The following information is from NAMI Baltimore, NAMI Vermont, “Stop Walking on Eggshells” by Paul T. Mason MS and Randi Kreger, “When Someone You Love Has a Mental Illness” by Rebecca Woolis, MFT, “The Complete Family Guide to Schizophrenia” by Kim T. Mueser and Susan Gingerich, and my own experience.

Let’s start with the bad news. When your family is dealing with a mental illness, the situation impacts young family members the most. This is true whether the children are the offspring or the siblings of the ill person. They are the most vulnerable because they have more limited coping skills and are more dependent on others.

NAMI’s research with adult siblings and adult children found that the younger the family member, the greater the potential impact. If the mental illness delays or disrupts early developmental milestones, the complications can go on for a lifetime.

“When Someone You Love Has a Mental Illness” says the worst times for children are at the onset of the illness, during the child’s adolescence and during bad episodes.

The Worst Case Scenario

Young children may become enveloped in their relative’s psychotic system with lifelong consequences. They may feel that their own needs are not important.  They may grow up too quickly. They may assume a parental role in the family.

Siblings and offspring may have “survivor’s syndrome,” feeling guilty that they were spared the illness. They also may have negative impacts on their academic and social relationships, being reluctant to bring people to the home.

As adults, these children may develop:

• Problems with self-esteem that leaves them more dependent on the approval of others.
• Perfectionism and the strong need for control to compensate for their chaotic upbringing.
• Worry about their own mental health and the mental health of their children.
• A feeling of social alienation and isolation.
• Inappropriate caregiving in close relationships (co-dependency).
• Reluctance to make long-term commitments.
• May enter an early marriage to get away from the home environment.
• Posttraumatic symptoms including heightened fear and anxiety, intrusive flashbacks, emotional numbing, etc.

When they become adults, the children may have these feelings:

• Concern about caregiving for the relative (94%)
• Difficulty balancing family and personal needs (81%)
• Feeling their own needs were not met (79%)
• Feelings of helplessness and hopelessness (75%)
• Guilt feelings (74%)
• Psychic numbing (70%)
• Problems trusting (69%)
• Problems with intimacy (69%)
• A sense of growing up too fast (67%)
• Depression (66%)

The Good News

Ultimately, most children in this situation grow into resilient adults. They usually do have intense feelings of anguish and loss. But they are survivors.

These children need three things to become survivors:

1. Information about mental illness and its meaning to the family. (Naming and taming)
2. Skills to cope with mental illness and its impact on their lives.
3. Support, including recognition that their needs and desires matter.

You can help them when you:

• Strengthen and support the family system as a unit.
• Reach out to the children to listen to them. Encourage them to ask questions and share their feelings. Tell them they are not to blame.
• Encourage their parents to get the child into therapy. Play therapy may help very young children. Older children may benefit from individual or group therapy.
• Reassure them that their needs matter and that you will support them in achieving their goals.

Helping Offspring of People With Mental Illness

Most children of people with mental illness will not develop the illness themselves. But they do not come through the situation unscathed. Studies indicate that having a well parent in the mix or a sustaining sibling relationship reduces the stress.

Many offspring are late bloomers because their development was placed on hold. Many talk about how weird it feels to “outgrow” a parent … to have their own maturity advance beyond the parent’s maturity.

As a parent, grandparent or other relative, you should increase your time and build a strong relationship with the child. What you say doesn’t matter as much as what you do. The child will learn about detachment, self-care, limit setting etc. from you. You can learn coping skills together as a family.

To get there, try to make an alliance with the ill parent. Tell them often that you know that they love their child and want to be a good parent.

At the same time, take steps to ensure the safety of the child at all times. When the illness is severe, it’s often best to not allow the ill parent to take care of the child.

Tell the child what illness the parent has, its symptoms and prognosis in an age-appropriate way. It is frightening to not know what is happening.

Listen to the child without judgment. Assure the child that all his feelings are valid and okay. Give the child frequent opportunities to discuss fears, questions and concerns.

Make reading material available, but don’t push. Just leave the material out for an older child to read when ready.

Create opportunities for the family to be “normal,” such as outings, holidays or vacations. Let the child know that it’s OK to have fun. Of course, make sure the family is represented at the child’s important occasions (recitals, graduations, etc.) Offer physical affection regularly, and foster a sense of humor.

Try to make sure that the child has an appropriate level of responsibility. Don’t allow them to become the parent in the home.

Help the child understand that they are in no way responsible for the illness, its symptoms, its severity. They can’t fix it by being extra good.

When the parent is hospitalized, give the child the option to visit them in the hospital. If they want to, prepare them about what to expect and talk about it afterwards. You also can give an older child the opportunity to privately talk to their parent’s doctor to ask questions.

Helping Siblings of People With Mental Illness

Sibling loss is normally intense. It resurfaces at every developmental milestone. Many say they feel invisible in the family once a sibling gets mental illness. They see the stress on their parents, and they don’t want to add to it.

Siblings also commonly have anxiety about developing the illness. Surveys conducted with siblings in young adulthood also find they have two questions on their minds: “What is going to happen to my sibling?” and “What will be expected of me when my parents are not able to care for my sibling anymore?”

Some ways to support siblings include:

• Encourage them to go to therapy, which they are be open about their feelings.
• Support them when they feel they must step out of the family problem.
• Empathize when they are torn between helping their parents and their ill sibling and moving their own lives along.
• Listen to them when they talk about survivor’s guilt. (It’s at its worst in the 20s.)
• Be open about the future when parents are not able to care for the sibling. Involve the sibling in creating options for future care.

Mental illness impacts the whole family, but you can mitigate the problems if you are intentional about dealing with them.