Article 3 of the Universal Declaration of Human Rights of 10.12.1948 (A/RES/217 A (III), https://www.un.org/depts/german/menschenrechte/aemr.pdf) states that “Everyone has the right to life, liberty and security of person”. This right applies to all humans, but especially protects those who are most vulnerable; children and adolescents. Their vulnerability makes the protection of their emotional and physical being, a task not only for their parents but for the society as a whole. For this reason, any violence against children can be described as an urgent public health problem. It is very important to note that the consequences of early experiences of violence often extend into adulthood and may even affect the lives of the next generation.
Unsurprisingly, child abuse is an emotionally charged issue. Due to the emotional aspect of this form of abuse, the issues raised must be handled sensitively and delicately in order to find an effective solution.
At first glance, it seems easy, doesn´t it? Here is an innocent child that was abused or neglected in a heartbreaking way and there is a guilty adult, most likely a parent, who is responsible for what happened. The victim has to be treated and the perpetrator has to be punished. Case closed. However, what at first glance seems so easy to solve often turns out to be a dilemma in reality. The determinants for child abuse and neglect are often complex and intertwined. So-called risk factors or determinants are poverty, single parenthood, parental mental health problems, cramped living conditions, characteristics of the child. Besides these direct effects, indirect effects exist. Moreover the presence of one risk factor increases the probability of occurrences of other risk factors.
Of all the determinants mentioned above, mental health problems are among the most prejudiced. Many people know little about mental health problems and consider those affected to be crazy, scary or even dangerous. But how do parents’ psychological problems influence the interactions with and relationships to their children? Do mental health problems inevitably lead to violent or neglectful behaviour? In order to answer these and other questions, it is important to know a little more about mental health problems in general. Since this is a very brief introduction to this topic, please be aware that mental health is a very complex issue. This article does not cover every single aspect of it.
Mental health problems affect a person on a cognitive, behavioral or affective level. Consequently, impaired mental health prohibits adequate recognition and reaction to a person´s emotional and social need. What may complicate interactions between adults has an even bigger effect on the relationship between a parent and his or her child. The younger a child the more it relies on parents or caregivers to satisfy their needs and to ward off potential harm. The necessary parental attention however binds psychological resources which are increasingly hard to free up in the presence of mental health problems. For example, maternal psychological well-being and the availability of psychosocial resources were found to be significant predictors of the interaction quality between mothers and their infants. A strained relationship between parents and their children increases the risk of child maltreatment.
Parents with mental illnesses may have a special need for support. Relatives or the social environment like friends or neighbors can provide this help. But these resources are often not available, when other determinants like single parenting, social isolation or poverty co-occur with mental health problems, child abuse may occur. In this case, the child and youth welfare service offers public support and protection. However, cooperation between child and youth welfare professionals and parents with mental health problems is often a challenge. This is particularly the case when the specialists have little expertise about mental health problems and their effects on the ability to interact with other people.
Mental health problems may change the way people talk or express their emotions. This case is an example of a severely depressed parent. The purpose of this case is to illustrate the possible misunderstandings between professionals and affected parents. In this case, the affected parent is unable to get up with its three-year old child in the morning, dress the child for Kindergarten and prepare breakfast. Instead, the child gets up, turns on the television in the morning and eats whatever food is within his or her reach. Alarmed by the child’s increasingly frequent absences, the Kindergarten perhaps first sought contact with the parent and then with the Child and Youth Welfare Office. The parent is very pleased about the offer of help and promises to improve. The Child and Youth Welfare Office install different kinds of supports like a maid or extended day care for the child. In the course of the cooperation, however, the circumstances do not improve much. This can be very frustrating for professionals trying to help the affected family. In particular instance, inexperienced specialists often see the lack of cooperation as a refusal on the parent’s part. However, there might be undiscussed underlying issues. This endangers the relationship between parent and professionals while deteriorating the situation of the child.
The reasons for the lack of implementation of the help offered may, however, be the parent’s mental illness. A lack of energy, difficulty getting up in the morning, difficulty in domestic life and similar patterns are all indicative of depression. Without treatment for the mental illness, there can be no lasting improvement for the children and their families.
For this reason, it is important to put aside simple cause-effect models in favour of more complex approaches that treat parents and children simultaneously. In very few cases are mental health problems unlinked to child abuse and neglect. However, other determinants such as low social support, single parenting and/or financial problems also further damage the relationship between children and parents.
For this reason, child and youth welfare professionals are recommended to analyse in detail whether a parent´s behavior is caused by unwillingness to cooperate or caused by mental health problems. In case of the latter, it is important to find out whether there is an understanding of the illness or if there is a motivation for a psychotherapy. Cooperation between health professionals and child and youth welfare services is in these cases are very important. Linking mental health issues with child abuse allows professionals to find underlying answers to the questions that child abuse and neglect raise.