Children Of Parents With A Mental Illness Research Articles

Children of parents with a mental illness - stigma questionnaire: validation and revision.

Mental disorders are often stigmatized in society. The stigma of mental illness affects people with a mental illness themselves as well as their family members-a phenomenon called stigma by association (SBA). Children of parents with a mental illness (COPMI) are a particular vulnerable group for SBA. In our systematic review, experienced SBA, anticipated SBA, affiliate SBA, and structural discrimination were identified as relevant stigma dimensions for children of parents with a mental illness. To assess SBA in adolescents who grow up with a parent with a mental illness, the COPMI-SQ was developed. N = 930 adolescents completed the study. Of those, N = 380 adolescents (sample 1; 72.6% female, mean age 17.12 (SD = 2.01) years) reported growing up with at least one parent with a mental illness. Using confirmatory (CFA) and exploratory factor analyses (EFA) as well as standard item and reliability analyses, we analyzed and revised the COPMI-SQ in the first sample. To validate the factorial structure of the revised COPMI-SQ, CFA was also conducted in the independent sample of the other N = 550 adolescents (sample 2; 80.0% female, mean age 16.36 (SD = 1.98) years) who reported not growing up with a parent with a mental illness. To test four measurement invariance, a multiple-group CFA was conducted in the combined sample of adolescents who reported growing up with and without a parent with a mental illness (sample 1 and sample 2). CFA in sample 1 resulted in an inadequate model fit for the theoretically assumed four-factor structure (CFI = .687; RMSEA = .064 (90% CI = .062-.066); SRMR = .092; AIC = 229 155.63). Following EFA and item and reliability analyses in sample 1, the COPMI-SQ was reduced to four scales ("Experienced SBA," "Affiliate SBA," "Shame," and "Anticipated SBA") and two additional screening scales ("Healthcare" and "Social support"). To facilitate questionnaire use, only the three best items were retained in each scale, reducing the total item number to 12 plus five additional screener items. CFA in sample 2 also resulted in an inadequate model fit for the theoretically assumed four factor structure (CFI = .667; RMSEA = .065 (90% CI = .063-.066); SRMR = .101; AIC = 335 651.99). In comparison, the final version of the COPMI-SQ-r showed the best model fit (CFI = .945; RMSEA = .062 (90% CI = .052-.072); SRMR = .049; AIC = 60 008.05). In the multiple-group CFA (sample 1 and sample 2), metric invariance was established (χ2 (208) = 481.58, p < .001; CFI = .939; RMSEA = .053 (90% CI = .047-.059); SRMR = .056). In sample 2, internal consistency was found to be good for the total scale (α = .84) and almost acceptable to almost good for the subscales (α = .64 to.78). The revised version of the COPMI-SQ (COPMI-SQ-r) is a reliable and economic questionnaire to assess SBA in adolescents who grow up with a parent with a mental illness. The COPMI-SQ-r can be used to help develop and evaluate anti-stigma and general interventions for affected adolescents.

Facial emotion recognition in children of parents with a mental illness

ObjectiveFacial emotion recognition (FER) is a fundamental social skill essential for adaptive social behaviors, emotional development, and overall well-being. FER impairments have been linked to various mental disorders, making it a critical transdiagnostic mechanism influencing the development and trajectory of mental disorders. FER has also been found to play a role in the transgenerational transmission of mental disorders, with the majority of research suggesting FER impairments in children of parents with a mental illness (COPMI). Previous research primarily concentrated on COPMI of parents with internalizing disorders, which does not cover the full spectrum of outpatient mental health service populations. Furthermore, research focuses on varying components of FER by using different assessment paradigms, making it challenging to compare study results. To address these gaps, we comprehensively investigated FER abilities in COPMI using multiple tasks varying in task characteristics.MethodsWe included 189 children, 77 COPMI and 112 children of parents without a diagnosed mental illness (COPWMI), aged 6 to 16 years. We assessed FER using three tasks with varying task demands: an emotional Go/NoGo task, a morphing task, and a task presenting short video sequences depicting different emotions. We fitted separate two-level hierarchical Bayesian models (to account for sibling pairs in our sample) for reaction times and accuracy rates for each task. Good model fit was assured by comparing models using varying priors.ResultsContrary to our expectations, our results revealed no general FER deficit in COPMI compared to COPWMI. The Bayesian models fitted for accuracy in the morphing task and Go/NoGo task yielded small yet significant effects. However, Bayes factors fitted for the models suggested that these effects could be due to random variations or noise in the data.ConclusionsOur study does not support FER impairments as a general feature of COPMI. Instead, individual factors, such as the type of parental disorder and the timing of its onset, may play a crucial role in influencing FER development. Future research should consider these factors, taking into account the diverse landscape of parental mental disorders.

