Barnardos' June 2014 conference on integrated supports for families experiencing difficulties with mental health bitly.com/1sq3EUu

1. The mental health of parentsThe mental health of parents
and their childrenand their children
– a GP perspective– a GP perspective
Professor Colin BradleyProfessor Colin Bradley
Professor of General PracticeProfessor of General Practice
University College CorkUniversity College Cork
for the Patients. Parents. People. conference, Barnardos, Croke Park, 19th
June 2014

2. Talk OutlineTalk Outline
• Psychological and social problems facedPsychological and social problems faced
by parentsby parents
• Medical responses to theseMedical responses to these
• PharmacologicalPharmacological
• Non pharmacologicalNon pharmacological
• Mental ill health in childrenMental ill health in children
• DiagnosisDiagnosis
• ManagementManagement
• Community based family supportsCommunity based family supports
• Inter agency workingInter agency working
• Confidentiality issuesConfidentiality issues

3. Psychological and social problemsPsychological and social problems
faced by parentsfaced by parents
• PovertyPoverty
• Educational disadvantageEducational disadvantage
• Lack of opportunityLack of opportunity
• UnemploymentUnemployment
• Unhealthy life-stylesUnhealthy life-styles
• AnxietyAnxiety
• DepressionDepression
• Substance misuseSubstance misuse
• Intra-familial violence and abuseIntra-familial violence and abuse

4. Impact on children ofImpact on children of
parental mental ill healthparental mental ill health
• Michael Rutter 1966 – Children of sickMichael Rutter 1966 – Children of sick
parentsparents
• Paul Ramchandani & Alan Stein 2003 –Paul Ramchandani & Alan Stein 2003 –
Impact of parental psychiatric disorder onImpact of parental psychiatric disorder on
children (BMJ)children (BMJ)
• SCIE (UK, 2009) Think child, think parent,SCIE (UK, 2009) Think child, think parent,
think familythink family
• Justine Horgan for NCAD (Ireland, 2011)Justine Horgan for NCAD (Ireland, 2011)
Parental Substance Misuse: Addressing itsParental Substance Misuse: Addressing its
Impact on ChildrenImpact on Children

5. ““Man hands on misery to man,Man hands on misery to man,
It deepens like a coastal shelfIt deepens like a coastal shelf
Get out as early as you can andGet out as early as you can and
Don’t have any kids yourself”Don’t have any kids yourself”
This Be The Verse, LarkinThis Be The Verse, Larkin

6. The Medical ResponseThe Medical Response
• The medical modelThe medical model
• History, examination,History, examination,
investigationinvestigation DiagnosisDiagnosis
• DiagnosisDiagnosis TreatmentTreatment
• TreatmentTreatment
• PharmacologicalPharmacological
• Non- pharmacologicalNon- pharmacological
• Very individually focussedVery individually focussed
• have you any children? – not usually askedhave you any children? – not usually asked

7. Pharmacological Treatments forPharmacological Treatments for
mental ill healthmental ill health
• BenzodiazepinesBenzodiazepines
• Non-benzodiazpine hypnotics (e.g.Non-benzodiazpine hypnotics (e.g.
Stilnoct®)Stilnoct®)
• Anti-depressantsAnti-depressants
• Selective serotonin reuptake inhibitors (e.g.Selective serotonin reuptake inhibitors (e.g.
Prozac®)Prozac®)
• Others e.g. TCAs, SNRI, MAOIs etc.Others e.g. TCAs, SNRI, MAOIs etc.
• Anti-convulsants e.g. Lyrica®Anti-convulsants e.g. Lyrica®
• Anti-psychotics e.g Seroquel®Anti-psychotics e.g Seroquel®

8. Non-pharmacologicalNon-pharmacological
treatmentstreatments
• Cognitive behaviour therapyCognitive behaviour therapy
• Skills based trainingSkills based training
• CounsellingCounselling
• Supportive psychotherapySupportive psychotherapy
• PsychoanalysisPsychoanalysis
• Stimulus controlStimulus control
• Sleep hygieneSleep hygiene
• ExerciseExercise
• Complementary treatmentsComplementary treatments
• relaxation techniquesrelaxation techniques
• physical manipulation techniquesphysical manipulation techniques

