Camden MALT

THE KIDSTIME WORKSHOPS

A MULTI-FAMILY SOCIAL INTERVENTION

FOR THE EFFECTS OF PARENTAL MENTAL ILLNESS

MANUAL

ALAN COOKLINPETER BISHOPDENI FRANCIS

LEONARD FAGINEIA ASEN

ISBN 978-0-9553956-9-7 ©2012 CAMHS Publications

Child and Adolescent Mental Health Services (CAMHS)Evidence-Based Practice Unit

UCL and Anna Freud Centre12 Meresfield Gardens

London NW3 5SU

EBPU@annafreud.orgDesign: Slavi Savic, CAMHS Press at EBPU

Print: Captiv8 UK Ltd

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KIDS TIMEThe authors wish to extend sincere thanks to the rest of their team:

Ros Barthelmy, Sabbi Jones, and Gwyn Daniel, who have been key in developing the workshops and making them work.

We are most grateful to the City Bridge Trust for funding the evaluation of the Kidstime programme and production of a training package for national dissemination.

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CONTENTS

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KIDS TIMEINTRODUCTION 11History And Summary Of The Kidstime Workshops 14CONCEPTUAL AND THEORETICAL UNDERPINNINGS OF THE KIDSTIME WORKSHOPS 17Bringing Children And Parents Together Around The Topic Of Mental Illness 19A Social And Educational Event For Parents And Children – Separately And Together, Rather Than A ‘Therapy’ 19The Principle Of Multi-Family Group Work 20

The Parents’ group 21The children’s and young people’s groups 23

Providing Opportunities For Developing RelationshipsAcross Families 24A Focus On Explanation 24SETTING UP AND GETTING STARTED 27Resource Requirements 29Staffing Requirements 29Referral And Selection 30Timetabling 31The Professional Network And Referrers 32GENERAL APPROACH 35Key Components Of The Role Of The Family Worker 37DETAILED ELEMENTS OF THE KIDSTIME WORKSHOPS 39Introductory Set Of Whole Group Activities 41Informal Social Encounter (15 minutes)- New families - ‘Welcome Briefing’ 41Informal Social Encounter (15 minutes)- Previous Attendees - ‘Welcome Back‘ 42Seminar/ Discussion Session For The Whole Group (15-30 minutes) 42‘Learning About Mental Illness’ 42Engagement/Introduction Part (5-15 minutes) 43Seminar Part (10 - 25 minutes) 44

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Separated Concurrent Groups (Approximately 1 Hour) 45Parents’ Group: (Referred To As PG) 45

General guidelines: 45PG1 - ‘Getting to know you’ 46PG2 - ‘Digesting the seminar’ 47PG3 - ‘Daily living reviews‘ 48PG4 - ‘Invitation to problem-solve’ 49PG5 - ‘Problem-solving for a family ‘ 49PG 6 - ‘Looking and planning ahead ‘ 50

Children’s And Young Persons’ Group (Referred To As C&YPG): 51

General guidance 51C & YPG 1- ‘Hello games and create stories’ 51C & YPG 2- ‘Warm-up and dramatise learning’ 53C & YPG 3- ‘Creating the dramas’ 53C & YPG 4 - ‘Filming the dramas’ 54

Closing Set Of Whole Group Activities 55Serving Of Pizza And Refreshments For The Whole Group (10-15 minutes) 55

Final discussion 57REFERENCES 61APPENDIX I 65Why Is Mental Illness Difficult? 66What Is Mental Illness? 66How Do People With A Mental Illness Feel? 66How Does This Happen? 67Will I Inherit Mental Illness From My Relative? 68Will I Get Mentally Ill From Doing Drugs? 68Who Can I Go To If I Am Worried About My Relative’s Mental Health? 68

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KIDS TIMEAPPENDIX 1A 69The Brain and Spinal Chord 70APPENDIX 2 711. Games, Games And More Games 72

Kidstime 72Gita, Gita, Gita 72Sign Names 72

2. Frozen Image Work 723. Thought-tracking 734. Creating Stories from Frozen Image Work 735. Improvisation 736. Building A Character 737. Hot-seating 748. Creating A Character As A Group 749. Talking Heads 7410. Forum Theatre 74Extra 74

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INTRODUCTION

THE NEEDS OF CHILDREN OF PARENTS WITH MENTAL ILLNESS

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KIDS TIMEThis manual describes the theory and practice of the ‘Kidstime’ approach to helping the children of parents with mental illness. The approach has developed over the past 12 years (Cooklin 2004, 2005, 2006, 2010).

The goals of these projects have been:

1. To help the children and young people gain under-standable explanations of their parents’ mental illness, and the behaviour in the parent which may be associated with this

2. To address the children’s various fears, confusion, and lack of knowledge about mental illness and its treatment

3. To help the parents who suffer from mental illness find a medium within which the illness and its impact can be discussed between themselves and their children

4. To help the parents access or rediscover their pride, confidence and competencies as parents

5. To help the children experience their parents responding in a more positive manner

6. To encourage the children and young people to feel freer to engage in pleasurable age-appropriate activities.

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Aldridge & Becker (2003) have estimated that there are 175,000 children and young people in England and Wales currently designated as young carers. Other studies have suggested that the ratio of physical to mental illness is commonly 3:1, indicating that 55,000 - 60,000 children are likely to be caring for parents with mental illness. However, Aldridge & Becker have also extrapolated from other studies to suggest that the numbers of children throughout the United Kingdom currently affected by parental illness (and often not designated as young carers) is closer to 3 million (or 1 million for parental mental illness). Parrott (2008) has estimated that as many as 2 million children live in a household where at least one parent has a mental health problem.

However, aggregated inner city studies suggest that in large cities the proportion of young carers of parents with mental rather than physical illness - or at least those children significantly affected by parental mental illness - is likely to be much higher. Several local audits from within central London mental health services suggest that there is consistent under-reporting of even the numbers of children in contact with parents with mental illness.

In the USA the National Co-morbidity Survey (Nicholson et al 1998, 1999) showed that 68% of women with mental health disorders are parents, compared with 57% of men. Similar figures are reported in the UK (Richman, 1976, Brown & Harris, 1978, Oates, 1997), and in Australia (McGrath et al 1999). Aggregated data suggest that having one parent with a mental illness gives a child a 70% chance of developing at least minor adjustment problems by adolescence. With two ill parents there is a 30 - 50% chance of becoming seriously mentally ill (Rubovits, 1996). A child with an affectively ill parent has a 40% chance of developing affective disorder by age 20, compared to 20-25% risk in the general population (Beardslee 1983).

However, Dunn (1993) found much higher levels of abuse and neglect, as well as isolation, reported retrospectively by adults who had experienced a mentally ill parent as a child. This more candid reporting from adults of abusive experiences, which as children they may have feared disclosing, suggests that there may be significant underreporting of abuse by children of parents with mental illness, even among those – relatively few – who have so far been given an opportunity to talk about their experiences.

These figures might seem too daunting to discuss with children and young people, if it were not that other studies have suggested that the future of risk of mental illness in the child is not irrevocable, and that there is much which can be done to increase the resilience of children and young people in relation to the effects of parental mental illness. This in turn is likely to lower their risk of future mental health problems. These actions range from the ‘ultimate’ interventions researched by the Finnish Adoption study (Tienari 1985, 1994, 2004), through the many reports of the positive benefits of a neutral, caring adult helping the child to appraise their situation more objectively (Schachnow, 1987., Rutter and Quinton 1984., Rutter 1987, 1990., Cowling 1999) to the positive effects on the child’s mental health of the minimal intervention of proper explanation of the parent’s illness by Falcov (1999, 2004).

Most statutory and voluntary approaches to the support of children who have been designated as young carers, or identified as being affected by parental mental illness, have focused on the individual child in one or more of the following ways:

1. Providing groups of children with similar experiences with the goal of diminishing social isolation

2. Providing pleasurable and diversionary activities

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3. Providing opportunities for children and young people to talk and safely express worries and anxieties

4. Providing counselling for the individual children and/or their families.

Whilst this approach may be very appropriate for those children who are predominantly caring for their parent’s physical needs, for children who are either caring for, or are affected by, parental mental illness (including parental substance misuse) there are additional and specific needs. These children and young people have particularly reported a need for an adequate explanation of their parent’s illness. Such explanations have not usually been adequately provided, and discussion of the nature of the parent’s illness within the family may have often been experienced by the child as either taboo or patronising and without substance.

Audits of the needs prioritised by groups of children and young people in the United Kingdom, Scandinavia, and Australia have consistently been reported as:

1. A ‘two-way’ explanation of the parent’s illness which provides clear, understandable, but substantive information, whilst heeding and taking account of the child’s own knowledge about the parent’s condition.

2. Access to a neutral adult with whom the child can discuss the illness, who can be contacted in times of crisis, and who can act as the child’s advocate.

3. An opportunity for the child to address his or her fears: that he or she will ‘catch’ the illness, that he or she ‘caused’ the illness, that the parent may die from the illness and/or that he or she will not see the parent again.

4. Interventions to diminish the child’s social isolation: learning that he or she is not ‘the only one’ with the problem, meeting other young people with similar experiences.

5. Rebalancing the child’s ‘inverted’ role as carer within the family: opportunities to do childish or youthful activities with other young people, sharing the load of responsibility with one or more adults.

In addition, the children and the parents may need specific help in how to manage their relationships, which may have been significantly distorted by parental mental illness. This is of particular importance for these particular children, because there is now good evidence that attempts to help a child, without positively influencing the child’s emotional environment, often fail. In turn, the children’s responses can also have a significant positive or negative influence on the parent’s mental state.

History And Summary Of The Kidstime Workshops

The manual for the ‘Kidstime’ social intervention has been based on the experiences and evaluation of three projects in central London, UK, in all over some 12 years.

The workshops originated in 1999, partly as a result of the experiences of similar workshops for adults and their relatives, over the previous 10 years (Bishop et al., 2002). Bishop had noted that nearly all interventions for the families of patients with mental illness were exclusively concerned with the adults, and that the most vulnerable members of the family – the children – were largely ignored. The workshops were originally called ‘What Shall We Tell the Children?’ workshops, as an expression of the discomfort which many parents felt about the task of trying to explain their mental illness to their children. The workshops were later renamed Kidstime – a suggestion from some of the child participants – as a recognition of the primacy of the needs of the children to be addressed in the workshops. As the workshops developed both the children and the parents participated in the production of one training film (Being Seen and Heard: The needs of children of parents with mental illness, Cooklin 2004) and the children participated in an ’explanatory’ short internet film (Cooklin and Njoku, 2009).

The Kidstime Workshops are monthly events for children and young people who have parents with mental illnesses – together with their parents. The workshops are run by a combination of mental health and social care practitioners, a drama practitioner and voluntary workers ( all from here on described as family workers – and defined below) and last 2.5 hours after school. They begin with a short seminar for the children and parents together, in which some aspect of mental illness, or questions about it, are discussed or demonstrated. This is followed by separate groups for the children and for the parents. The children’s group starts with games and warm-up exercises, then the children tell stories about family life, perhaps prompted by the seminar. They are helped to dramatise these stories and the resulting plays are filmed. The parents and children then gather as a single group to eat pizza and watch the filmed plays. Finally, there is a group discussion of what the children have produced as well as of issues raised in the parents’ group.

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Outreach work for individual families can be made available by the projects, particularly in response to matters which have been elicited during a particular workshop, but in the experience of the authors families tend to make only very sparing demands for this facility.

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CONCEPTUAL AND THEORETICAL UNDERPINNINGS OF THE KIDSTIME

WORKSHOPS

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KIDS TIMEWithin their monthly programme the Kidstime workshops incorporate a number of elements.

i. The context brings children and parents together around the topic of mental illness, rather than professionals engaging with them separately, as has tended to have been their previous experience. In this joint context, the mutual influences of parental mental illness on children, and children’s responses on parents, can begin to be discussed and addressed.

ii. The intervention is not designated as a ‘therapy’ but as a social and educational event for parents and children – both together and in separate groups.

iii. As the workshops include both joint groups of parents and children, as well as separate groups for each, elements of both Multi-Family work and Group work are utilised.

iv. Opportunities for relationships across families – both between children or adults of one family to the same age group in another, as well as cross generational inter-family relationships – are utilised.

v. There is a strong focus on explanation of parental mental illness.

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Bringing Children And Parents Together Around The Topic Of Mental Illness

Resilience studies have demonstrated that children can adapt with much less harm to a range of stressful situations, if they can feel less isolated, and can develop a mental picture of the source of their anxiety or distress. Partly out of a misguided attempt to protect their children, many parents with mental illness may attempt to avoid any discussion of their illness, and mention of its presence in the household may become taboo. The explicitness of the discussions within Kidstime – made easier by the fact that they may not identify any particular parent, child, or family – implicitly challenge that taboo.