Association of parental mental illness with anxiety and depression in adulthood: The role of potentially contributing factors

ObjectiveChildren of parents with a mental illness (COPMI) are at risk of developing mental disorders in adulthood, especially anxiety disorders and depression. The role of the family environment and demographic factors as related to adult anxiety and depression is insufficiently understood. We examined potentially contributing factors in the associations between a COPMI background with anxiety and depressive symptoms in adulthood. MethodCross-sectional general population-based study. Instruments were the General Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9) and a questionnaire to evaluate self-reported history of a COPMI background and family-related experiences (CEPMIF). Multiple regression analyses were used to examine the role of demographic and family-related factors in the association of a self-reported COPMI background with the level of anxiety and depressive symptoms. ResultsOf the 942 participants (mean age 48.1 (SD = 16.2) years; 53.7 % women), 116 (12.3 %) had a COPMI background. A COPMI background was associated with higher levels of anxiety and depressive symptoms. Within individuals with a COPMI background, relationship problems within the family were associated with elevated levels of anxiety and depression. LimitationsThe cross-sectional design does not allow for causal inferences, COPMI background was based on participant's self-report, and the type of parental mental disorder was not considered. ConclusionsAdults with a COPMI background have higher levels of anxiety and depressive symptoms. Dysfunctional family relationships during childhood were associated with the severity of mental health problems of adults who grew up with a mentally ill parent. There is a need for targeted interventions for adult COPMI.

Resilience, Social Connectedness, Mental Health Status and Quality of Life in Children of Parents with Mental Illness

Background: Children of parents with a mental illness (COPMI) are at greater risk of psychological and physical ill-health, increased behavioral and developmental difficulties, educational underachievement and lower competency than their peers compared to children of healthy parents. The aim of this study was to find resilience, Social Connectedness, mental health status and quality of life (QoL) in COPMI. Materials and Methods: Cross sectional Analytical study was used in the present study. Thirty COPMI with age group of 11–18 years of age, either of the biological parents was diagnosed with severe mental illness (Schizophrenia and Bipolar affective disorder according to international classification of diseases-10) were selected. Socio-demographic data sheet, Connor-Davidson Resilience Scale, KIDSCREEN-27 (QoL), Social Connectedness Scale, Strength and Difficulties Questionnaire (SDQ) were administered. Results: The finding shows that 33.3% of COMPI had low level of resilience and a stronger sense of social connectedness (M = 78.63, standard deviation [SD] = 6.83). Psychological wellbeing (M = 20.77, SD = 2.68) was higher than other domains of QoL, followed by autonomy and parents (M = 18.46, SD = 3.43), school environment (M = 14.56, SD = 2.87), physical wellbeing (M = 14.43, SD = 1.88), and peer and social support (M = 10.87, SD = 2.08). The finding shows that in the total difficulty score (SDQ), 26.7% falls under normal category while 73.3% have abnormal scores. Total Difficulties score (SDQ) has a significant negative correlation with QoL [r=-0.520, P = 0.01] and Social Connectedness (r = ‒0.478, P = 0.01). Conclusion: The study highlighted the risk of developing emotional and behavioral problems among COPMI. Resilience based intervention is required at school and community level for mental health promotion among children.

