It can be a confusing and sometimes scary time for everyone, but kids can be especially vulnerable as they may not have a full understanding of what’s going on. Add to that their vivid imaginations, and kids can take their own observations and draw conclusions that may create additional anxiety and fear. This is an important realization when preparing to provide explanations, and helping them to understand what’s happening. Overall, helping kids feel safe and included as active contributors in their family member’s recovery process is a helpful part of recovery, for them, and for the rest of the family! Here are some techniques that can help with this process.

Be honest, and appropriate

One way to help kids truly understand is by speaking honestly and optimistically about what’s going on, sharing age-appropriate details and creating a safe and comforting environment to share thoughts and feelings. Remember that even very young children pick up on non-verbal cues and body language, so don’t underestimate their intuitiveness. Adjust the kind of language used and the information disclosed, using these guidelines:

• For young children – toddlers or younger --, use simple language, short sentences and don’t over-explain. Answer questions one at a time. Providing too much information at this age could create confusion or fear that they, themselves are in danger.
• If your child is school-aged, they will be able to understand more. However, they may not be able to understand the more complex aspects of ‘adult’ situations. Be honest with them, encourage them to ask questions and answer them. Be careful not to tell them more than they are ready to hear.
• Teens may be reluctant to share what they’re really feeling and may feel added pressures related to associated stigmas. Let them know that you are there for them, and ready to talk if they want to, without putting additional pressure on them.

The most important messages to get across are—it’s not their fault, and it’s not their responsibility to ‘fix’ the situation:

• that they had no role in creating the situation with their family member(s); and
• that there isn’t any one thing they can do that will make their family member(s) better right away.

Everyone in the family can play a role in helping; it shouldn’t be just the adults. But, it’s important to realize that it can be enough for kids to simply have the courage to talk.

One nurse interviewed children to understand their perspective on having a parent who was hospitalized as part of their treatment and discovered the following three things that the children found most helpful:

1. be nurturing: “give them an ice-cream, something comforting, and a big family hug”
2. provide reassurance and support: “tell them it’s going to be okay”
3. provide opportunities to have fun and to act ‘normally’: going to school, playing games and maintaining daily routines (1)
4. Behaviours that were seen unfavourable by children included begin ignored, being dismissed and being excluded. (2)

Listen to understand and watch for signs of stress

You can gain a better understanding of what kids are thinking by listening. If you ask what they think might be behind changes they see in their family member’s behaviour, you may be surprised to find them taking the blame or connecting something unassociated to the situation. Kids can take on the role of parent or act as a confidant to their family member who is being treated, which is burdensome and damaging for a young person. Children who enter the ‘caregiver’/confidant role are more likely to experience “increased rates of depression, anxiety disorders and other psychiatric issues” that can continue into adulthood.(3) The effect of constant stress shows up in behavioural problems, damage to self-esteem and self-worth, difficulty at school with attendance and concentrating on schoolwork and loneliness.(4) It can be a very enlightening experience to see what’s happening through a child’s eyes.

Use what’s familiar

Build on familiar stories using books or favourite movies to help kids develop a better sense of what’s happening that can relate to. For example, talking about a beloved character like Eeyore from Milne’s Winnie the Pooh stories might help a child understand more about a family member’s depression.

Eeyore is much less energetic that the other animals and while he does participate in activities, he is more content to be alone. He doesn’t smile often, is pessimistic and fully expects negative things to happen to him because he exists. By contrast, his friend Tigger is highly animated, exudes optimism and outwardly expresses enjoyment when participating in many activities.

It can be reassuring to realize that Eeyore’s friends are always there for him and will regularly make a point of touching base. What do you think would happen if Eeyore talked to his friends about why he’s feeling so sad? It’s ok for Eeyore to tell his mom and dad what’s he’s feeling—his mom and dad are always there for him, even if he’s feeling sad. In these stories, the characters don’t judge Eeyore and don’t comment on his mood, they simply keep him involved in the family and community and show their love consistently.

What about when they’ve seen a lot

Where kids have been exposed to traumatic events, perhaps even where police have been involved, it’s especially important to help them talk about it. They may have questions about what they saw or why something happened. Don’t shy away from the discussion. Natalie Harris, a former paramedic, now an active mental health advocate has been on the front lines of situations where children have been heavily involved in a family member’s care and treatment. She says:

Don’t be afraid to show emotions in an attempt to protect [children] from pain. [Kids are] so in tune with our personalities, including our non-verbal language, that they can tell when we are sad. Denying this only confuses them and in fact makes them worry more…when I started telling my kids the truth about my emotions, they accepted it and went on with their days.(5) Explain that mental illness or addictions can sometimes make people confused and act in ways that are different and frightening. Listen without judgement or correction. Remember you have the benefit of an adult’s viewpoint. With your kids, it’s about creating feelings of safety, support and acceptance.