Whilst this intervention may increase dialogue between parents and children, and may also in turn lead to some level of improved and possibly mutual understanding, it has also been found to diminish the often involuntary over-identification by the child with the ill parent. Diminishing the identification of a child with an ill parent is also a specific goal of the Kidstime workshops.

Parents have also reported that the workshops help them to be focused on, and to discuss their children from, a parental perspective. Many parents have reported that they were aware that they needed an opportunity to do this, but felt disabled by their mental illness, or restrained by the role of patient in which they commonly experienced themselves in their dealings with professionals. They thus reported feeling isolated from other people who could help them re-engage with their parental roles. Whilst from both a research and clinical perspective it is evident that the parents’ mental health, the parent-child relationship, and the child’s well-being/mental health and development will all impact on each other, and also be each influenced by other factors (in the family, cultural, social environment or in individuals’ physical health), mental health services rarely represent this interacting process both in the way they are structured and operate.

This is particularly regrettable because all of these factors are either potentially stressful and increase vulnerability, or conversely may be positive and protective in their effect. Whilst a child’s mental health is affected by the parent’s mental health and the relationship s/he has with the parent, the parent’s ability to stay well is in turn affected by how the child is and how the parenting role and the relationship with the child is working out.

Many parents have reported ‘feeling better’ (without necessarily any external or ‘hard’ evidence of improvement in their illness) as a result of the workshops, principally because they have subjectively felt better, less guilty about being ill or about being emotionally unavailable at times, and often experience more pride in their children.

A Social And Educational Event For Parents And Children – Separately And Together, Rather Than A ‘Therapy’

Professionals faced with concern about the fate of these children may sometimes offer therapy or counselling to one or more children without first exploring the child’s own thinking and opinions about what this may mean to him or her. Many of the children have challenged common assumptions of some professionals that they might need greater access to counselling and other therapeutic resources. They have stressed that they want to see a greater awareness of their needs and problems with all the relevant professionals and the public, rather than themselves being singled out for some form of ‘therapy’ or counselling. This of course does

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not mean that some children will not need or want some form of therapeutic intervention either with their family or on their own, at some point. However, an offer of therapy as a first response may seriously misjudge the child’s perception of their predicament. This is because:

a. Their role as carers has meant that they may have had to take on great responsibility for family matters which they need to have acknowledged. Therefore the response of professionals needs to be more that of a friendly ‘colleague’ or a respectful uncle or aunt, rather than the formal and inevitably hierarchical role in which a therapist or counsellor may be perceived;

b. Given the (above) goal of diminishing identification of the child with the ill parent, the offer of therapy to the child may be perceived as a confirmation that the child will follow in the parent’s – ill – footsteps.

For these reasons, the Kidstime model focuses on a mixture of social events (which includes eating), fun and play, as well as learning something new. The role of staff is therefore as participant ‘older acquaintances’ or surrogate and benign ‘uncles’ and ‘aunts’ rather than formal professionals, with the overall atmosphere resembling a combination of a party and a family discussion.

The separate and joint elements of the programme are represented in Kidstime’s multi-family format which offers a number of different contexts where mutual influences between parents and children and the function of the illness can be named, thought about (including via didactic explanation), and discussed in a community of individual family members who share the predicament. This process can produce positive change in parent-child interactions (conducive to the mental health of each), and in children’s and parents’ understandings and behaviour.

These contexts include: the children being together, parents/carers being together, the whole multi-family community, the interactions that are between the members of one family together at Kidstime (as well as obviously at home), and the interactions that go on between members of different families (e.g. a parent of one child talking with a child from another family). Each context has different perspectives, interests and opportunities.

The Kidstime format structures the contexts in which family members participate during each session:

Single Family (arrive)

Multi-family Community: Introduction of new families and informal social encounter, followed by more formal multifamily exercises and seminar.

Children’s Group Parents’ Group: Group discussion

Multi-family Community: Eat pizza together, watch the children and young people’s films, report on parents’ group, and discussion.

Single Family (leave)

Parents and children travel and arrive together at Kidstime as a (single) family group (unless one or more of the children has been accommodated by the local authority). On arrival they join with the other attending families - creating the multi-family community. Thus the format replicates a variety of contexts in which family members may experience each other, experience separation from each other, plus what is likely to be the unfamiliar experience of the multi-family context.

The Principle Of Multi-Family Group Work

A key concept underpinning all multi-family work is that when families have something in common, they can be a resource to each other. This is of particular importance for the families in which a parent has suffered mental illness for two reasons:

a. These families have particularly suffered from stigma and social isolation

b. In the role of ‘patient’, in for example a psychiatric facility, many patients commonly do not interact positively with each other, and in fact may become even more isolated, unless the facility specifically encourages the relationships between patients as a positive resource. One reason for this isolation is the fact that people may protect themselves from the import of the behaviour

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they observe in others by defining themselves as ‘different’ and ‘not like them’. However, being together with other parents who may share similar experiences, but are specifically in the role of parents, tends to encourage peer support rather than isolation.

The use of a multi-family approach has now become an effective and recognised intervention for relapse prevention in major mental illness and schizophrenia in particular. It provides a new social context for the family, and as a result offers new and positive ways in which family members think about and respond to the person with the illness. It also effectively addresses social isolation and stigma (McFarlane, 1990, McFarlane et al., 1995, Bishop et al., 2002 op cit) . Multi-family work with families, presenting with abuse and other forms of intra-family violence and neglect, has been pioneered for more than three decades (Asen et al 1982, Asen et al 1989) and subsequently developed and elaborated (Asen & Scholz, 2010). With the exception of the report of Bishop et al (above), most of these programmes were explicitly designed as modalities for the delivery of treatment or therapy. By contrast a pilot of study of the ‘Keeping Families Strong’ intervention for families in which the mothers suffered from depression (Valdez et al., 2010) describes a ‘non-treatment’ multi-family intervention for this specific group using predominantly cognitive behavioural techniques.

The advantages of the multi-family approach for the ‘Kidstime’ group of families are:

a. It provides a context in which shared mental health matters can be discussed without the necessity of any one parent or family being exposed

b. it allows individual parents and children to hear both positive and corrective responses from other families (both adults and children), which may be both more acceptable as well as more meaningful than comments emanating from professionals

c. it allows for creative alliances and ‘comradeship’ between the parents of one family and the children of another – without the guilt and/or conflict which may be associated with their own within family relations – as well as within-generation alliances

d. it allows for a whole range of activities and exercises, which maintain the ‘party’ atmosphere of the workshops.

Because they run in parallel the separate parents’ and children’s groups allow parents and young children to experience separation from each other in a ‘stranger’ context other than school or nursery. This in itself sometimes leads to reflections by those parents on their feelings of connectedness or alienation from their child, particularly if a child has reacted with anxiety or ‘clinging’ behaviour at this point in the programme.

The Parents’ group is one context in which at different times all of the above matters concerning parental mental illness may be discussed and mutual concerns shared.

The Parents’ group

The group facilitates the sharing of mutual concerns, for example, children assuming inappropriate responsibilities, children being disrespectful, worries about heritability and the possible impact of separations during hospitalisations.

The groups take place after the initial meeting involving all participants together (adult family members, children and professionals). The parents’ group starts with a process of the adult family members - and one or two (or more) professionals - leaving the space where the group has been meeting together, and moving to another space. (Or the separation may happen the other way around with the children leaving.) There may be small children who come with their adults to the parents’ group, and the room will need some appropriate and quiet toys/materials for them to use.

A parent’s mental illness is likely to have implications for the security of the parent-child attachment. The context of separation to start the parents’ and the children’s groups highlights boundary and attachment issues that will inform the observing and thinking of Kidstime staff.

• How easily do parents leave and children remain?

• How easily/competently do children and parents function away from each other? How available are they for work/play in a peer extra-familial context?

• What is the balance of preoccupation between a focus on themselves and a focus on

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the family member(s) in the other group? (And for the parents: how readily/easily do they keep their children in mind?)

The parents’ group needs to achieve a balance in its focus between the needs of group members

a. as individuals suffering mental health problems (or partnered with or closely related to individuals with such problems)

b. as parents of children affected by mental illness, and parents whose parenting is affected by mental illness.

The group is a support for adults managing the effects of mental illness generally on themselves and their lives and specifically in terms of their parenting role and task.

As individuals suffering mental health problems

In relation to the general supportive function of the group there is the opportunity for members to share their stories and experiences. Our experience is that this is a positive process that promotes feelings of being understood, being supported and of ‘community’. Perhaps the most common report from adults attending the workshops is that their lives are affected by the isolation and stigma associated with mental illness and that the experience of being able to join with and be open with others in similar/comparable situations is uniquely helpful.

The group therefore needs to have space and a culture for the members to know, and be known by, each other. When the parents’ group contains someone who is new to the group, or members who have not met each other before, introductions and meeting others is the priority.

As parents of children affected by mental illness, and parents whose parenting is affected by mental illness

The mutual influence between parents’ mental health, children’s wellbeing and the parent-child relationship operates in various ways which can be recognised in a number of key issues that affect families for whom Kidstime provides a service. The role of the Kidstime staff in the parents’ group is to be familiar with these issues and processes and ready to facilitate consideration of them in the group, in response to things said by group members, presentations/discussions that have taken place, observations/knowledge of families attending Kidstime (and hypotheses about what may be helpful for them.)

These key issues include:

• The way children are prone to feel responsible for their parent’s mental illness, or need for hospitalisation, or inability to keep caring for them. This may be exacerbated by parents’ being more bad-tempered with and critical of their children when mental health symptoms are more pronounced.

• Parents’ likelihood to feel guilty about the deficits the mental illness has caused in their parenting abilities/resources and the belief or fear that their children’s well-being, mental health and future have been damaged.

• The way a parent may get ‘cut off’ from a child because the mental illness has preoccupied them and made them unavailable emotionally. This may be a continuing difficulty or may be in the past but continue to have some impact, produce some vulnerability, in the parent-child relationship.

• The amount of information and the degree of understanding that the children have or could/should have about their parent’s being ill, and the way that has affected them and the family. Typically the amount of information that children have before coming to Kidstime is very limited because of the inherent difficulties of explaining the concept of ‘mental illness’ to children and because of the feelings aroused that inhibit giving and discussing this information. The process of being referred, the experience of meeting other families similarly affected, and the exposure to information and discussion in the various Kidstime groups change the situation and open up possibilities for each family to talk more together at home. Whether, when, how to talk with the children, what exactly to cover - as well as the question of whether talking has been able to help with the children’s understanding of the parent’s illness and with parent-child relationships – need to be kept under review.

• Children’s anxiety about the parent’s welfare/health and tendency to take excessive responsi-bility for that. This may co-exist with a parent depending on their child for their main emotional support or for extensive practical help or care.

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• The propensity for families in this situation to become socially isolated with detrimental effect for the parent’s mental health and for the child’s development and well-being.

• Parents’ and children’s fear of relapse and of what will happen to the child in that situation; this fear is often too upsetting, or the solution too obscure, for a parent or child to voice with the other.

• Parents may have difficulties setting limits, exercising consistent authority, or they may be excessively indulgent with their children in the context of feeling distressed or guilty about what the children have experienced and/or of feeling loss of self-confidence/credibility through the impact of their psychiatric symptoms on their parenting role.

• Sometimes parents have behaved when ill in ways that were distressing, frightening or abusive for their children, and the experience continues to be distressing and negatively to affect family relationships – e.g. a parental suicide attempt, or some irresponsible or inappropriate behaviour during a manic episode. Often such events are too shaming/distressing for there to have been any acknowledgement or processing between parent and child, and there may be a belief in the family and/or the professional system that because the behaviour occurred when the parent was acutely ill and the parent’s responsibility suspended or compromised there is no need or call for it to be mentioned again in the family. The parents’ group may be a useful place where the idea of talking to children about such things can be considered and the experiences and thoughts of other parents accessed. The details of what the parent did may not always be appropriately shared in the group, but the opportunity to acknowledge such unaddressed outstanding areas of concern may lead to consideration of how a parent might talk with the child, including the possibility of getting some help (e.g. from Kidstime staff) to do this.

• The impact of one parent’s mental illness on the parenting/ partnership system, and the way disruption to that system affects different family members. The ‘well’ partner’s position is likely to be particularly difficult with he/she needing to cope with their partner’s symptoms, some ‘loss’ in the relationship (e.g. of emotional availability, or in an ‘unbalancing’ in terms of dependence and contribution) and to provide increased support to both the partner and the children at a time of crisis. The experience may be of being ‘over-extended’ and of being in the middle between the demands of a partner and those of the children. At the same time it may feel (and be the case that) professionals are concerned with - and are providing services for - the ill parent (and perhaps the ‘vulnerable’ child) while the other parent’s situation and what they have been going through is not adequately recognised or relieved. The parents’ group is a place the well parent’s experience and predicament can be accessed and acknowledged.