9. Problems withProblems with
non-pharmacological treatmentsnon-pharmacological treatments
• Require skilled personnel (who are inRequire skilled personnel (who are in
relatively short supply)relatively short supply)
• Require patient commitmentRequire patient commitment
• Time consumingTime consuming
• Slow to workSlow to work
• Expensive (seemingly)Expensive (seemingly)
• Not much good for social problemsNot much good for social problems

10. Problems withProblems with
pharmacological treatmentspharmacological treatments
• Require skilled personnel (i.e. doctorsRequire skilled personnel (i.e. doctors
but they are relatively available)but they are relatively available)
• Require patient commitment (but onlyRequire patient commitment (but only
to take the pills)to take the pills)
• Safer ones are slower to work &Safer ones are slower to work &
possibly less effectivepossibly less effective
• Safer ones are more expensive (but areSafer ones are more expensive (but are
still sometimes deemed affordable)still sometimes deemed affordable)
• Not much good for social problemsNot much good for social problems

11. More problems with pharmacologicalMore problems with pharmacological
treatments (esp benzo’s)treatments (esp benzo’s)
• DependenceDependence
• ToleranceTolerance
• WithdrawalWithdrawal
syndromesyndrome
• Drug-drugDrug-drug
interactionsinteractions
• esp. otheresp. other
psychotropicspsychotropics
• Cross dependence espCross dependence esp
with alcoholwith alcohol
• Street useStreet use
• criminalitycriminality
• Paradoxical effectsParadoxical effects
• DrowsinessDrowsiness
• Cognitive impairmentCognitive impairment
• AtaxiaAtaxia
• DizzinessDizziness
• Psychomotor retardationPsychomotor retardation
• Increased accidents/ fallsIncreased accidents/ falls
• ApathyApathy
• ConstipationConstipation

12. Mental ill health in childrenMental ill health in children
- diagnosis- diagnosis
• AnxietyAnxiety
• PhobiasPhobias
• Separation anxietySeparation anxiety
• ADHDADHD
• Developmental disordersDevelopmental disorders
• Autism spectrum disorderAutism spectrum disorder
• DepressionDepression
• Substance misuseSubstance misuse
• PsychosesPsychoses
• Behavioural problems – conduct disordersBehavioural problems – conduct disorders
• Eating disordersEating disorders

13. Mental ill health in childrenMental ill health in children
- management- management
• Non pharmacological treatmentsNon pharmacological treatments
• Pharmacological treatmentsPharmacological treatments
• Treatment in the child’s contextTreatment in the child’s context
• Home (“the child is a barometer of the home”)Home (“the child is a barometer of the home”)
• SchoolSchool
• Management of co-existing/ underpinningManagement of co-existing/ underpinning
parental mental ill healthparental mental ill health
• very, very tricky!!very, very tricky!!

14. Community based familyCommunity based family
supportsupport
• Tusla – Child and Family AgencyTusla – Child and Family Agency
• Family and Community SupportFamily and Community Support
•Family resource centres (107)Family resource centres (107)
•Psychology servicesPsychology services
•Early years servicesEarly years services
• Voluntary sectorVoluntary sector
• BarnardosBarnardos
• ISPCCISPCC
• Specific focus groups – COPE, AutismSpecific focus groups – COPE, Autism
Action, Down’s Syndrome IrelandAction, Down’s Syndrome Ireland

16. Inter-agency workingInter-agency working
• We all believe in it BUT we don’t always do itWe all believe in it BUT we don’t always do it
• Barriers for GPsBarriers for GPs
• Concerns re CONFIDENTIALITY – lack of trustConcerns re CONFIDENTIALITY – lack of trust
• Too many patients, too little timeToo many patients, too little time
• Too many agenciesToo many agencies
• Too many different people (who change all theToo many different people (who change all the
time)time)
• Meetings are difficult to attend (time, venue etc.)Meetings are difficult to attend (time, venue etc.)
• Meetings are not always fruitful (from ourMeetings are not always fruitful (from our
viewpoint)viewpoint)

17. Happy and unhappy familiesHappy and unhappy families
Happy families areHappy families are
all alike; eachall alike; each
unhappy family isunhappy family is
unhappy in its ownunhappy in its own
way.way.
Anna Karenina,Anna Karenina, Tolstoy