Eilis Hennessy, Áine French, Daráine Murphy
The paper is available in pdf here
Adolescence is a time of growing independence from family for the majority of young people, however this does not mean that parents no longer play a significant supportive role in young people’s lives. Parents may be the first to notice changes in mood or behaviour that signal distress in a young person, and they are likely to be contacted if concerns are raised by teachers. The decision of whether or not to seek professional support then frequently rests with parents, and it is parents who must provide support to the young person as best they can while seeking support. This can be a time of significant emotional stress for parents and a time when they may feel very unsupported and alone. In this paper we argue that there is growing evidence that providing easily accessible information and support to parents of adolescents can positively impact on the mental health of adolescents, regardless of their current state of well-being, and that it may be possible to do so in a way that is scalable and acceptable to parents.
There has been growing recognition in recent years of the important developmental changes that take place during adolescence as young people mature physically, cognitively, emotionally and socially and begin the important transition from childhood to adulthood. Although the physical changes associated with puberty and the maturing body have long been acknowledged, recognition of the significant changes taking place in the brain have only been documented and recognized relatively recently (Blakemore & Choudhury, 2006).
These developmental changes herald growth in a very wide range of skills across all domains of activity as young people become taller, stronger and more physically dextrous enabling the acquisition of new skills in sports, and greater stamina for engaging in physical tasks. New cognitive skills enable a deeper understanding of the world and the ability to see a wider range of perspectives on how the world works. Emotionally, young people are becoming more independent of parents and able to form and maintain strong friendships and intimate relationships. Socially the changes are marked by greater insight into other people’s thoughts and feelings and a growing ability to engage positively with a wide range of peer groups.
It is not surprising, however, that during a developmental period of such rapid change that some young people may at times struggle with the changes happening within their own bodies (including in their thought processes) as well as with the ways in which they are expected to relate to the world around them. There is now very strong evidence that such difficulties are experienced by a high proportion of young people around the world and that for some, these difficulties may persist for many years. Globally, approximately one in ten children and adolescents is diagnosed with a mental disorder (Polanczyk et al., 2015) and the numbers are increasing (Piao et al., 2022).
Despite the fact that so many young people experience some level of mental health difficulty in their adolescent and early adult years, research indicates that they rarely seek help on their own and need support and encouragement from others (Rickwood et al., 2015). Parents, therefore, are typically an important initial source of help for personal and emotional problems (Rowe et al., 2014) and their reaction to the young person may determine whether a young person receives professional help.
Research has shown that if parents are supportive and encourage their adolescent to seek help, they are subsequently more likely to obtain professional help (Gulliver et al. 2010). The significance of the role of parents is further underlined by the fact that in many jurisdictions, adolescents are legally required to have a parent’s permission to seek treatment when they are under 18 years of age (European Union Agency for Fundamental Rights, 2017; McNary, 2014).
Just as adolescence is a time of change for a young person, it is also a time of change for their parents. Adolescents’ growing need for independence means that parents must learn to balance protective concerns with support for autonomous decision-making (Hill et al., 2007). Parents have to distinguish where rules, guidance and supervision are necessary and areas where an adolescent can be trusted to make independent decisions (Kobak et al., 2017). Adolescents have better well-being when they are close and connected to their families and openly communicate about conflicts (Inguglia et al., 2014). Furthermore, adolescents who have good supportive relationships with their parents are better able to build supportive relationships with friends which is in turn reflected in higher psychological well-being (Helsen et al., 2000).
However, even in the context of the most supportive parent-adolescent relationships, seeking help for an adolescent’s mental health difficulty can be a complex process for a parent to manage (Boulter & Rickwood, 2013). Parents need to identify that there is a problem, they need information on where they can find help and they also need to acknowledge and respect the adolescent’s independence and desire for control of their own health care (Logan & King, 2002). This can be challenging for a parent to manage especially if an adolescent does not think anything is wrong and is, therefore, reluctant to seek help.
For a parent, the help-seeking process must begin with identifying that there is a problem. For some parents there will be a very dramatic event, such as a suicide attempt, that makes it crystal clear that professional help is needed. However, for the majority of parents, the challenge is that the onset of a mental health difficulty may be marked by subtle changes in a young person’s behaviour (e.g. increasing tendency to spend time alone) that don’t initially cause any concern. Even when such behaviour persists or is accompanied by other behavioural changes, parents may be reluctant to seek help because they have a fear that contact with mental health professionals will result in their child being ‘labelled’ and societal stigma will result in harm to the young person (Sayal et al., 2010). Parents’ concerns can be addressed, however, if they can access information about adolescent mental health (e.g. signs and symptoms of mental health difficulties), are given information on where to access help and given assurances that early intervention will help the adolescent (Honey et al., 2015). Unfortunately when parents don’t have this knowledge it can result in more negative attitudes towards seeking help which can have a detrimental impact on the adolescent, including delaying access to treatment (Gronholm et al., 2015; Hurley et al., 2020a). Such findings demonstrate that parents require information and support to enable them to determine if their adolescent requires help, and how to sensitively encourage the young person to accept such help (Rickwood et al., 2005; Rickwood et al., 2015).