• (Arising from the preceding) the experience of family members when a parent’s mental ill health necessitates a change in the way a child is parented, e.g. by the well parent having to assume more (or all) of the day to day responsibility and exercise more (or all) authority. The parents group provides an opportunity for parents to consider together what changes have occurred in their cases, how the change was managed, and what the experience and effect has been for (especially) the children. A crucial aspect to this may be consideration of how a parent resumes their former parental role, including how confident/ready they feel to do this, and how this is welcomed (or not) by partner and child(ren) and how it is responded to.

The children’s and young people’s groups

The children’s and young people’s groups provide a child centred context initially of play, which both diminishes anxiety, and encourages self expression and imagination, followed by elicitation of stories (commonly related to the theme of the earlier ‘seminar’), then dramatises and films the stories. The groups therefore lead to a substantive ‘production’, which is often a source of pride, and which minimises the impact of any implied or perceived criticism of the parents who readily share in the pride of what has been produced.

Confidentiality is inevitably a potential matter of concern in relation to both the parents and the children as well as in the programme as a whole. It can have complex manifestations, such as a mother saying to a family worker – in front of her 9 year old son – that she did not want

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him to know that she had had a mental illness. Perhaps surprisingly concerns about confidentiality, which frequently play a major role in the delivery of many mental health services, seem to be easily surmountable within these workshops providing two conditions are met:

a. At the point of first introduction (or induction) to the workshops, parents and their children have a brief initial meeting with one of the family workers and are invited to define any aspects of life which they wish to insist the children do not disclose to others. In fact it has been extremely rare for parents to put any constraints on their child’s participation since this procedure was regularly introduced. On the other hand if this discussion is not a regular part of the introduction for all new families, then some parents are likely to complain about what their children reveal.

b. The family workers make explicit that – within the constraints of child protection and safety, when they may have to break this code – that they will not report any specific disclosure of particular families, but that they cannot be responsible for what other parents and/or children disclose.

Providing Opportunities For Developing Relationships Across Families

The value of these relationships has been already highlighted in the description (above) of the multi-family contexts available within the Kidstime workshops.

As noted these relationships may be important at all levels: between parents, who may contact each other or offer support between workshop dates, and between children and young people of both similar and different ages, within which they may learn a relatively new skill in having friends or be able to substitute the benefits of older or younger siblings. The latter may be of particular benefit to only children for whom the relationship with the ill parent may be most intense.

However there can also be very specific benefits for both parents and children from what have been described and developed as surrogate relationships by the Marlborough Family Service (Asen et al, 2001 ) over some 30 years. This approach aims to help both parents and children to learn (or re-learn) the benefits of adult/child relationships by fostering relationships between the children of one family and the parents of another. This then takes place in a context which is free from the guilt or conflict which often inhibits intra-familial relationships. The fact that this occurs within a multi-family context, and is therefore both part of the ‘culture’, and is happening mutually, gets over the common jealousy or rivalry which may occur when parents or children see each other having relationships with others of their own age.

A Focus On Explanation

As noted above, there is evidence that even explanation on its own can have an impact on the protection of children from the negative effects of Parental Mental Illness.

Explanation as a medium of discourse with children has certain other advantages:

a. it engages the child’s thinking, and as a result may diminish their more automatic emotional responses to irrational parental behaviour. This in turn can lead to a diminution of the child’s identification with the ill parent

b. it is respectful of the child’s position as carer and can lead to a two way discussion of what the child already knows or has concluded him or herself

c. it can more easily avoid the dangers of children feeling patronised, which these children in particular object to so strongly. Within that context a child may well begin to trust the professional, and may in the long-term disclose therapeutic needs which can be responded to more appropriately.

However, the form and content of explanations requires further comment. In reality few patients, and possibly fewer of their adult relatives receive an adequate explanation of their mental illness. This failure may result partly from a reticence among mental health staff to clearly define the nature of different mental conditions, from uncertainty about their own authorisation to do so, to a lack of agreed definitions of mental health problems and their treatment within the mental health services. In addition the majority of mental health staff may shy away from trying to offer an explanation to children, fearing that their lack of training disqualifies them from engaging with children, whilst workers with children commonly do not feel competent to discuss or explain mental illness. It is therefore not surprising that children and young people generally receive even less explanation, and that such explanations as they receive are often banal, non-specific, and in fact may give little or no real information. Within the Kidstime programme the goals

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of explanations of parental mental illness – whether with a child on his or her own, with his or her parents, or in the group of children or families – are:

a. To allow the parent’s illness to become discussable, and therefore cease to be an ‘unmentionable’ fear for the child (as for example the possibility of relapse).

b. To define the parent’s illness as a more ‘technical’ event and therefore something which less recruits the child’s identification with the parent. As such it tends to objectify the child’s experience of the mental illness, which in turn may assist a child in distinguishing the illness from his or her own experience.

c. To help the child to discriminate between ‘normal’ parental behaviour, and ‘illness’ behaviour (although many children in this situation are remarkably adept at this discriminatory skill).

d. To allow specific recognition of the child’s contribution to the parent’s care from professionals and familial adults.

To achieve these goals the explanation needs to be:

a. Technical – i.e. in a medium close to a topic the child may be familiar with from school – such as in a science subject

b. Process – i.e. providing the child with a framework within which to understand the process of development of an illness, rather than statically listing signs and symptoms of a particular diagnostic category. The latter is important both because many parents may dispute their diagnosis, as well as because many mental health problems may not be easily or consistently categorised in the same manner. Parents are much more likely to accept a process description

c. Two way – i.e. it needs to promote a sharing of ideas between child and professional, and juxtaposition of the differences, so that the child can begin to construct their own less noxious image of the parent and his or her illness

d. Differentiated - i.e. it needs to help the child clearly differentiate mental illness, from common (and often dramatic) perceptions of physical illness.

Whilst there is no specific prescription for such explanations, the above principles have been found to be useful in engaging the thinking of many children of different ages.

Appendix I offers a range of explanations which can be used in the seminar sessions, and from which family workers can then construct their own explanations. Family workers can also use the film ‘When a parent has a mental illness....’ which can be purchased on DVD from the Royal College of Psychiatrists or streamed or downloaded free from the website of the College. This offers a child friendly explanation and discussion, presented by a young person who has herself been a young carer for many years.

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SETTING UP AND GETTING STARTED

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KIDS TIMEColleagues who have considered setting up a Kidstime workshop in their locality have sometimes described the prospect as daunting because

• the resource implications seemed to be insur-mountable

• they feared the intervention might not be welcomed or accepted by local families and/or professionals.

In relation to the latter concern it can be reported that 90% of the families referred to one of the central London projects have attended on more than one occasion, and that the feedback forms from those who have attended (both children and parents) have been universally positive, regardless of the diagnosis of the parent’s illness. In fact Kate’s son Sean (then aged 10) was reported to have said to her “Thanks for having a mental illness Mum…I really love coming here”.

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Resource Requirements

The following are an estimate of the resource requirements to run a local Kidstime workshop.

The workshops commonly are held monthly after school for 2 .5 hours from 5pm until 7.30pm, with a 1 hour meeting for the family workers to plan the workshop and review points of concern and interest beforehand, and a 0.5 hour review meeting after the workshop; so in all 4 hours per month. In some cases it may be necessary - albeit often temporarily whilst a parent is still recovering from illness – for assistance to be provided with transport to the venue.

A venue of about 100 sq metres (or larger) is ideal, with audio-visual playback facilities if available. However, the following list of recommended resources is based on the assumption that the venue has no in-built facilities:

• Approximately 40+ stacking chairs

• Tables for refreshments

• Soft drinks, tea/coffee, and nibbles for the ‘arrival’ phase.

• Some more substantial food for the break before showing the films. Pizza has been found to be particularly convenient because it can be ordered and delivered without the family workers having to engage in catering, it is popular with nearly all the children and parents, and it is usually culturally acceptable as fully vegetarian selections are commonly available.

• Flip chart and coloured pens.

• A4 paper and washable coloured pens for use by the children, both in the dramas and as exercises.

• Sets of pencils for completing evaluation forms.

• A video camera (simplest and cheapest is ‘Flip’ for £80 including a rechargeable battery), lap-top and case, portable projector, and lap-top high-gain speakers. The total package can currently be purchased for about £1,300.

The venue may be based at any of the agencies participating or often more easily in the base of a voluntary agency. This is because both parents and children will then be less likely to be on edge in respect of what they may perceive as the intrusive power of, for example, a mental health unit or a statutory social service centre (‘where they may take your kids away’), and most children will avoid workshops if held in their own school.

Staffing Requirements

From two to five family workers. There are advantages and disadvantages with the differing size of staff groups. With a small number of families attending a group run by one agency, two family workers can be quite adequate, particularly if the age range of the children attending is not too broad. The small team allows for coherence in the approach and easy liaison between the members.

When the number of families attending is much larger (between six and ten families), then it may be useful to have two workers for the parents’ group. This is particularly helpful if one or more of the parents requires an interpreter, when the group may at times tend to function at two different speeds. The second family worker can carefully monitor say the ‘interpreted’

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group, to ensure that they are not left behind, if those whose first language is English speak excitedly or with much emotion. When there are large numbers of children – particularly a combination of excitable young children together with adolescents – it can also be helpful if there are two or more family workers. This is particularly helpful if the group breaks into two or three sets to prepare different dramas, when each group can work with one family worker. The larger staff team is also relevant if the workshops are run as a collaboration between different agencies, such as in Camden and Islington where two London boroughs and one health provider contribute to the workshop.

However, regardless of the team size, each team needs to allocate different functions to each team member; for example, organising the venue, transport, and food, leading the seminar, leading the parents or the children’s groups , or participating in different ways in either. Teams may also be augmented with volunteers or professionals from other agencies who want to learn from observation. Some of the above tasks may then be allocated to volunteers as appropriate to their particular experience and training.

The family workers all need to be committed to the 4 hours/month of the workshops, whilst one of two of the workers needs to take on the responsibilities of:

• responding to referrals, enquiries, and processing the same, as well as making transport arrangements for the families where needed

• meeting new families at home or on-site prior to their first visit (unless they have been prepared by their own mental health or children’s services worker)

• providing outreach brief interventions for the small number of families who request the same.

These additional tasks are likely to require a commitment of an additional 10-14 hours of staff time, spread between two or three family workers.

The overall cost of setting up and running a monthly Kidstime programme has therefore been estimated as £8,000-12,000 p.a. for 10 monthly sessions, assuming that all costs (including for example the venue) have to be met, but depending on the travel costs and number of family workers participating.

The term ‘Family Worker’ is applied to all the staff contributing to the Kidstime workshops. They may be drawn from any of the professions of mental health workers, social workers, psychologists, young carers workers, psychiatrists, family therapists, or workers with special skills such as drama, or art therapy. The specific background training of the workers is of less importance than that they either have or are committed to develop the following skills:

1. an ability to engage with and talk with children of different ages in a straightforward, non-patron-ising and respectful manner

2. a broad knowledge of the mental health field, and an ability to discuss and explain a variety of mental health problems in adults

3. an ability to engage in multi-age group activities and games in a participant and playful manner

4. knowledge of talking with families about painful or conflictual matters

5. knowledge of working in large multi-family groups.

At least one member of the team will need to have experience of systemic work, and some level of systemic training.

As noted there are particular advantages in the workshops being organised as a collaborative venture between different agencies - statutory and voluntary – both in order to facilitate the development of a broad base of participants, as well as to ensure a smooth referral process.

Referral And Selection

Referral of suitable families may be from any source, but particularly (in order of common frequency); mental health workers, children’s social workers, voluntary workers (particularly those concerned with ‘young carers’), psychiatrists, family therapists and psychologists, general practitioners, and by recommen-dation from other families who have attended.

Whilst the source of referral is not significant, it is important that the Kidstime family workers ensure that the referrer understands the nature of Kidstime, and its potential benefits and limitations. A ‘family friendly’ brochure is useful such as that attached (Appendix II). It is also important that the team running the workshop have the contact details of a named worker (either from the mental health and/or children’s services as appropriate) for each family, who can be contacted when the need arises. This may be in relation to acute concerns or crises – such as new evidence of a significant child protection concern - or

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information which comes to light which needs to be acted on; for example children having particular difficulties at school, or manifesting behaviour which may indicate a developmental delay which requires proper assessment.

Some professionals – particularly from the mental health services – may feel reticent about raising the needs or potential problems of their children with their patients. They may be concerned that the patients will be very protective of their children and/ or that raising the subject may be interpreted as a criticism of their particular skills as a parent, or even that it implies that the child protection services may remove their children. This is more likely if the potential needs of the children are only raised with a selected few parents. It is much preferable if the possible needs of the children are made a universal point of discussion with all patients who are either admitted to in-patient facilities or referred to community mental health services. One approach is to provide a leaflet to all patients – along the lines of:

“Did you know.....that

Of all children who are significantly affected by their parents’ mental illness, over 70% will suffer some mental health problems as a result

Quite small interventions can greatly reduce the later effects on children’s own mental health.