Mental health literacy websites for children of parents with a mental illness.

This review of online mental health resources was conducted to evaluate and document the availability of mental health resources pertinent to the needs of children of parents with a mental illness (COPMI). This review identified available websites and analyzed the appropriateness of content and readability. We conducted an extensive 6-month review of websites with available mental health literacy content that may be found by COPMI searching for information. Web content was evaluated and described with qualitative thematic analysis techniques. Web content was also evaluated for reading levels using the Flesch-Kincaid readability analysis tool. The researchers described 7 descriptive themes, 10 content areas, and described what information was available across websites and where gaps existed. They also concluded the average reading level of the websites was 9.7, which was substantially higher than current web development recommendations. Websites can be a valuable tool for COPMI without access to direct services. To improve current web resources, developers should strive to offer content specific to the identified needs of COPMI. Additionally, web content should be developed at a level that is accessible to teens and parents.

Helpful resources recognized by adult children of parents with a mental illness in Japan.

This study aimed to identify the resources recognized as helpful by children of parents with a mental illness (COPMI) to cope with the difficulties they experienced in their lives. A qualitative descriptive design was employed. Semi-structured interviews were conducted with 10 adults who experienced parental mental illness in their childhood. Participants were asked to discuss resources that were beneficial to them. Text segments from the verbatim transcriptions were identified with summarizing codes, and the codes were compared and contrasted to generate subcategories and categories. The case characteristics and subcategories were reorganized to retest the validity of the categories. Parental mental illness onset occurred before birth or in early childhood for four participants and during elementary or junior high school for six participants. Six categories emerged: protection from the harmful influences of parents' symptoms; care received from adults at home and school; occasional experience of mutual affection and support within the family; emotional validation and sustained support by others; understanding how to cope using information on mental illnesses; and time for oneself and experiences away from the parent. Helpful resources recognized by COPMI involved not only emotional connections, but also resources related to their daily lives and time for themselves. Understanding the gaps in COPMI's resources can facilitate effective support. Emotional validation by others and time for themselves and away from the parent are important for promoting their development. Society needs to better understand mental illness.

Children of Parents with a Mental Illness: Predictors of Health-Related Quality of Life and Determinants of Child-Parent Agreement.

(1) Background: Health-related quality of life (HRQoL) is frequently reduced in children of parents with a mental illness (COPMI). Child self- and parent proxy-ratings vary with raters’ characteristics and facets of HRQoL. This study aimed at analyzing risk and protective factors associated with HRQoL in COPMI, and at examining the magnitude, direction, and predictors of child–parent agreement. (2) Methods: Analyses were based on baseline data of the German CHIMPS (children of parents with a mental illness) project with n = 134 parents diagnosed with mental illness and n = 198 children and adolescents aged 8 to 18 years. (3) Results: Both children and parents reported significantly lower HRQoL than the reference population, particularly for the child’s physical and psychological well-being. Parents’ proxy-report indicated a lower HRQoL than the children’s self-report. Child and parental psychopathology, social support, and the child’s age significantly predicted HRQoL. Interrater agreement was satisfactory and better for observable aspects like physical well-being and school environment. The child’s gender-identity and mental health significantly predicted child–parent agreement. (4) Conclusions: Parental psychopathology significantly reduces children’s HRQoL. Interventions should promote resilience in children by targeting risk and protective factors. Child–parent agreement emphasizes the need to obtain both self- and proxy-reports, whenever possible.

