QUESTION
My wife has always suffered on and off from depression. This would often get worse when our children were born ( two boys and a girl, aged 8,6 and 5) but in recent years she has been coping well. We have supportive extended family on both sides and she works part-time. She has been on medication for the last six years and this has seemed to help her and she has been the full -time carer of the children in the home.
However, recently she has been down in the dumps again – and her psychiatrist has recommended that she goes into hospital for a few weeks to review her medication. I am really worried about how disruptive this might be and I want to know how to talk to the children about this.
We have never really spoken to them about their mother’s depression – but recently the eldest asked me why her mother “becomes so quiet and doesn’t talk ” and I was unsure what to say. I also worry how her going into hospital might affect them. I can reduce my work and be there more during this time and my own mother will be around to help. I guess I am wondering how to explain it to them all.
ANSWER
Parental depression and mental illness impacts the whole family and children can be affected in lots of different ways. Frequently, children experience their parent as withdrawn or less available when they are in a bout of depression. Further, parents can be reluctant to explain what is going on, which can cause the children to worry or even to wonder if their parent’s behaviour is their fault.
In addition, an inpatient stay for a parent in hospital puts stress on the whole family and adult mental health services can focus only on the individual patient and forget they are parents whose children need help to manage also. However, it is great that you are thinking of your children and how to help them. There is a lot you can do to help them cope and being sensitive to their needs can make a big difference.
Talking to children about parents mental health problems
Rather than avoiding a conversation, it is important to talk to your children about what is going on for their mother in a concrete way that is appropriate for their age and understanding. At different ages, each of them will need different levels of information. Your eldest is already asking questions suggesting she is worried and she will need particular support and reassurance.
The ideal way to start a conversation is for you and your wife and to sit down and talk to the children as a group and then to follow up with one-to-one conversations.
Pick a good time when you are all relaxed and explain in the simplest terms that the youngest can understand.
Picking the right language is important, for example, “you know that Mummy has been feeling a little sad recently, well to help her feel better she is going to go into a special hospital for a few weeks”.
It can be helpful to use the word depression to explain what is happening. Most children are familiar with the concept of physical illness and the need to go into hospital to get better. “Mummy will be going into a special hospital that helps people with depression.”
In your initial explanation, keep your voice tone neutral and matter of fact so you can tune into your children’s reactions to the information. Pause and give them plenty of time to ask you both questions and to express their feelings.
Having one to one conversations
It is important to follow up with each of your children on a one-to-one basis to see they feel about things and if they have any further questions. This allows you to personalise the information according to their age and what they might be worried about. For example, when alone with the eldest you might ask “what did you think of what we told you about Mummy feeling depressed? Do you have any questions?”
Your daughter may want more specific details of how the depression affects her mother and to talk about her own feelings and fears. She may in particular need to be reassured that she is not at fault for how her mother is feeling. Let her know that she can come again to talk to you and make sure to check in regularly as to how she is feeling.
Minimise the disruption of hospital
If you are worried about the disruption of a hospital stay, talk to the medical team about this. Can her medical treatment be regularised on an outpatient basis, while providing supports at home? If she needs to be hospital how can this stay be kept short?
Make sure to reassure the children about the practical arrangements about who will be caring for them and when they can visit or talk to their mother by phone. A rota and clear routine during the hospital stay can really help young children cope and feel secure.
Support wife’s relationship with children
When a parent becomes depressed or mentally unwell, they can find the demands of parenting extra stressful and it can be harder for them to be in the parenting role.
Accept that you and other family members may have to take a more central role in the parenting for the time being and make sure to support your wife’s relationship with the children.
Make sure she has one-to-one time with each of them when she can check in and play with them as well as have relaxed enjoyable time with each of them. This will help maintain a good connection between them and be good for the mental health of both your wife and the children.
Focus on your family’s long term mental health
Supporting your wife’s long-term mental health is the key to helping her and the children. Explore long term supports that can be put in place for your wife when she comes out of hospital.
Discuss with her what would help her and there are lots of options to consider such as outpatient counselling, or community support groups such as those organised by Aware (www.aware.ie) or Grow (www.grow.ie).
Dr. John Sharry, Irish Times Newspaper, May 2013. John writes in The Irish Times Health Plus every Tuesday.
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