Visions Journal

Keli Anderson

Reprinted from the Supporting Parents issue of Visions Journal, 2021, 17 (1), pp. 8-9

Parenting is hard even without mental health challenges in the family. But when a parent or their kids do face these or substance use challenges, what makes it ridiculously hard is the stigma families are subjected to.

Stigmatization of people with mental health or substance use challenges is a defining issue for society. Stigma not only harms people with mental illness and addiction, it injures their family members, who are often stigmatized by association.

The term "family stigma" refers to blame, shame and contamination that falls to family members based on some aspect of one member's experience. Typically, parents are blamed for causing their child or youth's mental health challenge or mental illness. Siblings and spouses are often blamed for not helping their family members or ensuring they adhere to treatment plans. And children or youth are fearful of being contaminated by the mental illness of their parents.¹

Family stigma undermines the critical role that families play in caring for struggling relatives and creates pervasive barriers to help seeking, early detection, assessment and intervention.^2–3 For example, a parent may not want to seek help for a child or youth struggling with anxiety for fear that others will judge them for being too anxious and for inflicting that on their child or youth.

But when has shaming or blaming people ever been appropriate or beneficial? I'd like to look at some issues related to two areas of family stigma.

Family stigma related to parental mental illness and substance use

If a parent has mental illness or a substance use disorder, they and other family members, including children, may experience stigma. Children and youth may feel embarrassed by the struggles of a parent and will sometimes be reluctant to make new friends or bring friends to the family home. This stigma might also look like:

• seeing the looks, glares and side-eyes of passersby, hearing snide comments

• receiving uninvited, non-stop "advice" and coping with the fatigue of wading through information people give you

• a youth or child recognizing their notoriety in a setting if, for example, a parent has a visible altercation with school personnel; these types of situations often result in judgement rather than empathy, and internal thoughts like, "they know my voice there" or "oh, they know all about us"

Family stigma related to child and youth mental health challenges and substance use

For much of the twentieth century, parents and parenting practices were held to be fundamentally responsible for child and youth mental health challenges or illness. Still today, while there is extensive and multi-faceted literature on stigma and the stigmatization of mental illness in adults, far less research has examined the stigma associated with child and youth mental illness.

Yet, for children and youth with mental health and/or substance use challenges, these barriers to care can have dire consequences across the lifespan. For other family members, this stigma might show up as:

• a chorus of internal critical voices with messages like, "I'm a bad parent," "he just needs more discipline" or "I should stop giving in to him"

• questions and judgements about yourself as a parent

• self-doubt

• internal debates about the impact of gossip, with thoughts like, "what will people think?" and "how will our family be treated?"

Parents of children using substances are perhaps hit hardest by family stigma. That's because those challenges are often seen as a result of absent supervision or boundaries set by parents. Parents are blamed. This may result in thoughts like, "we should have been more strict" or "we must have done something wrong."

Unfortunately, all of this blame, internalized stigma and shame can lead to a reluctance to ask sooner for support or help for a loved one. And if, when seeking help, parents encounter blame and shame related to a child or youth with mental health or substance use challenges, harms and negative impacts may follow for:

• parents' sense of ability and empowerment

• parents' experience with services, leading to an "us (parents) versus them (services)" attitude that negatively affects decision-making and future help seeking

• service providers' engagement with parents

• the child or youth's ability to get help

• parents' engagement with the child/youth/young adult

Getting past judgement and stigma aimed at families

No matter who has a mental health or substance use challenge in a family, everyone is impacted, and families often can and do help with needed care; they may also need help as a result. It is imperative that health care providers, service providers and systems look beyond the person in front of them and think of the experiences or needs of others in a family.

Lastly, given how frequently parents or caregivers feel judged or blame themselves for possibly having done something wrong to cause the mental health or substance use challenges their kids are experiencing, they do not need others to make them feel worse.

My hope is that people will be inclusive and choose caring over judgement. Wrapping care and caring around a whole family not only makes the most sense, in my experience it can change everything for the better—for everyone.