Supporting Children of Parents With a Mental Illness: State of Research and Two Practice Approaches and Claims for the Government

Supporting Children of Parents With a Mental Illness: State of Research and Two Practice Approaches and Claims for the Government Children of parents with a mental illness (COPMI) are at an increased risk to develop (severe) mental disorders (SMI) themselves. Estimates for Germany result in about 25 % of COPMI. This is thus a large and high risk group. On the other hand, prevention programs for COPMI are still scarce, especially in Germany, and central features of the transgenerational transmission of mental disorders have not been studied in conjunction to shed light on potential transmission mechanisms. The current article presents two current research projects on COPMI focusing on preventive approaches. The BMBF funded project "Children of Parents with a Mental Illness At Risk Evaluation" (COMPARE) targets parents of children aged 1.5 to 16 years of age. Parents need to fulfil a current DSM-5 based diagnosis of a mental disorder and then receive either 25-45 sessions gold standard cognitive behavioural therapy (CBT) or CBT plus 10 sessions Positive Parenting Program (PPP) to test the effects of parental therapy on the children and whether an additional parent training results in incremental effects above and beyond CBT alone. The project "The Village" is a model project in the region Tyrol, Austria, targeting the improved identification and collaborative care of COPMI.

Supporting children who have a parent with a mental illness in Tyrol: a situational analysis for informing co-development and implementation of practice changes

BackgroundA research project, which aims to improve the situation of children of parents with a mental illness (COPMI) is currently underway in the Austrian region of Tyrol. The project aims to strengthen formal and informal support structures around the child, through enhancing their village of collaborative support. Understanding the current situation in the region is vital for implementing practice change. This paper aims to gain knowledge regarding the Tyrolean societal and service provision context.MethodsWe collected qualitative (17 interviews among stakeholder and people with lived experience) and quantitative data (e.g. health insurance data) regarding overall societal characteristics, epidemiology of mental illness, currently existing services, uptake of services, and current practices and challenges of identifying and supporting COPMIs. We analysed data along eight external context dimensions: 1) professional influences, 2) political support, 3) social climate, 4) local infrastructure, 5) policy and legal climate, 6) relational climate, 7) target population, and 8) funding and economic climate.ResultsWe identified that there is awareness of potential challenges related to COPMIs at both a professional and planning level. Additionally, there is a lack of installed support processes and standards to meet these children’s needs across Tyrol. A variety of services are available both for unwell parents, as well as for families and individual family members. Yet, only one small service addresses COPMIs directly. Services fall into different sectors (education, health, social affairs) and are funded from different sources, making coordination difficult. Access varies from universal to rather restricted (i.e. through referral). The potential number of parents which could be reached in order to identify their children via adult mental health, differs considerably by setting. Societal structures indicate that the informal and voluntary sector may be a realistic source for supporting COPMIs.ConclusionsThe societal structures and the current services provide a rich resource for improving identification and support of COPMIs, however considerable coordination and behaviour change efforts will be required due to the fragmentation of the system and professional cultures. The insights into the context of supporting COPMIs have been of high value for developing and implementing practice changes in the local organizations.

정신장애를 가진 부모의 자녀(Children of Parents with a Mental Illness, COPMI)에 대한 설명 모델과 심리사회적 개입에 대한 고찰

This review provides the mechanism of transgenerational transmission of mental disorder (TTMD), the factors involved in them, and the psychosocial interventions in the Children of Parents with a Mental Illness (COPMI). The TTMD is a combination of biological risk factors and various psychological risk factors including parent-related factors, family condition, child-related factors and social-environmental factors. Interventions in the COPMI consist of peer support programs, parent education, family intervention, professional education, and community networking. Evidence on the effectiveness of intervention programs is accumulating. Policies and researches are needed to strengthen medical and social support in Korea to reduce social losses from TTMD.

Children of Mentally III Parents at Risk Evaluation (COMPARE): Design and Methods of a Randomized Controlled Multicenter Study-Part I.