One such intervention is the Kidstime workshop, which can be made available to you and your family........Read on.... “

With this in mind there does not really need to be any selection of referred families, apart from the following exclusion criteria:

• Parents who are currently presenting with florid and/or highly intrusive psychotic behaviour – although the children may attend with the other parent, or even with an alternative carer until the ill parent has recovered sufficiently to attend.

• Parents or teenagers who are currently participating in major abuse of alcohol or class 1 or 2 drugs, particularly if they currently present in an intoxicated state. Occasional use of alcohol or cannabis should not need to be a bar to attendance.

• Parents or teenagers who are suspected or convicted sexual abusers, or are known to have paedophile tendencies must be excluded from Multi-family programmes because adequate scrutiny and monitoring are not possible in these contexts.

Separation or divorce of the parents should not represent a bar to attendance. In some cases, when it is clear that there is little or no remaining acrimony between the parents, they may attend together with the children. More commonly one or other parent will attend with the children, or they may take it in turns.

Timetabling

Whilst the Kidstime workshops meet relatively frequently, other meetings with funders, managers, possible referrers, or ‘away days‘ for the team etc may be required from time to time. It has also been found useful to have a steering group, which can include representatives of users and young carers but to which selected managers, funders, or other relevant professionals (such as local safeguarding managers) may be invited from time to time. The inclusion of users and carers is particularly useful, although not always easy to maintain because of shifting populations etc. The steering groups commonly meet between one and three times per year.

The model of Kidstime described in this manual is of a monthly event lasting 2.5 hours. A common timetable would be:

16:00 Family workers meeting. It can also be useful if a user or carer representative from the steering group can attend this meeting.

17:00 Arrival of the families. Light refreshments of soft drinks, biscuits, and ‘nibbles’ are usually provided, and a social mingling is encouraged

17:15 Whole group meeting or parents, children and workers, participating in ‘joining’ exercises and then the seminar/demonstration session.

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17:30 Parallel separate parents’ group and children’s activity/drama groups. At the end (last 10-20 minutes ) of the children’s group some activity/ies or drama/s are filmed by one of the children/ young people.

18:45 Whole group meets for further refreshments (usually pizzas and further soft drinks).

19:00 Whole group meets for feedback of the themes/topics discussed by the parents (with some questions/discussion) and viewing of the film produced by the children.

19:15 Whole group discussion of the film and other events of the evening.

19:30 Families depart

19:45 Family workers review meeting.

Comment: These are of course only guidelines, and the precise timings, as well as the exact definition of each of the activities, will vary from workshop to workshop, depending on the constellation (ages, interests, and problems) of those attending, as well as on any particular interest or concerns which have been manifested or voiced.

The Professional Network And Referrers

Kidstime is an innovative and unusual intervention and may not easily fit with the obviously available therapeutic services – particularly as it is specifically not defined as a therapy or treatment.

Therefore it is often necessary for the family workers to accept an educational role in relation to local professional groups - in all the relevant agencies and professions referred to in the list of referrers (above) - both about the risks to, and needs of, these children, as well as about the potential benefits of attendance at Kidstime. The innovative nature of the programme may attract requests for visits and observation of the groups by interested professionals. Whilst these may be valuable for the relevant professionals, as well as for the programme – in terms of the dissemination of greater knowledge about the needs of these children and the benefits of the programme – they should be limited to one or at most two visitors per Kidstime event. This policy needs to be both discussed with the participants of the workshops, and the benefits to the group, as well as the commitment to confidentiality by the visitors, explained. Visitors who attend also need to be prepared to be fully participatory, for example in games etc, particularly if they attend the children’s groups. With these provisos it has been found that visitors are usually well tolerated.

Similarly referrers are encouraged to attend with the family or client with whom they have been working, for at least the first workshop attended by the family. They will also need to agree to be fully participatory. Not all referrers will agree or be able to attend in this way – particularly because the workshops are held after normal working hours – in which case it is important that there is a more detailed discussion of the referral between a Kidstime worker and the referrer. This discussion needs to ensure not only that the referrer fully understands the aims and objectives as well as the methods used by Kidstime, but also the Kidstime worker needs to ensure that the worker has adequately explained all of the above to the parents and that any relevant feedback from this discussion is relayed back to the Kidstime team.

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GENERAL APPROACH

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KIDS TIMEThe thinking underpinning the Kidstime workshops has already been detailed above, as have both the recommended attributes as well as the tasks of the family workers.

However, the role adopted by the family workers in the process of the various components of the workshop is of particular importance for the perception of the workshops in relation to other experiences. This is because it commonly contrasts the perception of the workshops in relation to other experiences which family members may have had of either statutory or therapeutic services. Therefore the way in which family workers in the Kidstime workshops represent their role is an important component of the potential benefits of the workshop, and this point has been underlined by a majority of families through the regular feedback forms.

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Key Components Of The Role Of The Family Worker

• Family workers are actively participant in the activities of the workshop, and engage playfully in the games, activities and dramatisations.

• Family workers do not assume a hierarchical position, other than in relation to essential organisational matters; Room booking, organisation of the food, organisation of transport when required, timetabling etc, or when the behaviour of children requires some control.

• Family workers ensure that they have - or will quickly refer to another family worker who has – adequate knowledge of a range of aspects of mental illness, its treatment, and the organisation of mental health and children’s services.

• Family workers will be available to impart, but not impose, knowledge about mental illness, but will also engage in dialogue of their knowledge in relation to the opinions and beliefs held by family members.

• Family workers are always seen as available by family members if they wish to raise individual concerns or ask for advice. This will occur informally during the unstructured parts of the workshop, but may lead to a time being arranged for a fuller discussion.

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DETAILED ELEMENTS OF THE KIDSTIME WORKSHOPS

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KIDS TIMESome teams have found it useful to have a prior discussion with the co-leaders on the day before to discuss possible themes and strategies based on topics that have been brought up at previous workshops, or based on adapting the workshop to the needs of possible participants (E.g. where very young children are concerned, or those who have difficulties integrating or verbalizing).

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INTRODUCTORY SET OF WHOLE GROUP ACTIVITIES Informal Social Encounter (15 minutes) - New families -

‘Welcome Briefing’

USE

NB: Some teams have preferred that this meeting takes place outside the workshop as a separate event. During period when families arrive and new families may be introduced.

SEQUENCE

Chairs are set out in a circle. New families are welcomed and found a separate area to sit and meet a staff member for briefing.

AIMS

To generate a welcome and relaxed atmosphere. To allow new families to feel welcomed, to understand the Kidstime context and to define essential areas of privacy to their children. To communicate a mixture of structure and informality which can reassure parents and children of the safety of the context.

MATERIALS

Refreshments – biscuits, juice, fruit Flip Chart – for Welcome sign List of Names circulated.

INSTRUCTION

Welcome and then meet an individual worker for:

a. Description of the Workshop

b. Explanation of goals of the Workshop

c. Ask ‘Is there anything which your children know or have seen which you want to tell them not to share with anyone else in the Workshop.

d. New option: Invite them to meet family A or B to hear from them about the workshop.

WORK FOCUS

Engagement in the Kidstime social milieu

CRITICAL SITUATIONS

If a parent does define some family experiences or matters they wish the children to keep confidential, then ask the child ‘So do you know exactly what you’re not allowed to talk about?’.

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Ask parent ‘If your child did tell another child, what do you fear would happen or they (the other child/children) would think?’

If a matter is defined as “not to be shared”, the question may be revisited in a later workshop to ask if the parent has changed their view after hearing of other families’ experiences.

Informal Social Encounter (15 minutes)- Previous Attendees - ‘Welcome Back‘

USE

During period when families arrive and new families may be introduced.

SEQUENCE

Chairs are set out in a circle. Families arrive, greet others that they know, are introduced to others, help themselves to refreshments and find themselves a seat.

AIMS

To generate a welcome and relaxed atmosphere, when some families may also share what has happened since the last workshop.

MATERIALS

Refreshments – biscuits, juice, fruit Flip Chart – for Welcome sign List of Names circulated.

INSTRUCTION

Welcome and take refreshments Encourage to talk to new families

WORK FOCUS

To re-engage families in the Kidstime social milieu.

CRITICAL SITUATIONS

Staff monitor all participants for evidence of increased distress in the children and/or increased distress or disturbance in the parents – whether manifested by individual behaviour of either or by evident disturbances in the relationships. When such is apparent it may be addressed tangentially in either the parent’s or the children and Young Persons’ groups.

Seminar/ Discussion Session For The Whole Group (15-30 minutes) ‘Learning About Mental Illness’

This may have a variety of formats depending on the number of new families present and the age and other compositions of the group on each occasion. It is usually in 2 parts; a) An engagement section b) a more formal ‘explanatory’ or exploratory section

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Engagement/Introduction Part (5-15 minutes) USE

With whole group together, after the unstructured ‘meeting’ and refreshment period.

SEQUENCE

Chairs are set out in a circle. One staff member leads, welcomes all present and especially new members (families or professionals). Commonly participants are invited to engage in one of a number of exercises ( see Appendix 2 ). Although these exercises vary in format they have identical goals.

AIMS

1. To allow each member of the group to speak, some perhaps for the first time in the session; To have a voice; To build confidence and communication skills.

2. To establish a sense of ‘community’ and acceptance. The group learns about each other. Each person is listened to and the view or feeling that they express, or not, is validated.

3. Sometimes to introduce a topic that will feed into the following split session (young people’s drama session / adult’s discussion session).

MATERIALS

Sometimes use of chairs, otherwise no specific materials.

INSTRUCTION

For the engagement /Introduction section One family worker asks each member of the group to say their name and asks one or two questions. Each member of the group is invited to share their thoughts and/or feelings regarding these questions. E.g. what do you like about the spring? What kind of food/s do you like? What makes you happy? What makes you unhappy?

WORK FOCUS

1. Engages the group as a whole and acknowledges membership of a group directly or indirectly sharing the experience of mental illness..

2. Engages families in the expression of simple ideas or feelings – such as about particular weathers, current events or festivals.- sharing names, likes and dislikes etc. with minimal self disclosure.

3. Sometimes introduces a topic for the following split session.

CRITICAL SITUATIONS

1. If one or more parent shows particular disturbance - e.g. manic episode – to the point that others become frightened or cannot engage, then staff present may have to intervene directly, whilst diffusing any potential conflict which the incident has aroused.

2. Similar response to above if one or more children present as out of control or bullying others.

3. If one of the children refuses/is unable to speak to say their name and/or answer the questions then the staff present and sometimes other members of the group will encourage and support them by speaking or suggesting answers for them or by reassuring them that they are a part of the group, of the ‘Kidstime Community’.

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NB: In fact both possibilities are extremely rare within the Camden and Islington Kidstime groups. Although possibility number 3 does occur on a semi-regular basis, particularly with younger, newer, and sometimes teenage members.

Seminar Part (10 - 25 minutes)

USE

With the whole group of parents, children, and family workers

SEQUENCE

After the introductory session one or more family workers will either a. Refer to a discussion or film from a previous workshop, and identify one or more topics to follow up.

b. Refer to a likely common theme, such as the impact of the impending Christmas, or Summer holidays on the family

c. Refer to a particular topic – for example how children manage if their parents do not get up in the morning, or some child behaviour problem that parents feel unauthorised to discipline as a result of their illness – and;

• Invite ideas, comments

• Suggest an exercise to illustrate the problem

• Invite the children to represent the idea in a dramatic or ‘physical’ form (such as when a parent suffers intrusive thoughts, one child playing one thought, another other thoughts, and another playing the person the parent is trying to speak to - such as one of the child’s teachers)

d. Suggest discussion of some other aspect of mental illness, or of mental health services, which the family workers have observed might be cogent at the moment.

AIMS

• To offer a mutually acceptable knowledge base in which discussion of parents’ and children’s experiences, beliefs and opinions can be encouraged.

• To develop a model of thinking about mental illness which can allow mutual further discussion.

• To promote resilience amongst all family members in their struggles to engage services positively.

• To mutually develop ideas which can assist both children’s and parent’s understanding of services, and how to extract maximum benefit from the same.

MATERIALS

Flip Chart, sometimes video

INSTRUCTION

The key instruction is non-verbal rather than from content of narrative. That is by one or more staff members standing and taking on a ‘teaching’ role, the instruction is that the group will now engage in a process of partly didactic learning.

Comment

In reality most of the learning is interactional rather than didactic, but the non-verbal communication is that ‘this is now a serious part of the event in which the question of mental illness in the parents will be explicitly referred to.

The most common instructions are:

1. We are now going to think about……(a model of mental illness, some aspect of mental illness, or some questions raised by participants about either mental illness or mental health and social care services.

