue with the child

4 Partnering with parents

5 Resilient families

6 Enabling the future

Family Focus intervention

The futureDissemination into routine practiceSkills training for primary, secondary &

tertiary workforceRights agenda & legal initiatives Younger age groupsCoordinate and support evaluation &

research initiativesGrowing consumer leadership Marketing strategies (especially to rural

areas)

The future (continued)Key partnerships

AOD Physical illnessChild protectionIncarceration

Collaborations Professional Academic Non government & governmentCare pathways Consumers

New COPMI website

do what it does without input

COPMI couldn’t

from so many people ...

Australian Government

Department of Health and

Ageing

Thank you ...

Useful resources

Resources for dads

Challenges Impact is difficult to assess Evidence base limitations Preventive health is poorly funded Mental health is poorly funded

relative to physical health Child and adolescent mental health is

poorly funded relative to adult mental health (WHO, 2003)

The futureDissemination into routine practiceSkills training for primary, secondary &

tertiary workforceRights agenda & legal initiatives Younger age groupsCoordinate and support evaluation &

research initiativesGrowing consumer leadership Marketing strategies (especially to rural

areas)