The Parent’s Mental Illness Presenting Through the Physically Well Infant

Parental Mental Health

The review of referrals at RCHIMHG revealed that the majority of infants (75%) had at least one parent with a significant mental health problem. The full spectrum of mental health problems was represented— with parents experiencing mild anxiety or depressive symptoms through to posttraumatic stress disorder and to major psychotic illnesses. The relationship between the parent’s own psychological state and her response to her infant’s hospitalisation is complex.Influences include the parental couple’s previous relationship and mental health, the process of the pregnancy and child’s birth, the infant’s own medical problem and the relationship of the family with the health care system itself.

A parent’s mental health may be severely compromised although the infant appears physically well.When a parent has decompensated the hospital may still have a major role in intervening in such a family crisis. The paediatric hospital is a place where troubled parents will bring their child when they fear for their health. Three-month-old Carl was brought to a hospital emergency department by his mother Joan, who was in a very distressed and agitated state. Carl was admitted to a general paediatric ward. Joan talked directly and intently to the medical and nursing staff, insisting that there were tests to be done: she was horrified at the sight of insects emerging from his skin through his scalp and his arms. Suddenly she would point to a minuscule blemish on his otherwise pristine skin, exclaiming in horror that the baby was infected, perhaps to die, with these apparent insects. Her husband, thin and wiry and rather hostile to the staff, agreed with her observations and demanded immediate action. His son needed some blood tests he said, and maybe X-rays to see how they had managed to track from his throat to the top of his scalp.

Carl’s body seemed very passive, lying there languidly across his mother’s lap as she pushed his head sideways and prised open his tight mouth to demonstrate the creatures. His gaze was frozen: he looked fixedly on the nurse as the infant mental health consultant tried to commence an assessment of the situation. His eyes spoke. His body seemed to have given up, it was limp and passive, and he responded to the handling by his parents as if he were a rag doll. His mother’s concern was clearly for him, but she seemed so agitated she could not see him as a person. There was no attunement between Joan and her infant son; it was as if all that his mother could see were the insects, which no one else could see. She could not see the distressed intensity and fear in his gaze. Despite attempts by the medical staff to reassure her that all would be done for her son’s welfare, Joan and her husband picked up their children and tried to flee when there was a suggestion that Carl’s sister also needed to be examined. They feared that their children would be removed from them. Both children became even more fearful as their parents’ agitation increased. The adult mental health crisis team and police were called to try and contain the situation and Joan was taken to an adult mental health assessment unit. Her agitation and paranoid ideation intensified over the subsequent 24 hours but then she slept and calmed when given a moderate dose of a major tranquilliser. Joan revealed that she had been using amphetamines, and that this was a long-term habit. Her need had spiralled desperately in recent times as she strived to keep herself awake sufficiently to care for her children.

Joan was experiencing an acute paranoid psychotic illness secondary to her drug misuse. Her husband was also using ‘speed’, and he became uncontactable for some weeks following Joan’s transfer to the acute psychiatric unit. As Joan was recovering from her acute psychotic illness she seemed reassured that her baby was at the hospital, even as she began to realise that he was not infested with insects. It seemed that for Joan the distress of becoming a parent again was a significant precipitant for her intensified dependence upon stimulant drugs and her psychotic break. Amy’s mother was able to modify the disorganising threat of the trauma she experienced.

Carl’s mother was unable to do so.

The care of mothers with a psychotic illness requires close collaboration between specialist perinatal psychiatric services and the mother’s ongoing mental health team and psychiatrist. This close collaboration is especially important because in the busy caseload of an adult mental health clinician the needs of the infant may not be apparent to the treating team.The gravity of the parent’s illness may make it very hard to see the emotional and developmental needs of her young infant. There is an increasing literature describing the mental health needs of parents and their infants (Stone, Chapter14this volume; SvedWilliams, 2004).

A national initiative, Children of Parents with Mental Illness (COPMI)1has produced some extremely useful resources and publications to assist those caring for mothers with chronic or severe mental illness in order to coordinate the care of the infant and the infant parent relationships. Grunebaum, Weissman, Cohler, Hartman and Gallant (1982) followed a cohort of such families for many years in Chicago and demonstrated how hard it can be for mentally ill parents who strive to continue to provide care and love for their children in the face of the pervasively disruptive impact of serious mental illness.They emphasised the need for active links between mental health, family support,child health and child protective services.

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