Summer 2025 Issue

Shining a Light: The Invisible Group
By Michelle D. Sherman, PhD, LP, ABPP
Social Work Today
Vol. 25 No. 3 P. 26

Children Whose Parents Manage Mental Illness

The Tony-award-winning musical, Next to Normal, vividly depicts a family struggling with maternal bipolar disorder.1 The show portrays the mom (Diana) going through the highs of mania, frenetically making sandwiches on the floor for the family’s lunches, and the painful depths of despair, grief, and a suicide attempt. The intense musical also offers a window into the confusing, heart-wrenching experiences of her husband (Dan) and teenage daughter (Natalie).

Although the impact of mental illness on partners is occasionally portrayed in the media, relatively few shows focus on the offspring. Next to Normal explores Natalie’s poignant journey head-on, and lyrics from the show will elucidate key elements of her experience.

Eighteen years ago, I wrote an article for this magazine entitled “Reaching Out to Children of Parents With Mental Illness,” which described 10 ways social workers can help children of parents managing psychiatric problems. Although more research on the children’s experience has emerged in the intervening years, sadly, very little has changed in the United States with respect to recognizing these youth or providing prevention or intervention services.

One in Four Kids
Recent research from the CDC assessed adverse childhood experiences among high school youth and found that over one in four youth had a parent/guardian with severe mental health problems or who was suicidal.2 These kids can experience many feelings—sadness, anxiety, embarrassment, confusion, anger, and guilt.

In Next to Normal, Natalie experiences many of these emotions, including a desire to escape the family stress (“I wish I could fly and magically appear and disappear, I wish I could fly. I’d fly far away from here”).

Near the end of the show, Diana tries to reassure her daughter, who responds with considerable anger. Natalie sings: “It’s so lovely that you’re sharing. No, really, I’m all ears. But where has all this caring been for sixteen years? For all those years I’d pray that you’d go away for good, half the time afraid that you really would. When I thought you might be dying, I cried for all we’d never be. But there’ll be no more crying. Not for me.”

Meta-analyses have found that children of parents with mental disorders have a higher lifetime risk of developing a mental health problem than the general population. More specifically, the chance that an offspring will develop some form of mental illness is 55% with parental bipolar disorder, 51% with parental depressive disorder, and 17% with parental psychosis.3

Natalie worries about her future wellbeing given her mom’s illness. When Natalie’s boyfriend expresses his desire to be loyal to her over time, she shares many of her fears: “You say that right here but then give it a year or 10 years or a life, and I could end up your wife, sitting staring at walls, throwing shit down the stairs, freaking out at the store, running nude down the street, bleeding out in the bath…”

Of note, some children can grow as part of the experience of parental mental illness; they may develop strong autonomy and empathy for others. However, due to the additional responsibilities they may assume at home, they can struggle in various life domains, including school and peer relationships.4

Invisible Youth
Sadly, these children are often invisible in the health care system. Many providers do not consistently assess the impacts of parental mental illness on youth, thereby missing opportunities to support the parent and their children. Further, the fragmented, siloed mental health care system often leads to adult and youth mental health professionals not easily collaborating in support of families.

At the same time, some health care providers assume these parents are ineffective and neglectful. It is well known that parenting can be more difficult when managing serious mental illness, but many people are great parents and derive a lot of meaning from this role.

Sadly, some people fear disclosing parenting challenges out of concern that their children may be removed from their homes. This worry is understandable given the research on the disparities in Child Protective Services (CPS) involvement; parents with mental illnesses have been found to be eight times more likely to have contact with CPS than those without.5

Thus, to use a phrase often used in another domain, there is a “don’t ask, don’t tell” predicament here that often results in both parents and children not getting support. Cheri Bragg, a social worker and long-term mental health advocate, says, “Like all children, children of parents with mental health labels need to be seen, heard, and valued. We need to change the false narrative of genetic destiny and invisibility to one of hope and continued healing.”6

Opportunities for Social Workers
Social workers have important opportunities to see, hear, and value these children, be it in schools, inpatient psychiatric units, CPS programs, addiction treatment centers, primary care clinics, and other settings. Given social workers’ holistic and systemic conceptualization of client functioning, their skills in engaging key stakeholders in treatment planning, and their expertise in connecting with resources, they can be true champions in supporting these youth.