Traumatic experiences can have delayed effects

A new study on Post Traumatic Stress Disorders (PTSD) in young people published in the Lancet Psychiatry indicated a couple of different factors contributed to PTSD—including first hand experiences, but also knowledge of events that “had affected someone they knew but they had not directly witnessed.”(6) Symptoms of PTSD can show up as flashbacks, nightmares, avoidance, isolation, detachment, guilt, irritability, impulsive behavior or even physically as aches and pains, diarrhea, irregular heartbeats, and headaches.(7)

Harris corroborates this. In an interview, she shared some of her own experiences with PTSD that were triggered from paramedic calls that she had been out on years before. She spoke about nightmares which escalated in severity to night terrors and how they were out of control and happening all the time. She was irritable, angry, felt isolated and was beginning to withdraw even more from daily life. It led her down a path where she tried to cover up the nightmares by drinking because she was afraid to go to sleep. She simply wanted to drink so that she could pass out and not have to pay attention to the terrifying things she was reliving in her nightmares.

“My family could see what was happening, even though I was trying desperately to hide it. I wasn’t able to realize that they were in tune with these symptoms because I couldn’t be," Natalie shared.(8)

Create a connection to physical health

When you speak with your kids, be sure to emphasize that are many trusted people helping, like doctors and nurses. This can be a great chance to make a connection to physical health. Talk about how sometimes when they don’t feel well physically, they might need things like medicine or bandages to help them feel better. Speaking about how mental illness affects their family member’s brain may also help a kid understand by creating a physical association with an area of the body.

When you get sick, is that your fault? No, it isn’t. But you get better by taking care of yourself. It’s kind of the same thing when you’re not feeling well mentally. It’s not your fault, but you can help yourself feel better by taking good care of yourself.

It's hard, but don’t shy away from stigma

Mental health and addiction are difficult to understand, and families receive different expressions of concern and offers of assistance than when someone is being treated for a serious physical health problem. Sometimes, the stigma associated with caring for family member with serious mental health or addiction problems becomes so overwhelming, it can be easier to conceal difficulties or withdraw from extended family, friends and the community.(9)

Having a conversation to discuss how some people may decide to say unkind things about them or their family can be upsetting because children who have lived within these family situations may not view the behaviours as, “out of the ordinary” at all.(10) Although social stigma has come a long way, it’s not entirely gone. Giving kids the tools to understand and act as advocates by talking about how they choose to respond within those situations can make them feel better prepared and more confident.

Consider making an “advanced plan” for child care

One thing that could be quite helpful in giving kids assurances that not only is their family member being cared for, but they also aren’t being forgotten is the preparation of an “advance plan” in the event of a relapse. This document is like a documented safety plan for care and can be drawn up with the advice of therapists and input of the family member in treatment, the kids, other immediate family members.

It records items such as who will be involved, what information is confidential and who will be informed; describes symptoms and give guidelines for people to understand when a relapse may be occurring; talks about the actions and supports that should be put in place for treatment care of children in the event of a relapse; specifies the conditions when alternate child care will not be needed; and indicates when and how the agreement can be cancelled.(11)

One child and family therapist working as part of a community mental health team said that, “this model is not a legal agreement, but an expression of the parent’s concerns and intentions made when they were not acutely ill.” She further states that, “it is like disaster planning [and] promotes putting energy into solutions, breaks down denial and allows parents to express care and concern for their children…[with] honest communication and builds a support network for the family.” (12)Be sure to present the plan in an age appropriate manner. Speaking to kids about relapse and risk planning needs to be handled carefully in an effort to avoid additional fear and/or confusion.

(1) Gryba, H. (2004). When a Parent is Hospitalized for Treatment of a Mental Illness: A research project examining a child’s perspective. Visions: BC’s Mental Health and Addictions Journal. Vol.2 No. 2 |Spring 2004. Retrieved on February 26, 2019 from http://www.heretohelp.bc.ca/sites/default/files/vi...

(2) FMHA, camh, CMHA, and OFCMHAP. (2006). Caring Together: Families As Partners In The Mental Health And Addiction System, p. 8. https://www.camh.ca/-/media/files/pdfs---public-po...

(3) Ibid. p.5

(4) Ibid. p.5

(5)Harris, N. (2018, April 26) Accept Your Crying Kid’s Feelings (And Your Own, While You’re At It). Huffington Post. Retrieved February 25, 2019 from https://www.huffingtonpost.ca/natalie-harris/how-t...

(6)Therrien, A. (2019, February 22). PTSD affects ‘one in 13 by age 19’. BBC News. Retrieved February 26, 2019 from https://www.bbc.com/news/health-47317891?fbclid=Iw...

(7)Ibid. What is PTSD?

(8) Phone interview with Natalie Harris, February 26, 2019.

(9) FMHA, camh, CMHA, and OFCMHAP. (2006). Caring Together: Families As Partners In The Mental Health And Addiction System, p. 4. https://www.camh.ca/-/media/files/pdfs---public-po...

(10) Lees, Dr. Robert (2004). We’ve Come A Way, But Not Far Enough; Supporting families with parental mental illness. Visions: BC’s Mental Health and Addictions Journal. Vol.2 No. 2 |Spring 2004. p. 4. Retrieved on February 26, 2019 from http://www.heretohelp.bc.ca/sites/default/files/vi...

(11) Van Vollkinburgh, S. (2005). Working together with Parents with Mental Illness to maintain their Child’s Mental Health. Visions: BC’s Mental Health and Addictions Journal. Vol.2 No. 2 |Spring 2004. p.33. Retrieved on February 26, 2019 from http://www.heretohelp.bc.ca/sites/default/files/vi...

(12) Ibid.