Parenting behaviours can impact on young people’s wellbeing and serve to support their mental health and wellbeing; parents can help a young person to identify when they may need professional support for their mental health and can help them to identify and seek out that support. Parents can have a positive effect and actively support young people in treatment and recovery.
There is now a evidence base indicating that providing training to parents can have a positive impact on adolescents as well as on the parents themselves (Doyle et al., 2022). Benefits for young people include improvements in their wellbeing, and their mental and physical health. By undertaking training, parents and carers can improve their parenting skills and increase their knowledge and feeling of self-efficacy. For example, the teen Triple P programme has been shown to improve parents’ reports of family cohension and reduce interparental confict; adolescents reported increased feelings of connection to family and school (Chand et al., 2013). Parents of young adolescents who attended the Parents Plus programme had reduced stress and improved satisfaction, their children’s difficulties reduced (Nitsch et al., 2015). There is also evidence that parent interventions can be delivered effectively online with similar positive outcomes for parents and adolescents (Spencer et al., 2019). World Health Organisation guidelines on parenting interventions are due to be published at the end of 2022.
The evidence thus far demonstrates the value of universal parent training for the wellbeing of parents and their adolescent children. However, parents of adolescents frequently face the challenges associated with mental distress or emerging mental health difficulties that may present unique challenges that generic parent training programmes have not equipped them to manage. Yet parents’ ability to recognize mental distress and their understanding of mental health are important factors in determining their chances of help seeking (Hurley et al., 2020b). Parents therefore need access to trustworthy sources of information that can help them to identify whether or not there is a problem that needs professional intervention and where to access further help if needed. How parents can access this information is very important. Because of the stigma associated with mental health difficulties many parents may be unwilling to seek support for an adolescent for fear that association with a mental health service will have a negative impact. Parents of adolescents who had engaged in self-harm reported that they would particularly like to receive information from other parents or at least hear about other parents experiences (Hennessy et al., 2022) and research findings have found that there are benefits from parent peer-to-peer support (Hopkins et al., 2021).
Parents can also benefit from increasing their mental health literacy (this might include learning about mental wellbeing, adolescent development, and how to support and seek help for an adolescent who is distressed) so that they are likely to recognize difficulties should they arise and know what to do in those circumstances. Research evidence suggests that parents’ mental health literacy can be increased in a variety of ways including once-off sessions to improve their ability to recognize the symptoms of mental health difficulties and knowledge of where to seek help (Hurley et al., 2020a).
What do parents need?
The value of engaging parents in supporting young people’s mental health and in supporting recovery, when young people experience mental health difficulties requires policy initiatives that support parents to meet the needs of all adolescents.
What are we arguing for:
- Psychoeducation for parents – parents frequently report that they find it difficult to distinguish between ‘normal’ adolescent or teenage behaviour and behaviour that is likely to be indicative of a mental health difficulty. This need should be addressed in a variety of ways: i) parents should be offered psychoeducation as part of whole-school mental health promotion or mental health literacy interventions; ii) parents should have access to online information and short courses that are written specifically for their needs, that provides information on help seeking and advice on managing difficult conversations with adolescents.
- Parents need to be confident that information they access about youth mental health is trustworthy. It is therefore important that resources are made available on the websites of known and trusted healthcare providers (e.g. the Health Service Executive in Ireland) or specialist youth mental health services (e.g. Jigsaw). There are government-funded hubs providing information to parents in other countries such as in Australia (https://raisingchildren.net.au/) and the UK (https://www.youngminds.org.uk/parent/). However, it should be noted that these pages require regular updating to reflect current evidence-based information on best practice. Without guidance or a trustworthy website to consult parents may instead be consulting low-quality websites containing misinformation (Lewis et al., 2014).
- Specialist adolescent mental health service providers should be supported to develop websites that host information on adolescent mental health problems for the adolescents and parents that they serve. Websites should ensure that information is provided on what to do if there is a medical concern/emergency or if they feel their child is at immediate risk.
- Parents consistently report that they would value hearing about the experiences of other parents and learning from them. A system of peer support to facilitate parents learning from one another should be established and online information sources developed for parents should include testimonies from other parents who are willing to share their experiences and to offer suggestions and hope. Peer-to-peer information helps to reduce parents’ sense of isolation (the feeling that they are the only family experiencing difficulties) and also helps to tackle stigma (Murphy et al., 2022).
- Parents need information on adolescent mental health that is specifically designed to address their concerns and information requirements. However, it is also important to recognize that some groups of parents will have additional information needs – this may include, for example, the parents of young people who identify as LGBTQ+; parents whose first language is not English, parents of minority religious and ethnic groups. Adolescents who are members of some of these social groups are known to have higher rates of mental health difficulty so it is particularly important that their parents can readily access information. This might be achieved by identifing organisations that work with parents from groups that may have specific additional information needs and encouraging them to liaise with primary care services and adolescent mental health service providers to co-produce information for parents.
- Despite the fact that there has been a lot of research on the value of information and training for parents of adolescents, much of this work has been with mothers only. It is important that information resources are designed and presented in a way that is attractive to mothers and fathers and that resources are advertised and promoted in places that will likely be seen by all parents.
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