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2. These are the topics which were raised last time that we did not discuss….which do you think we most need to discuss today?

3. Let’s list the topics that parents and children would like to discuss toady.

WORK FOCUS

The focus of the seminar is:

1. To initiate discussion of mental illness between parents and children as a whole group.

2. To develop an explanatory model of mental illness and its treatment which is under¬standable by and acceptable to, both parents and children.

See Appendix 1 for a range of explanations which can be used in the seminar session. Family workers can also use the film ‘When a parent has a mental illness....’ which can be purchased on DVD from the Royal College of Psychiatrists or streamed or downloaded free from the website of the College. See also the ‘nature of explanations’ for discussion of the principles underlying explanations.

3. To overcome discomfort or ‘taboo’ about the acknowledgement of mental illness, and discussion of its meaning and consequences.

CRITICAL SITUATIONS

1. If one or more parent shows particular disturbance - e.g. manic episode – to the point that others become frightened or cannot engage, then staff present may have to intervene directly, both to attend to the distress as well as to diffuse any potential conflict which the incident has aroused.

2. Similar response to above if one or more children present as out of control or bullying others.

3. If the children as a group do not engage (relatively rare) or become bored, then curtail this session and follow up the salient issues in the subsequent children’s group.

Separated Concurrent Groups (Approximately 1 Hour) Parents’ Group: (Referred To As PG)

General guidelines:

1. Keep a predominantly parental focus, by ensuring that there is a persistent concern with the children’s experiences and needs (albeit with a recognition of adults’ needs to connect with others who have experienced mental illness, and to share stories and predicaments – not all of which need to relate to parenting).

E.g. • [After two group members have compared experiences of manic episodes]

a. “What do you think your children noticed at that time,what did they make of it?”

b. “Would it be helpful for them too [the respective children] to talk and compare experiences”

• “Do you think Mohamed and Halima know too about the history of mental illness in the family? Could they worry about that?”

• “In what ways do you think involving your children in Kidstime has been, or could be, helpful to them?”

• “Do you know what your children have said at school or to their friends about you (or your partner) being ill (or being in hospital)? Have you been able to discuss with them what might be a good thing to say?”

• (If a parent is not feeling great or is irritable/cross) “How easy is it, do you think, for children to know whether this is part of normal ups and downs or whether their parent could be getting ill?”

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Rationale: This is at the core of Kidstime: Parents being supported to identify the experiences and needs of children, which arise from their situation of having a parent who suffers mental illness. Parents’ ability to recognise and meet those needs is assumed to be crucial in terms of mitigating negative effects on the child’s emotional well-being, and important for the parent’s’ recovery/ maintenance of mental health in terms of their ability to manage the parental role which is likely to be key to their sense of who they are.

2. Keeping a ‘psycho-educational’ frame but from a position of curiosity and open-mindedness as to whether, or how well, ‘the knowledge’ might fit.

E.g. • “We know children often get the idea that they are responsible for things that go wrong in the

family - like when parents split up - and blame themselves to some extent. Has anyone had any sense that their child might have felt some responsibility for you (or you partner) getting ill?” (Rather than: “John seems as if he might blame himself for your getting depressed”).

• “There’s some evidence that children can be helped and can manage ok when a parent gets mentally unwell, if they get a clear explanation of what is happening to their parent and the opportunity to ask questions and talk about things from their point of view. Does that make sense?...What’s been, or might be, useful in helping your children in this way?”

Rationale: Normalises the experience – ‘it goes (or often goes) with the territory’ – and is less pathologising (1st example). It leaves key responsibility with the parent for picking up on and being concerned with the experience of their child; the adult is supported in their parental role and positioning. It’s reassuring/motivating in terms of ‘good news’ and positive steps parents can take (2nd example).

3. Seek contributions from all group members.

E.g. • “Has anyone else had that experience/thought?”

• “Is that how it has been for most people or are there different experiences/ideas?”

• “I was wondering, Jane, what you thought about what Kate was saying.”

• “Would that be the same or not for a family from your cultural tradition?”

• “Do you think that that’s how [your daughter] Mandy thinks about it or not?”

Rationale: • To enable the voices and experience of all parents to be heard, and to optimise for all members

the potential benefits of participation in the group.

• To maximise the range of experiences and perspectives available to the group and so enrich understanding and problem-solving.

• To promote community and mutual support.

PG1 - ‘Getting to know you’

USE

When someone is new to the parents’ group.

SEQUENCE

Established group members introduce themselves in turn and say something about their family situation and their connection with the Kidstime workshop (e.g. who’s in the family/household, who has the mental illness, what illness it is). This should be a short summary rather than long story-telling; the actual time available will depend on how long the group meeting is to run, how many group members there are on the particular occasion and whether there is one or more new members. (Staff members say at least something about their professional role and their involvement with the Kidstime project). This is followed by an invitation to the new member(s) to say something about their own situation and their coming to the workshop, and – if appropriate/comfortable - the group attends to and asks about that.

AIMS

To help the new member and other members get to know each other. Promote culture of sharing and connecting with each others’ experiences.

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INSTRUCTION

“Welcome to the parents’ group. When someone new joins us what we usually do is go round and let people introduce themselves to you and say something about their situation and what’s brought them to ‘Kidstime’ – so you know something about us. And then if it feels comfortable for you afterwards to say something about your situation and reason for coming that would be useful. Is it ok for us to do that?...the main guidelines that we have for talking in the group are that people should only share things that they feel comfortable about sharing, and that we agree to treat things that are said in the group as confidential to the group.”

WORK FOCUS

Welcoming and starting to connect with new member. Choosing what seems the most salient and most helpful information to give. Organising what one says in relation also to what feels comfortable in the setting and to the time available.

CRITICAL SITUATIONS

An established group member takes too long, and there is perhaps a move away from the task of introductions/meeting to an invitation to focus on and work with the established group member’s situation. Need to keep clear sense of time available to each member and be ready to ‘chair’ the process and hold, and keep overt, its focus (as in AIMS above).

A new member does not feel comfortable or ready to say much about themselves (unusual). Be ready to move to another focus e.g. other group members saying, as useful information for the new member, what their and their children’s experiences of Kidstime has been.

The following are examples of particular sequences that Kidstime staff working with the parents’ group might seek to introduce and follow in line with the described aims/framework of the group.

PG2 - ‘Digesting the seminar’

USE

To follow-up themes/issues that were the subject; or arose in the context, of the seminar/ presentation/group discussion that took place before the parents’ group.

SEQUENCE

Group members comment spontaneously on what has been said/discussed in the whole group just finished, or the facilitator asks for comments/reactions or offers their own. A discussion is facilitated with the Kidstime staff member(s) aiming to elicit the thoughts/comments of each group member, to promote conversations between group members, to invite group members to reflect on the children’s experience and the implications for what they need from their parents.

AIMS

To facilitate the processing of, and self-reflexive thinking on, information/ideas that have been presented. To access the potential of the group to help with this process in ways that provide understanding, support and contribute to problem-solving.

INSTRUCTION

“What did people think about that exercise/video/presentation?” “What do you think your children made of it?” “How did it connect with what happened in your family’s situation (or with how your children responded, or with what you think, or with what you think your children understood… etc)?”

WORK FOCUS

How easy is it for parents to talk with others about their experiences and family situations?

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How easy to reflect on those? To what extent is there a sense of difficult experiences and feelings being voiced and processed, and of adequate ability and energy to address what may be continuing effects for the children and the family on the parent having been ill.

CRITICAL SITUATIONS

There may be some other matter or concern - perhaps arising from something current in the experience of a group member - that may need to be addressed or that it would be more helpful for the group to consider. Facilitators keep that possibility in mind, and might check it with group members at the start.

If the group is finding it difficult to stick with the topic/issue presented, the facilitators need to judge the relative values of persevering to help the group focus and think about the topic or of switching focus.

PG3 - ‘Daily living reviews‘

USE

Introduced at or near the start of the group to see how things are currently for families attending Kidstime, whether parents and children are coping well, ok, or whether there is any need for additional support/intervention.

SEQUENCE

The facilitator asks group members to say how things are for them and their family at the moment. Group members do this in turn; other group members ask questions, respond with support, understanding from their own position, or offer advice.

AIMS

To be aware of the current experience of individual families attending Kidstime, including whether there is difficulty/stress that might impact on children’s well-being and on a parent’s mental state;

• To access support, especially peer support, for parents

• For Kidstime staff to be informed in their considerations of how to understand and work with the families attending and what liaison may be needed with other professionals and agencies involved with the family.

INSTRUCTION

“Could we go round and hear from everyone in turn how things are at home at the moment and whether there’s anything in particular that it could be useful to hear or think about in the group? Does anyone have something going on that they know they might need some extra space to talk about?” (If the answer is ‘yes’, the facilitator then decides with the group the best way to use the time; e.g. the person indicating a need for more time might start and aim to use 15 minutes with the rest of the time split equally among the other group members. If the answer is ‘no’ people speak in turn e.g. going round in a circle from the facilitator’s left. )

WORK FOCUS

Consider whether parents and children are coping well, ok, or whether there is any need for additional support/intervention.

CRITICAL SITUATIONS

A group member does not restrict themselves to their ‘allotted’ time and thus deprives other members of theirs. The facilitator responds in terms of their understanding/judgement of whether (one end of continuum) this is about difficulty in managing or sharing time or (other end) the group member is presenting a current need – not previously identified – that the group should prioritise. In the former case facilitators need to ‘chair’ the meeting and ‘keep time’; in the latter they need to intervene to highlight what is happening, to consult with group members and agree how to proceed and whether/how to re-allocate the remaining time.

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PG4 - ‘Invitation to problem-solve’

USE

To follow up/explore a particular concern/curiosity that Kidstime staff may have about a family’s situation, or that a parent may raise.

SEQUENCE

The Kidstime staff member indicates for the parent the concern/curiosity they have in mind and asks whether it could be useful to discuss in and with the group. A significant part of the parents’ group time is devoted to discussion of the identified issue/concern.

AIMS

A more or less formal ‘problem-solving’ approach may be adopted (see immediately below) or the emphasis may be more on a) the parent feeling understood, supported, that they are not ‘the only one’ to experience the difficulty and b) on the parent getting feedback on how the situation looks/feels from other points of view.

INSTRUCTION

E.g. “I thought earlier that Margaret seemed quite hard to manage at the moment…” or “ …that Margaret’s behaviour seemed to be getting to you at the moment”, or “ …that Jim seems quite unsettled/withdrawn/etc today”. And then: “Could it be useful to think about that in the group and see if there are any thoughts or ideas that might help?”

WORK FOCUS

A parent brings a difficulty or concern to the group. The difficulty/concern may relate obviously to parental mental illness or may be relevant in the sense that it is a source of stress that potentially threatens the mental health of vulnerable family members. The Group provides help in terms of support, advice, different perspectives/ideas and problem-solving.

CRITICAL SITUATIONS

A parent may not want their situation to be focussed on in this way and clearly should feel able to decline the suggestion without feeling under any contrary pressure facilitator accepts parent’s reluctance and is ready to take/suggest an alternative course. A parent may feel over-exposed by the facilitator’s observation and suggestion. Where this seems possible facilitator could consider ‘floating’ the idea privately in direct conversation with the parent before the parents group is assembled.

PG5 - ‘Problem-solving for a family ‘

USE

To use the group to help problem-solve around an area of difficulty that one parent identifies for themselves and their family, but which may have relevance for other members of the group.

SEQUENCE

It’s agreed that the group will focus on a particular situation and apply a ‘problem-solving’ approach. A group member agrees to present a situation/issue that is problematic for them. The approach maybe more or less formally structured (see Falloon, McFarlane for the latter) but has the following general features:

• a clear definition of the problem is established

• different ideas of what might be tried are suggested without at first any evaluation of them so that a range of ideas is generated and this extends beyond the familiar/obvious

• all the ‘solutions’ are evaluated in turn, the chair/scribe listing both ‘pros’ and cons’

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• the relative merits of the ‘solutions’ are considered and ‘the problem-owner’ chooses a preferred solution to try

• the group helps the ‘problem-owner’ to operationalise step by step what they will do in implementing the ‘solution’

• there’s an agreement for the plan to be carried out and reviewed as to what success it had, whether it needs modifying/adapting/replacing.

AIMS

To enhance problem-solving abilities/energies which may be restricted by psychiatric symptoms (depression, anxiety), and by social isolation.To develop the Kidstime parents’ group as an available and ‘sympathetic’ resource to parents who may feel that their own resources are inadequate at times for their parenting task.

INSTRUCTION

“We (the parents group facilitators) are aware that…(for example) a problem that several families have had is their children having to cope with unkind/hurtful comments or bullying because their mother of father has been mentally ill. We thought it could be useful to think of ways to try and help with this by doing a problem-solving exercise together now. Would that be ok? Who would be prepared to tell us about the situation they have had with their children so we could use that to think about things that might be tried?