The science of resilience has grown tremendously in the past couple decades, and social workers can help these at-risk youth build their wellness. Assisting youth in making healthy choices such as engaging in regular exercise, avoiding substances, eating a healthy diet, staying connected with peers, and using healthy coping tools can make a big difference.

Four Steps Social Workers Can Take Today
Reflect on your practice: How much am I talking with adults/youth about parental mental illness? How can I teach parents how to promote resilience in their kids?

Talk about these kids with your colleagues. Perhaps engage with the inpatient unit nursing staff about how they interact with youth who are visiting their parents? Maybe regularly ask about the kids when staffing cases in treatment team meetings? Consider educating your colleagues in your school system about these kids and their needs? Perhaps contribute to the small research base on needs of these young people?

Consider creating a support program in your setting. With one in four kids having parents managing serious mental health problems, there are many youth who could benefit from support, both from you and their peers (the interactive book I’m Not Alone listed in the sidebar can be used as a curriculum for such a group).

Learn about resources (see sidebar below).

In the final song of Next to Normal, Natalie sings, “We need some light. … You can’t sit here in the dark and all alone. It’s a sorry sight.” Social workers have opportunities to shine “light” on these youth and their families, offering resources and helping them feel less alone and afraid.

— Michelle D. Sherman, PhD, LP, ABPP, is a board-certified clinical psychologist in Minnesota who has dedicated her career to supporting families of adults living with a mental illness or trauma history. She is a fellow of American Psychological Association’s Society for Couple and Family Psychology and was named their Family Psychologist of the Year in 2022. She is the editor in chief of the journal Couple and Family Psychology: Research and Practice. She worked for 17 years in the VA system and as a professor at the University of Minnesota and Oklahoma medical schools. In her personal life, she writes books (with her coauthor mother) for family members who love someone living with a mental illness/PTSD (www.SeedsofHopeBooks.com).

Resources

BOOKS

For Youth
Clarke LA. Wishing Wellness: A Workbook for Children of Parents With Mental Illness. Magination Press; 2006.

Sherman MD, Sherman DM. I’m Not Alone: A Teen’s Guide to Living With a Parent Who Has a Mental Illness or History of Trauma, 2nd ed. Seeds of Hope Books; 2024.

Villatte A, Piché G, Habib R. When Your Parent Has a Mental Illness: Tips and Stories From Young People of Quebec. Université du Québec en Outaouais: LaPProche Laboratory; 2020. https://lapproche.uqo.ca/wp-content/uploads/2022/01/When_your_parent_has_mental_issue_VA_web.pdf

For Parents
Sherman MD, Sherman DM. Loving Someone With a Mental Illness or History of
Trauma: Skills, Hope, and Strength for Your Journey. Johns Hopkins University
Press; 2025. [Has a specific chapter on parenting.]

ONLINE RESOURCES
COPMI (Australia): Children of Parents with a Mental Illness: https://www.copmi.net.au

Our Time (Canada): Offers free Kidstime workshops to parents managing mental illness and their children: https://ourtimecharity.org.uk/

Temple University’s Collaborative on Community Inclusion of Individuals with Psychiatric Disabilities: Parenting with Mental Health Challenges: Includes self-advocacy plans that detail desired care for children during a crisis: https://tucollaborative.org/parenting/

References
1. Kitt T, Yorkey B, Rapp A. Next to Normal. Theater Communications Group; 2010.

2. Swedo EA, Pampati S, Anderson KN, et al. Adverse childhood experiences and health conditions and risk behaviors among high school students—Youth Risk Behavior Survey, United States, 2023. MMWR Suppl. 2024;73(4):39-50.

3. Uher R, Pavlova B, Radua J, et al. Transdiagnostic risk of mental disorders in offspring of affected parents: a meta‐analysis of family high‐risk and registry studies. World Psychiatry. 2023;22(3):433-448.

4. Goodman SH, Rouse MH, Connell AM, Broth MR, Hall CM, Heyward D. Maternal depression and child psychopathology: a meta-analytic review. Clin Child Fam Psychol Rev. 2011;14(1):1-27.

5. Kaplan K, Brusilovskiy E, O'Shea AM, Salzer MS. Child protective service disparities and serious mental illnesses: results from a national survey. Psychiatr Serv. 2019;70(3):202-208.

6. Bragg C. Invisible trauma: the children left behind when parents are hospitalized. Mad in America website. https://www.madinamerica.com/2018/11/invisible-trauma-children-parents-hospitalized/. Published November 25, 2018.