Objectives: Mental disorders are frequent, associated with disability-adjusted life years, societal, and economic costs. Children of parents with a mental illness (COPMI) are at an increased risk to develop disorders themselves. The transgenerational transmission of mental disorders has been conceptualized in a model that takes parental and family factors, the social environment (i.e., school, work, and social support), parent-child-interaction and possible child outcomes into account. The goal of the “Children of Mentally Ill Parents At Risk Evaluation” (COMPARE) study will thus be twofold: (1) to establish the efficacy and cost-effectiveness of a high-quality randomized controlled trial (RCT) with the aim of interrupting the intergenerational transmission of mental disorders in COPMI, (2) to test the components of the trans-generational transmission model of mental disorders.Methods: To implement a randomized controlled trial (RCT: comparison of parental cognitive behavioral therapy/CBT with CBT + Positive Parenting Program) that is flanked by four add-on projects that apply behavioral, psychophysiological, and neuro-imaging methods to examine potential moderators and mediators of risk transmission (projects COMPARE-emotion/-interaction/-work/-school). COMPARE-emotion targets emotion processing and regulation and its impact on the transgenerational disorder transmission; COMPARE-interaction focuses especially on the impact of maternal comorbid diagnoses of depression and anxiety disorders and will concentrate on different pathways of the impact of maternal disorders on socio-emotional and cognitive infant development, such as parent-infant interaction and the infant's stress regulation skills. COMPARE-work analyzes the transmission of strains a person experiences in one area of life to another (i.e., from family to work; spill-over), and how stress and strain are transmitted between individuals (i.e., from parent to child; cross-over). COMPARE-school focuses on the psychosocial adjustment, school performance, and subjective well-being in COPMI compared to an adequate control group of healthy children.Results: This study protocol reports on the interdisciplinary approach of COMPARE testing the model of the transgenerational transmission of mental disorders.Conclusion: The combination of applied basic with clinical research will facilitate the examination of specific risk transmission mechanisms, promotion, dissemination and implementation of results into a highly important but largely neglected field.Clinical Trial Registration: DRKS-ID: DRKS00013516 (German Clinical Trials Register, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013516).

Dutch youth of parents with a mental illness reflect upon their feelings of guilt and shame

Children of parents with a mental illness (COPMI) have a higher risk of acquiring a mental illness themselves. Feelings of guilt and shame could increase COPMI risks of acquiring mental health disorder symptoms. These feelings of guilt and shame could also impact the quality of the parent-child relationship. Data were drawn from the qualitative part of a mixed method study featuring 18 face-to-face interviews with Dutch COPMI aged 12–21. Interviewees were asked about their experiences with guilt and shame related to their parent with mental illness and the extent they felt that these feelings affected their relationships with their parents. Qualitative thematic analysis (QTA) revealed that most COPMI youth described feelings of guilt and some of them reported feelings of shame. They reported making behavioral adjustments especially using caution in parental communication. In their perception, guilt and shame did not have long-term impacts on their relationships with parents.

Cost-effectiveness of preventive case management for parents with a mental illness: a randomized controlled trial from three economic perspectives.

BackgroundThe children of parents with a mental illness (COPMI) are at increased risk for developing costly psychiatric disorders because of multiple risk factors which threaten parenting quality and thereby child development. Preventive basic care management (PBCM) is an intervention aimed at reducing risk factors and addressing the needs of COPMI-families in different domains. The intervention may lead to financial consequences in the healthcare sector and in other sectors, also known as inter-sectoral costs and benefits (ICBs). The objective of this study was to assess the cost-effectiveness of PBCM from three perspectives: a narrow healthcare perspective, a social care perspective (including childcare costs) and a broad societal perspective (including all ICBs).MethodsEffects on parenting quality (as measured by the HOME) and costs during an 18-month period were studied in in a randomized controlled trial. Families received PBCM (n = 49) or care as usual (CAU) (n = 50). For all three perspectives, incremental cost-effectiveness ratios (ICERs) were calculated. Stochastic uncertainty in the data was dealt with using non-parametric bootstraps. Sensitivity analyses included calculating ICERs excluding cost outliers, and making an adjustment for baseline cost differences.ResultsParenting quality improved in the PBCM group and declined in the CAU group, and PBCM was shown to be more costly than CAU. ICERs differ from 461 Euros (healthcare perspective) to 215 Euros (social care perspective) to 175 Euros (societal perspective) per one point improvement on the HOME T-score. The results of the sensitivity analyses, based on complete cases and excluding cost outliers, support the finding that the ICER is lower when adopting a broader perspective. The subgroup analysis and the analysis with baseline adjustments resulted in higher ICERs.ConclusionsThis study is the first economic evaluation of family-focused preventive basic care management for COPMI in psychiatric and family services. The effects of the chosen perspective on determining the cost-effectiveness of PBCM underscore the importance of economic studies of interdepartmental policies. Future studies focusing on the cost-effectiveness of programs like PBCM in other sites and studies with more power are encouraged as this may improve the quality of information used in supporting decision making.Trial registrationNTR2569, date of registration 2010-10-12.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1498-z) contains supplementary material, which is available to authorized users.