WORK FOCUS

A. the development of problem-solving skills and practices B. sharing, supporting, problem-solving in relation to the particular issue being addressed.

CRITICAL SITUATIONS

The approach requires some discipline and facilitators need to be reasonably familiar/experienced with it, and able to help group members stay with the process, go through its steps and so learn the approach for themselves and their families.

PG 6 - ‘Looking and planning ahead ‘

USE

When a parent has indicated this is a concernor routinely, as part of the process of supporting families to manage optimally despite a parent’s having a vulnerability to mental health breakdown.

SEQUENCE

Group member responds to something said, or initiates discussion about possibilities of future episodes of severe mental ill health or hospitalisation and how such possibilities may be affecting family members, and what talking or planning there may have been or there may need to be about this.

AIMS

To help with children’s anxieties about what will happen to them if the parent becomes ill (or becomes ill again) To help with parents’ anxieties about this To facilitate problem-solving and planning around this concern and the possibility of putting contingency plan(s)in place To help the parent talk with their child to understand whether there are concerns and what they might be, and to be able to address these and discuss/plan with the child.

INSTRUCTION

“One of the most difficult things when a parent has a mental illness can be if the parent has to go into hospital, or is too unwell to look after their child(ren), - what happens about the child’s care? I was wondering about what happened in the cases of people here in the group, or what would happen.”

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WORK FOCUS

Being able to talk about and plan for the possibility of a mental health relapse.

CRITICAL SITUATIONS

1. A parent may find difficult and resist any discussion that confronts the possibility of relapse. It may help:

a. That other parents contribute comfortably to the discussion and may be able to speak about discussions with their children and/or plans they have made for/with them

b. If it is mooted that despite a parent’s considering relapse ‘out of the question’, there is a likelihood that the possibility of the parent again becoming ill is a real concern for the child.

2. The question of how the child(ren) will be cared for and supported if the parent were to relapse may be difficult to think about or plan for because it involves complicated/ conflictual family relationships. For instance the issue may be that there are family members (e.g. the father when the couple are no longer together, or a maternal grandmother) who might step in to care for the children when this is not wanted by the parent or child(ren) - but this is difficult to address. Or it may be that there are family members who the parent would wish to care for the children but high levels of conflict in the relationships have prevented this from being explored. The facilitators need to be sensitive to the possibility of these kinds of situation and prepared to provide or access help for the parent to take forward a preferred plan for how the children should be cared for.

Children’s And Young Persons’ Group (Referred To As C&YPG):

General guidance

The focus in this part of the programme is on the C&YP. Once their parents have left for the Parents’ group the C&YP can be free to play, explore and express their ideas using drama techniques, safe in the knowledge that their parents are close by and being taken care of.

The use of drama is of particular importance in this context. The games, exercises and creation of stories the C&YP are able to develop in the context of play and playful activities help them to express their fears and emotions, and to create new realities for themselves. They can then gain ownership & control of the stories they create, which in turn tends to lead to increased confidence and to a stronger and more positive sense of self.

It should be stressed however, that the approach used is not coming from a dramatherapy or psychodrama perspective, although of course there are crossover techniques used in facilitating the drama. Although the aim of the workshop is not for it to be ‘therapy’ the results do have therapeutic value. If possible it is therefore desirable to recruit a drama facilitator or drama practitioner to achieve the above. This discipline has so far been integral to the development of the approach.

C & YPG 1- ‘Hello games and create stories’

USE

When someone is new to the Kidstime Group

SEQUENCE

The new member/s are welcomed. Name games and Introduction games are played. The Drama facilitator/Family worker explains, briefly, what happens in this part of the workshop and invites other members of the group to share their explanations and thoughts about the workshop.

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Once it is felt that the new member/s are comfortable enough, the group explore a thought, story or issue using drama exercises and techniques and create a piece of drama that is filmed.

It is important that the focus is on the process rather than the product and although there is a great value in producing a short film to show at the end of the session, this is less important than ensuring new members feel welcomed and comfortable. As a consequence, when there are new members to the group the ‘games and getting to know you’ part of the session is extended.

AIMS

To welcome the new member into the Kidstime group and help them to feel comfortable whilst ensuring that the existing members of the group continue to feel safe and valued and that the supportive Kidstime community is maintained.

MATERIALS

Paper and pens/crayons a. for younger, artistic, less-verbal members of the group to use to express themselves

b. to write up ideas, thoughts, story outlines etc during the drama session

c. flip video camera or equivalent.

INSTRUCTION

“Okay, now that all the grown-ups have gone, well most of them and all of your parents, it’s time for us to play some games and do some drama . First we want to say hello and welcome to Khushboo…………I know there are quite a lot of us and only one (or 2 or 3 or whatever) of you so in a moment we will play a game to help us to learn each others’ names but first I just want to explain what Kidstime is about. Can anyone help me out here and tell Khushboo what we do in this bit?’”

Once some of the group have spoken and said a bit about what we do and what they like about the Kidstime workshop, the Drama/family worker adds any details that may have been left out or not made explicit.

“That’s right, we play games and do drama exercises to create stories and plays that we film and then show to the whole group when we all come back together. Do you like drama? Making up stories? Acting? Do you do drama at school? …..Our stories can be about anything that we want them to be. Often they are about mental illness and what it is like having a parent with a mental illness because that is the thing that the group have in common, But they can be about anything that we want them to be.”

WORK FOCUS

Welcoming the new member and ensuring that they feel safe Ensuring that the existing group members get appropriate attention and continue to feel safe, supported and valuedMaintaining the balance of the group dynamic.

CRITICAL SITUATIONS

1. The new member is very fearful/states that they don’t like/hate drama.

Reassure them that they do not have to do anything that they do not want to do. Whether that be acting, telling their own story, etc. Ask why they don’t like drama? Bad experience at school? It usually is. Reassure that the emphasis is on having fun and telling stories….not necessarily their own stories. Ask what they do like to do. Engage the rest of the group in the reassurance and answers. Offer alternatives to their objections e.g. you could help to make up the stories but you don’t have to act in front of the camera, you could help to direct, operate the camera, etc. 2. There is a time issue - not enough time to create a complete drama/play to film because more

time has been spent on the welcoming games and exercises.

Simply film some part of the process. This could be a snippet of one of the games (“Anyone Who’ works well) or one of the introductory exercises, E.g. Interviews in pairs, find out your partners name & 3 things about them to introduce them to the group. If any scenes or parts of scenes have been created, then these could be filmed. When the film is shown later in the workshop, explain that what they are going to see is a ‘snapshot’ or a ‘work in progress’.

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C & YPG 2- ‘Warm-up and dramatise learning’

USE

Following Up on a Topic raised in the seminar: E.g. What Is A Mental Illness? What do you think it is like to have a Mental illness? How does It Feel?

SEQUENCE

Warm Up games . Re-cap on seminar discussion. Using drama explore what it is like to have a mental illness and how it might feel.

AIMS

To build on the learning and understanding gained from the seminar to help them explore what their understanding of their parent’s mental illness is and how their parent may feelto express how they feel about mental illness.

MATERIALS

As before

INSTRUCTION

“Okay so who can remember what we were talking about in the big group? That’s right, we were talking about mental illness, what it is and what it feels like. I’m going to put you into smaller groups and give each group a big piece of flip chart paper and some pens. I want you to create a Mental health character, a creature, and give it a name. What do you think it would look like? Draw it on the paper and imagine how it would feel. Write those feelings next to it.”

The next stage

“Okay so now that you have created your Mental Health character/creature , I can see that this group’s is called Mentoskins. I want you to imagine what Mentoskins would say. Which one of your group would like to play Mentoskins? It could be one or more or all of you. What does Mentoskins want to say? What does Mentoskins want to do? Are there any other characters in your story? Who are they? Let’s see what happens when they meet.”

WORK FOCUS

Is explanation of mental illness and its associated impacts on the child’s life.

CRITICAL SITUATIONS

A member of the group may struggle to understand something about mental illness that was raised in the seminar, or may have further questions. - It is important that the C&YP are encouraged to think further about mental illness and to ask questions. Reassure them that is ok to be confused a good thing to ask questions. If the drama facilitator/family worker is unable to answer them in a clear and consistent way then refer them to a member of the team who can. E.g. ‘That’s a really good question, I’m not sure that I know the best answer, let’s go and ask Alan”.

C & YPG 3- ‘Creating the dramas’

USE

Working with a Topic raised by the C&YP during the drama session E.g. Bullying

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SEQUENCE

Introduction games & exercises: Once warmed up ask C&YP for suggestions for stories to be filmed. This can be done in smaller groups or in one big group. Write up ideas on flip chart paper. Group discussion regarding suggestions. Group choose which story/topic to explore further. Those not chosen are kept on record for future sessions. This can be done as a whole group or as smaller groups. Story/ stories created, rehearsed, and filmed.

AIMS

• To identify what issues and concerns the group have.

• For the group to have ownership of the stories and films produced.

• To allow the issues, concerns and questions of the C&YP to be raised and explored in a safe space and with the added ‘safety net’ of the drama. Their ideas are then shown ‘one step removed’ via a character in a film, and shared with the parents in this way.

INSTRUCTION

To raise potential topics and ideas for stories which can facilitate the group discussion and brainstorming:

Ask the group which one they want to focus on for this workshop. The other ideas can be kept and used in future workshops. If there is no clear favourite consensus then more than one topic can be developed, time and staffing permitting.

Once the topic has been identified a variety of drama techniques can be used to help the C&YP develop their stories. (see Appendix 3). They can then be rehearsed and readied for filming. They can be anything from a still ‘frozen’ image, to a scene that lasts a few minutes, to a series of scenes that can last up to 10 minutes.

WORK FOCUS

The thoughts and the ideas of the C&YP are brought to the forefront. They are encouraged to explore issues and concerns that are important to them, which in turn can be shared with their parents through the watching of the film.

CRITICAL SITUATIONS

One or more of the group disclose that they are being bullied/have been bullied • ensure that they are supported, discuss strategies & support with the group. Make sure that the

story that is then created does not become theirs.

Part of the process involves the group drawing on their experiences as material for the stories that they create but it is important that there are clear boundaries and that the group are clear that they are playing characters and not themselves. They may need to be ‘de-roled’ after the session.

Younger children need their older siblings in the group to look after them

A balance has to be struck so that the older sibling doesn’t end up being in the caring/ parenting role. If staffing allows this responsibility can be shared. If not then the younger child may need to join the parent in The Parents’ group.

C & YPG 4 - ‘Filming the dramas’

NB: The drama segments which the children and young people produce may vary from less than a minute to a maximum of ten minutes in length. Because the children often enjoy and are used to – from school – working in small groups, there will commonly be between 2 and 4 separate productions to film

USE

In the C & YPG, usually with a small group

SEQUENCE

The ‘dramas’ will have been rehearsed for between 5 minutes and 15 minutes. The drama practitioner or another family worker will then explain to the child or young person operating the camera roughly how

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the action will progress, so that he or she can decide on the best vantage point. The sequence is then filmed using a ‘Flip’ camcorder (or similar) which is easy to use and can be quickly downloaded to a computer for playback about 10-20 minutes after the end of the filming.

Training a young person to use the camera can take only a short while. In particular he or she needs to learn not to move the camera unnecessarily, to attempt to keep the action central in the picture, and generally not to use the zoom feature. He or she also needs to keep the zoom as wide as possible so that the camera is held as close as possible to improve the sound quality

AIMS

The aim of the filming is so that the children and young people have a ‘finished product’ to show to their parents, which at the same time commonly illustrates dilemmas currently faced by the children. This then nearly always becomes a source of pride for both the children and their parents. As a result the content of the dramas tends to become very much more palatable, and can then often be discussed in a manner that would have previously seemed to both parents and children to be too threatening

MATERIALS

A Flip or similar camera and playback facilities (as defined under resources above)

INSTRUCTION

All the children and young people are asked to be silent while each sub-group is filmed.

WORK FOCUS

The goal is to produce a product which is a source of pride for both generations. Parents will commonly express surprise at the ‘realistic nature’ of what the children produce, and rarely if ever seem to be offended, even if the children act being mentally ill, or even (as in one staged ‘anti-advert’ for Kidstime) talk about the ‘mad people’ in the group.

CRITICAL SITUATIONS

If one or more of the sub-groups become very excited, they may become rowdy and interfere with the filming of another group. Usually 1 or 2 requests or injunctions are adequate to deal with this. If necessary they can be asked to wait outside the room until the pizzas are served

Closing Set Of Whole Group Activities Serving Of Pizza And Refreshments For The Whole Group

(10-15 minutes)

USE

With the whole group after the Parents and Children’s Groups

SEQUENCE

Pizzas are served and parents are supported in their stipulations to the children about dietary restrictions (e.g. vegetarian for some religious groups), and the groups mingle and talk.

AIMS

• To further strengthen the social nature of the group

• To underline the ‘normality’ of the Kidstime social event.

MATERIALS

Pizza and other refreshments

INSTRUCTION

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• Children should wait till the adults arrive before starting

• Adults to help children regulate the number of pizza sections eaten fairly

WORK FOCUS

• To assist all families to participate in a ‘normal’ social event.

• To support parents in a mild exercise of regulating children’s behaviour.

• To generate a social atmosphere conducive to the discussion of the videos of the children’s work and of the parent’s feedback from their group.

CRITICAL SITUATIONS

• Some children may become excited and take more than their fair share

• Some parents may abrogate responsibility for the regulation of the feeding part of the programme.

In both cases the family workers should observe, prompt, but only intervene if it seems that either some children will unfairly lose out, or if it seems that the situation is liable to get out of hand. Watching the films of the children and feedback from The Parents’ group (5- 20 minutes)

NB: These are described together because they are both a part of one feedback and sharing event

USE

With the whole group after the Parents and Children’s Groups, and whilst some parents and/or children are still eating

SEQUENCE

The family worker who has been leading The Parents’ group either encourages one or more parents to report the main themes of their discussion (almost always without any specific, or at least personal detail), if he or she decides that it will be either too conflict laden or that the particular group is too reticent, then the family worker will offer a short summary him or herself The filmed segments are then shown to the whole group – usually lasting between 5 and 15 minutes in all.This is invariably followed by applause from all the adults present, and commonly several parents will express surprise at either how realistic a particular drama was, how accurately it represented an experience (such as part of an illness) that this or that parent had endured, or just how good the acting was. It is usually left to one of the family workers to also praise the young person who operated the camera.

AIMS

• To foster connection between the children’s and parent’s experience, whilst attempting to diminish the identification of the children with the parent’s disturbance.

• To create a context in which shared pride is developed between parents and children, which can in turn diminish parental guilt and shame.

• As a result of the above, to generate an emotional climate in which positive discussion of parental illness (as a group of parents, and without singling out any particular parents) as well as the response of children and young people, can be discussed.

MATERIALS

Video play back facilities (as above)

INSTRUCTION

‘Who would like to say something about The Parents’ group….?’, in the case of that group. ‘Silence please…and lights please…!’ before showing the films

WORK FOCUS

As under ‘Aims’ above

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CRITICAL SITUATIONS

Rare, but occasionally • A particular parent may become distressed in facing what their child has seen and/or

experienced.

• A particular child may become embarrassed by what they have represented

In all cases either of the above can usually be relatively easily resolved during the ensuing discussion (below).

Final discussion

USE

With the whole group after the Parents and/or their group leader (family worker) have reported the themes discussed in The Parents’ group, and the parents and children have watched the film/s produced by the children.

SEQUENCE

One family worker raises a question arising from one or both of the feedback sessions. “ So what did you think Andrew in the film was afraid of....?” or perhaps later “was anyone surprised or is that what you would have expected?.” then as opinions are generated “So do you all agree with that then...?” Usually there are one or two dissenting voices “ No, I think he was trying to....” Sometimes the children and the parents will take different positions “ Well, I think she started staying out late because she was too worried about her mum..”

AIMS

• To develop dialogue about mental illness and to challenge prior taboos about its discussion.

• To develop both shared and differentiated narratives between parents and children.

• To generate an atmosphere of tolerance and mutual respect between parents and children

MATERIALS

N/A

INSTRUCTION

As above, under ‘sequence’.

WORK FOCUS

Family workers will attempt to achieve differentiation between different points of view, whilst subsequently attempting to link differing opinions either by the identification of common themes: “ So did anyone notice that both the parents and the children were showing that they did not want to have to pretend to think or feel what other people might expect, but to say what they actually felt ?” or alternatively to demonstrate that apparent disputes may be representing different aspects of a similar concern. So for example after a parent has complained that they are not listened to by professionals, a question posed by a children’s drama about who to tell if one is upset or angry, could be linked “So you think it would be much better if you could be sure they want to hear your opinion........but then what do you think about the question raised in the film...... Do parents mostly want to hear what their children think or feel, and what should the children do if they believe that the parent does not want to hear what they feel at a particular time (like if the parent is feeling unwell)...what should they do ?”

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CRITICAL SITUATIONS

• If one parent attempts to dominate the discussion with a particular or an extreme point of view, or one which the family workers believe is unacceptable.

Family workers may have to intervene to ensure that multiple points of view are expressed, and rarely may have to express a counter point of view.

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REFERENCES

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KIDS TIMEAldridge J, Becker S (2003) Children Caring for Parents with Mental Illness. Perspectives of Young Carers, Parents, and Professionals. Policy Press.

Asen K E, Stein R, Stevens A, McHugh B, Greenwood J & Cooklin A., (1982) A day unit for families. Journal of Family Therapy, 4: 345-358

Asen K E, George E, Piper R, & Stevens A., (1989) A systems approach to child abuse: management and treatment issues. Child Abuse & neglect, 13: 45-57

Asen E, Dawson N, and McHugh B., (2001) Multiple Family Therapy: The Marlborough Model and its Wider Applications, Karnac, London.

Asen E, and Scholtz M.,(2010) Multi-FamilyTherapy: concepts and techniques, Rotledge, London.

Beardslee R, Bemporad J, Keller M, et al (1983) Children of parents with major affective disorder. A review. American Journal of Psychiatry 140: 825–32.

Bishop P., Clilverd A., Cooklin A., and Hunt U., (2002) Mental health matters: a multi-family framework for mental health interventions, Journal of Family Therapy, 24: 31-45

Brown GW, Harris T (1978) Social Origins of Depression. A Study of Psychiatric Disorders in Women. Tavistock.

Cooklin A, and Gorell Barnes G (2004) Family therapy when a parent suffers from psychiatric disorder, in Parental Psychiatric Disorder Eds. Seeman M., Gopfert M. and Webster J., Cambridge University press, Cambridge.

Cooklin A, Balmer S, Hart D, et al (2004) Being Seen and Heard. The Needs of Children of Parents with Mental Illness (training film). DVD and Training Pack, © Royal College of Psychiatrists, Gaskell, London.

Cooklin A (2005) Young carers, young victim or young survivors? Impacts on, and responses of, children of parents with mental illness. In Partners in Care Training Resource (ed M McClure). Royal College of Psychiatrists.

Cooklin A., (2006) Children and parents with mental illness, in Children in Family Contexts Ed. Combrinck-Graham, L. Guildford Press, New York.

Cooklin A, (2006) Children as carers of parents with mental Illness, Psychiatry 5:1, 32-35

Cooklin A, and Njoku C., (2009) When a parents has a mental illness…..: DVD and internet film © Royal College of Psychiatrists, London.

Cooklin A, (2010) Living upside down: being a young carer of a parent with mental illness, Advances in psychiatric treatment 16: 141-146

Cowling V (1999) Children of Parents with Mental Illness. ACER Press.

Dunn B (1993) Growing up with a psychotic mother. A retrospective study. American Journal of Orthopsy-chiatry 63: 177–89.

Falcov A (1999) Addressing family needs when a parent is mentally ill. In Approaches to the Assessment of Need in Children’s Services (eds H Wood, W Rose): pp 235–60. Jessica Kingsley.

Falcov A (2004) Talking with children whose parents experience mental illness. In Children of Parents with Mental Illness. Personal and Clinical Perspectives (2nd edn) (ed V Cowling): pp 41–56. Acer Press.

McFarlane, W.R., (1990) Multiple family groups and the treatment of schizophrenia. In M.I.Hertz, S.J.keith, & J.P.Docherty, eds., Handbook of Schizophrenia, Volume 4: Psychosocial Treatment of Schizophrenia, Elsevier Science Publishers.

McFarlane W.R., Link B., Dushay R., Marchal J., and Crilly J., (1995) Psychoeducational multiple family groups: Four-year relapse outcome in schizophrenia. Family Process 34:127-144.

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McGrath J, Hearle J, Jenner L, et al (1999) The fertility and fecundity of patients with psychoses. Acta Psychiatrica Scandinavica 99: 441–6.

Nicholson J, Sweeney EM, Geller JL (1998) Mothers with mental illness I. The competing demands of parenting and living with mental illness. Psychiatric Services 49: 635–42.

Nicholson J, Nason MW, Calabresi AO, et al (1999) Fathers with severe mental illness. Character-istics and comparisons. American Journal of Orthopsychiatry 69: 134–41.

Oates M (1997) Patients as parents. The risk to children. British Journal of Psychiatry 170 (suppl. 32): 22–7.

Parrott L., Jacobs G., and Roberts D., (2008) SCIE Research briefing 23: Stress and resilience factors in parents with mental health problems and their children, London, SCIE.

Quinton D, Rutter M (1984) Parents with children in care. 1 Current circumstances and parents, 2 Intergenerational continuities. Journal of Child Psychology and Psychiatry 25: 211–31.

Richman N (1976) Depression in mothers of preschool children. Journal of Child Psychology and Psychiatry 17: 75–8.

Rubovits P (1996) Project CHILD. An Intervention Programme for Psychotic Mothers and their Young Children. In Parental Psychiatric Disorder. Distressed Parents and their Families (eds M Göpfert, J Webster, M VSeeman): pp 161–9. Cambridge University Press.

Rutter M (1967) A children’s behaviour questionnaire for completion by teachers: preliminary findings. Journal of Child Psychology and Psychiatry 8: 1–11.

Rutter M (1990) Psychosocial resilience and protective mechanisms. In Risk and Protective Factors in the Development of Psychopathology (eds J Rolf, AS Masten, D Cicchetti et al): pp 181–214. Cambridge University Press.

Shachnow J (1987) Preventive intervention with children of hospitalised psychiatric patients. American Journal of Orthopsychiatry 57: 66–77.

Tienari P, Sorri A, Lahti I, et al (1985) Interaction of genetic and psychosocial factors in schizophrenia. Acta Psychiatrica Supplement, 319: 19–30.

Tienari P, Wynne LC, Moring J, et al (1994) The Finnish adoptive family study of schizophrenia. Implications for family research. British Journal of Psychiatry 164 (suppl 23): 20–6.

Tienari P, Wynne LC, Sorri A, et al (2004) Genotype–environment interaction in schizophrenia-spectrum disorder. Long-term followup study of Finnish adoptees. British Journal of Psychiatry 184: 216–22.

Valdez C R., Mills CL., Barrueco JL., and Riley AW: A pilot study of a family-focused intervention for children and families affected by maternal depression. Journal of Family Therapy (2011) 33:3-19

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APPENDIX I

MENTAL ILLNESS IN YOUR FAMILY – A RANGE OF SAMPLE

EXPLANATIONS WHICH FAMILY WORKERS CAN USE IN THE

SEMINAR SECTION, EITHER VERBATIM OR AS PART OF EXPLANATIONS DEVELOPED BY

FAMILY WORKERS

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KIDS TIMEWhy Is Mental Illness Difficult?

Illness in parents is always difficult, because the person who is there to look after you suddenly can’t do it, and you may have to be the ‘carer’ – the one who does the looking after - instead. This is always a bit confusing, but when a parent has a mental illness this can be even more confusing because:

1. She or he may not look ill or need to go to bed, although she or he may often (in some illnesses) not feel very energetic and look and behave tired.

2. The illness can affect how your Mum, Dad, or some other adult you rely on, thinks and feels about many things.

3. This change in his or her feelings may affect you, and make you wonder if it was because of something you did.

This leaflet is to help you answer some of the many questions you are sure to have if you have a parent with a mental illness. It will explain about mental illness, why it happens – as far as we know that – and what can help if you are living with someone who is mentally ill.

What Is Mental Illness?

All of us face problems in life at some time. Sometimes they can make us upset; such as sad, angry or depressed. Of course all of us get depressed or unhappy and miserable at some time, but it usually passes in a few hours or a day or two. When it doesn’t or when there are things making us too anxious or too upset to manage, then a more ‘stuck’ depression can set in, or a person can become worried about many things, some of which may not really matter. That person may even worry about silly little things that you or even he or she would laugh about another time. Their sleep may be upset. They may even feel a bit ill physically or have headaches or other pains. Other ways that the same kind of worries can show themselves are not being able to concentrate or worrying about food.

These are mental health problems which can generally be overcome if you the person find someone to talk to who understands these things. Most people get through these times by talking with their families or friends, or - if they are younger - sometimes teachers and youth workers. Sometimes people who are feeling like this may need to talk to a specialist, or even take some medicine to help.

It is when these problems get a bit out of hand that people can begin to behave in rather extreme ways; sometimes not eating, hurting themselves, or behaving in ways which seem to be against other people.

How Do People With A Mental Illness Feel?

Sometimes depression gets bad so that the person can’t sleep properly, loses his or her appetite and doesn’t enjoy anything.