When your parent has a mental illness: children's experiences of a psycho-educational intervention

Psycho-education is a key component of interventions for young people who have a parent with a mental illness. When your parent has a mental illness is a psycho-educational booklet designed for young people, developed by the Australian Children of Parents with a Mental Illness (COPMI) national initiative. The booklet aims to promote young people's understanding of their parents’ mental illness. This pilot study sought to ascertain possible differences in knowledge of mental illness after the young people viewed the booklet; another aim was to obtain young people's feedback on how they used the booklet. A mixed methods research design was employed. Nine participants between 12–15 years of age completed the Children's Knowledge Scale of Mental Illness questionnaire before and after reading the booklet. Five of these participants then took part in follow-up interviews. No significant change was recorded on the Knowledge Scale. In the interviews, young people indicated that the booklet helped them initiate conversations with their parent about the parent's illness. Results tentatively indicate the effectiveness of the booklet as a psycho-educational resource for young people whose parent has a mental illness. Implications for practice and future research in this area are discussed.

Effects of preventive family service coordination for parents with mental illnesses and their children, a RCT.

Children of parents with a mental illness (COPMI) are at increased risk for developing psychiatric disorders, especially when parenting is compromised by multiple risk factors. Due to fragmented services, these families often do not get the support they need. Can coordination between services, as developed in the Preventive Basic Care Management (PBCM) program, improve parenting and prevent child behavioral problems? This randomized controlled clinical trial (RCT) compared the effectiveness of PBCM with a control condition. Ninety-nine outpatients of a community mental health center were randomized to intervention or control. Primary outcomes included parenting quality (assessed by the HOME instrument), parenting skills (parenting skills subscale of FFQ), and parenting stress (PDH). Secondary outcomes are child behavioral problems (SDQ). Outcomes were assessed at baseline and after 9 and 18 months. Effects were analyzed by Repeated Measures Analysis of Variance. Most families were single-parent families belonging to ethnic minorities. The results of the first RCT on effects of PBCM suggest that this intervention is feasible and has a positive effect on parenting skills. There was no evidence for effects on the quality of parenting and parenting stress, nor preventive effects on child behavioral problems. Replication studies in other sites, with more power, including monitoring of the implementation quality and studying a broader palette of child outcomes are needed to confirm the positive effects of PBCM. Long-term prospective studies are needed to investigate if improved parenting skills lead to positive effects in the children in the long run.

Online support for children of parents suffering from mental illness: A case study

From epidemiologic research, we know that children of parents with a mental illness (COPMI) have an elevated risk of developing a serious mental disorder. Aside from studies based on risk and resilience, there has been little research on the children's own perceptions. The aim of this study was to expand our understanding of key variables influencing COPMI's seeking support and to explore whether a website targeted at COPMI could help them improve their ability to cope with their circumstances and to find professional help. This case study illustrates one visitor's use of a website that was specifically designed to help COPMI. The visitor was a young adult female whose two parents both suffered from mental illness. She participated for 3 years in an intervention delivered through the website. Several things helped to inform us about her perspective on living with parents suffering from mental illness, her use of the website and the benefits she derived from using the website. These included (a) her story as she told it in the exit interview, (b) her messages to her peers and counsellors, (c) her user data and (d) the content of her chat conversations with her peers.