Sometimes the person worries so much that he or she doesn’t go out, can’t sleep and feels anxious all the time that bad things will happen.

Sometimes the person gets thoughts about keeping everything in order and has to do things, like activities such as too much washing, which he or she may believe will stop bad things from happening. These are called obsessive thoughts.

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Sometimes the person can behave in a way that seems as if he or she doesn’t care about anyone else, and just wants to have things their way. This might mean that the person upsets other people but it may be that really he or she feels very unhappy inside him or herself, without really knowing why.

Sometimes when a person gets ill things can go beyond what we can normally understand. A person’s behaviour, as well as what they say may seem to just not make any sense.

The reason this happens is usually a mixture of different things – such as the way people are built or made up (like what they inherit in their genes), but this is always affected by how they live their lives ( including stresses and strains such as losing a job or splitting up with a partner), as well as the kind of life they live when they are growing up.) It can also happen because their mind or brain gets overloaded – that is it cannot cope with or manage all the things going into it. We don’t exactly know why this happens to some people, but there are some ideas below.

How Does This Happen?

Although some kinds of worries and anxieties can make it worse, worries on their own cannot make a person have mental illness. It seems to happen when a part of them feels especially weak (something in the brain), and then some special stresses are added that they cannot cope with.

Here’s One Way Which Might Help You To Understand It:

[See the picture Appendix 1a]

Here’s a brain inside the body. The blue lines are nerves which send messages to your muscles so you can move. They are called motor nerves. The red lines are also nerves, but they send messages back to the brain so you can feel what is happening. They are called sensory nerves. Try this experiment:

Close your eyes and make your arm and hand do several different movements. Then before you open your eyes, guess where the end of your finger tips will be. Open your eyes and see if you were right. Then close your eyes again and touch your left ear with your right hand. Did you manage it ? If you did it shows that the nerves you used are working well together. Your motor nerves told your hand where to go, but your sensory nerves told your brain where your hand was going. That’s good coordination. So the brain talks to the body and the body talks to the brain. Well the same thing also happens between the brain and the mind – or what you think.

You can make your brain concentrate on one thing or another, but if you try to think about too many things you can get very muddled and often can’t concentrate on any one of them. That’s why teachers often want to stop children from talking in class or from looking out of the window and so on. But most of us are really good at focussing even if there are lots of things going on. Try this experiment with three or more friends.:

Stand in a room and all talk at once. The amount of sound will be all the noise each one of you made added up. One friend should be selected (without the others knowing) to keep saying the name of one of the others, but no louder than the others. He or she will, probably hear their name quite soon, even though the other sounds were louder. This is because our brains can sift out or sieve out or filter out (whichever word you like best ) the things we need to pay attention to. Otherwise our minds would be overloaded and couldn’t work at all. We think that there is a part of the brain which does this job. But when someone has a severe mental illness they often can’t choose what to hear, so they hear everything. So you can see how their mind could then become very jumbled up and have strange thoughts and ideas which don’t fit. This can happen for three main reasons:

1. their brain is just having to cope with too many ideas, worries, feelings and everything, so that it just can’t filter out what is important

2. because in the person’s early life they have had just too many things to cope with, so that they have too many feelings and ideas going round and round inside their mind, to cope with any new ones

3. because the bit of the brain that does the sifting out or filtering is not working properly. We do not know exactly why that happens to some people, but that part

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of the brain does seem to be a bit weaker in some families. That does not mean that those people have to get a mental illness, because it needs the other stresses for that to happen, and anyway there are ways to protect your brain from ‘overload’. In fact if your parent has had a severe mental illness, it is likely that he or she will have been given medication, and that medication will often be aimed at helping the brain ‘filter’ to cope.

Will I Inherit Mental Illness From My Relative?

Everyone has episodes in their lives which could trigger stress responses or make existing problems worse. Some of us cope better than others, a fact which depends on many things about our biological makeup and what happens in our early lives. Although one in four of us may one day have some sort of diagnosable mental health problem in our life-time, very few of us will have a serious mental illness. Even if both your parents have mental illness you are still much more likely not to have mental illness yourself than you are to have it. If you are worried at any time that you may have symptoms it is sensible to go straight away to your GP. Starting treatment early can really help in terms of keeping you well and able to function normally. However,talking to someone who you trust about the feelings inside you can help to protect you.

Will I Get Mentally Ill From Doing Drugs?

There is still not evidence that says that drugs actually cause permanent mental illness. What looks to be more likely is that heavy drug use, and that includes alcohol, could affect your memory permanently. It is unwise to use cannabis heavily in your teenage years if you have a family member who has mental health problems, particularly schizophrenia, as some research studies show close links in these cases. There are other resources you can find which explain more about this

Who Can I Go To If I Am Worried About My Relative’s Mental Health?

Often people who are mentally ill either don’t realise that they are getting ill or don’t want people to know about it – so they try their best to manage. This can put an enormous strain on the other members of the family. You can always go to your GP, but s/he may not be able to do anything against the wishes of your relative, unless they are becoming a danger to you and others. If this is the case don’t hesitate to ask for help.

You can also ask Social Services to help in either case. People worry that involving Social Services will mean that they are taken away from their parents, but this is the last thing Social Workers want to do. They will want to help you to manage in your own home, with the support of other members of your family.

You may feel very stressed out by your relative’s illness and the behaviour it produces. School nurses or school counsellors can be very helpful in talking all this through with you and being there if you need to get things off your chest.

If at any time you feel really frightened by your relative’s behaviour and you are unable to contact a doctor or a social worker you should dial 999. You may feel bad about this but it could be the only way to get the help your relative needs.

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APPENDIX 1A

THE BRAIN AND SPINAL CHORD

Brain

Spinal Chord

Nerves to muscles `Motor Nerves`

Nerves that send feelings to the brain

`Sensory Nerves`

The Brain and Spinal Chord

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APPENDIX 2

10 IDEAS FOR DRAMA IN ‘KIDSTIME’ WORKSHOPS

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KIDS TIME1. Games, Games And More Games

Having a wide collection of games is useful. Games to warm up, help to build confidence, to help the group get to know each other, to play and have fun, to experiment with different ways of communicating, to help to build characters and to develop ideas.

A couple of my favourite warm-up games are:

Kidstime

• All form a group sitting – less one chair

• One in the middle says “All those who…(must be something the speaker is wearing, did that day or has as an attribute (e.g. black hair).

• Those in the category must change seats.

• Whoever is left out is then in the middle

• The person in the middle may also say ‘KIDSTIME !’ when the whole group must change seats, and one will be left out to go in the middle

Gita, Gita, Gita also known as Bob, Bob, Bob

• Group makes one big circle

• Everyone goes round & says their name. This should be said as loudly & confidently as possible. Go round again if necessary.

• One person stands in the centre of the circle

• The aim is to get out of the centre & join the big circle. To do this they have to say someone’s name three times before that person says their name once.

Sign Names

• Group makes one big circle

• Everyone thinks of a sign, a physical action that says something about them. This could describe their physical appearance, an interest they have or simply be a movement they like.

• One by one each person says their name and does their action at the same time. Everyone repeats this.

• The group call and respond. One person starts off by using their name and sign and following it with someone else’s name. That person continues the game e.g. Gita to Keith, Keith to Deni, Deni to Jason, and so on.

2. Frozen Image Work also known as freeze frames, photographs, still images, body sculptures and tableaux These can be individual or as groups

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If they are portraying emotions such as anger, or themes that may contain physical violence, such as bullying, it is important to stress that no-one should get hurt making these pictures. This is one reason that they are frozen so that any physical violence is frozen rather than acted out. The images can then be worked with safely.

Abstract Frozen Images

Emotions e.g. anger, happiness, peace, love, justice etc

Physical Frozen Images

E.g. Shapes : triangle, star, rectangle, etc E.g. Machines : computer, toaster, car, etc E.g. Structures: Tower Bridge, Taj Mahal, Elizabeth Castle, etc

Situational Frozen Images

Set up scenes by suggesting ‘titles’ E.g. ‘The Playground’, ‘The Staff Room’, ‘The Family’, ‘Friends’, ‘The Rollercoaster’, etc

3. Thought-tracking

This can be used to develop frozen images. Statues, characters, pictures can all be brought to life. What are they thinking? What are they saying?

4. Creating Stories from Frozen Image Work

There are endless possibilities:

• Using thought-tracking –getting characters to interact with each other, moving on from the image.

• Starting from the frozen image – What happens next? What happened just before? Fast forward 10 years…show me that picture/scene.

• You can move backwards and forwards in time to create and develop

• Characters and stories.

• Create 3 images using the original image showing the beginning, middle and the end of a story.

5. Improvisation

Start gently and build up skills and confidence. A non-verbal impro game is a good start such as ‘Shake hands’. Pair work – give themes/suggestions. Ask for suggestions or collect them from an intro game.‘Speed Impro’ is a good way of lowering the stakes and building confidence as everyone is improvising at the same time and the split focus can be freeing, increasing investment and creativity.

6. Building A Character

Again this can be done in many ways. You could use the Frozen Image Work or the Improvisation as a stimulus. Once a character has been established it can be developed. As the group walks around the room ask questions to start this process: How does your character walk? What is your name? How old are you? Where do you live? Who with? What do you like? Think of 3 things you like. What are your dreams? What are your fears? How do you feel about the people around you? Etc.

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7. Hot-seating

One person is in the ‘hot-seat’ in character. The group can ask any questions they like. You can set the parameters for the answering of the questions e.g. you must tell the truth, you can refuse to answer, you can be vague etc

Hot-seating is useful to develop and explore characters. Hot-seated characters can then be put into scenes with one another.

8. Creating A Character As A Group

Using a series of objects e.g. a jacket, an empty photo frame, a torn piece of a map, a train timetable…..etc etc as a group build up a picture of who this person is. Give them a name and a context. Something has happened to them today, what is it? Decide who you are in relation to this character. How do you know them? What is your relationship to them? When was the last time you saw them?

Options include : Interview each member of the group. Put them into scenes with one another. Create a story with or without the central character.

9. Talking Heads

Technique in which people talk directly to camera on a subject/issue. This can be as themselves or in character. Useful as a debriefing after a scene/play/film.

10. Forum Theatre

Create a scene or play showing the leading character, the ‘protagonist’, facing difficult situations (oppressive forces) and not dealing with them very successfully. Show the piece straight through once. Replay the scene and this time engage the audience in trying out possible solutions to the difficult situations.

Extra: ‘Selective Hearing’

In pairs choose a sound or name Do not tell anyone else. Pairs break up and spread out in the room (mingle with others). Close eyes. On a given signal, try to locate your partner with eyes closed, using your sound or name. Can make it more difficult by playing some music at same time (only necessary when with small groups).

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‘Home was sad, Kidstime was fun. That’s what I looked forward to. I looked forward to having fun, you know being a child. But at home you have to be an adult, look after yourself, look after mum, look after the house, give her medication; at Kidstime you’ve having fun. You’re being looked after and you’re not looking after others. …there are people there who are paying attention to you and you can go and speak to because you probably can’t speak to your mum because you know she’s not well she probably won’t understand. But Kidstime was time for the kids; I think that’s why it’s called Kidstime. ‘Ex-attendee - young person

‘When I started the Kidstime project, I felt like I couldn’t really express myself, because I know that people often thought that because my mum had mental illness I may have mental illness, so I didn’t want to say anything, because I didn’t want to seem odd or say anything inappropriate, so I kept to myself. So when I started coming to this project, you realise that, not necessarily, because when you know that other people have the same problem as you, and they look normal, they seem normal, that’s its okay to come out and just, you know, express yourself a bit more. So I just felt like I wouldn’t necessarily, after learning about the illness I felt like I wouldn’t necessarily become mentally ill, so it’s okay for me to express myself. ‘Ex-attendee- young person

‘I’ve learned a few more names of illnesses and I’ve learned some side effects of illnesses and how to know the difference between if a parent is, stroppy to know the difference if it’s ill stroppy or normal stroppy. ‘Young attendee

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For more information go to :www.annafreud.org/pages/camhs-evidence-based-practice-unit.html

or email EBPU@annafreud.org

EvidenceBasedPracticeUnit

The ‘Kidstime’ is an approach to helping the children of parents with mental illness. The approach has developed over the past 12 years (Cooklin 2004, 2005, 2006, 2010). ‘Kidstime’ aims to: • help the children and young people gain understandable explanations

of their parents’ mental illness, and the behaviour in the parent which may be associated with this

• address the children’s various fears, confusion, and lack of knowledge about mental illness and its treatment

• help the parents who suffer from mental illness find a medium within which the illness and its impact can be discussed between themselves and their children

• help the parents access or rediscover their pride, confidence and competencies as parents

• help the children experience their parents responding in a more positive manner

• encourage the children and young people to feel freer to engage in pleasurable age-appropriate activities.