Prevalence of parents within an adult mental health service: Census results 2008–2011

The objective of this article is to determine the prevalence of parents of children (aged 0-17 years) within a mental health service system and gather contextual data regarding this population. The study uses a census approach. The Census is conducted annually across Central Coast Adult Mental Health Services, NSW, Australia. All five community mental health teams and four acute inpatient units within the service participate, with each team completing Census forms for active clients identified as parents on Census day. The Census form collects data on parents and children including demographic data, parental diagnosis, parental contact and risk factors. Consecutive data shows 25-28% of active clients are parents. Annually, at least 400 children are identified; approximately 60% reside permanently with their parent with a mental illness. The Census is a valuable tool to determine the prevalence of parenthood. Moreover, it collects contextual data on this population. Data show an emerging relationship between parental diagnosis and parental contact. A picture of level of risk across the system has also been highlighted. Results add to the evidence regarding parental mental illness and circumstances of these families. The data clearly articulate a large need for interventions for children of parents with a mental illness (COPMI) within this population, given the high proportion of children who permanently reside with their parent with a mental illness.

“Knowledge is Power”: Educating Children About Their Parent's Mental Illness

Given the prevalence and associated vulnerabilities of children of parents with a mental illness (COPMI) it is essential to develop appropriate interventions. While education is an important component in many interventions, little is known about what topics are covered, delivery mode, and the efficacy in meeting the needs of this target group. Eighteen facilitators responsible for delivering COPMI programs across Australia were interviewed, fifteen of whom include education about mental illness in their treatment programs. According to program facilitators, education about mental health was important because they believed that knowledge equates to power, and can be cathartic. Education chiefly consisted of signs, symptoms, and treatments of various mental illnesses. The dominant mode of delivery was small and large group discussion. When delivering education, there was some consideration for children's ages. However, there was less differentiation in programs according to the diagnosis of parents' mental illness. Clinical and research implications conclude the article.

Commentary on consumer and carer participation in a national mental health promotion initiative

Current Australian Government policy acknowledges that consumers and carers are an integral component of improving all aspects of mental health, from individual service provision to policy development. However, although the ability of consumers and carers to influence mental health programs and services in Australia has increased over the past decade, the theory of partnership for consumer and carer participation has many challenges when put into practice. The Children of Parents with a Mental Illness (COPMI) national initiative has endeavoured to overcome these challenges and integrate consumer and carer participation across the initiative through a range of strategies. This paper explores and describes how consumers and carers have engaged with the initiative and overcome barriers or worked through ways to negotiate them. Examples and consumer and carer reflections are provided specifically in relation to the development of both public information and workforce development resources. The COPMI national initiative’s experience adds to the body of knowledge that is increasing as consumer and carer participation becomes more integrated across the mental health sector.

The Koping Program: A decade’s commitment to enhancing service capacity for children of parents with a mental illness

Children of parents with a mental illness are known to be at heightened risk of experiencing a range of psychosocial difficulties, including the potential development of their own mental health problems. In 1999, the Child and Youth Mental Health Service (CYMHS) of the Royal Children’s Hospital, Children’s Health District, Brisbane, Queensland, established a selective prevention initiative – since known as the Koping Program – to enhance service provision for this priority group. Sustained local resourcing of the program has enabled the achievement of numerous quality outcomes for young people, their families and service providers. These are reviewed according to the eight national Children of Parents with a Mental Illness (COPMI) action areas: promoting wellbeing and reducing risk; support for children and families; addressing grief and loss issues; access to information, education and decision-making; care and protection of children; partnerships and cross-agency processes; workforce development and workforce reorientation; and research and evaluation. Brief commentary is provided on factors underlying success of the Koping Program, along with its limitations and future directions.