Policy approaches to support parents to support their children's mental health

Following on from World Mental Health Day on 10 October, this second of two blog posts by Prof Gordon Harold and Prof Leslie Leve suggests some policy approaches to support children's mental health in the long-term by supporting parents.

The role of the inter-parental relationship

One of the most significant influences on children’s mental health, and a factor affected by adult mental health, is the quality of relationships that children experience with their parents. Positive parenting has long been recognised as a core building block for children’s positive mental health and long-term life chances. More recently, though, wider family relationship dynamics, including the quality of the relationship between parents, have been recognised as a significant factor for children’s mental health.

For in addition to elevated rates of mental health problems reported by children and adults during the period of the pandemic, multiple other indicators of adverse inter-parental and parent-child relationship dynamics have also been reported, including higher rates of domestic violence, inter-parental conflict and more challenging parent-child relationship experiences. Importantly, other research points to some positive pandemic impacts, with fathers in particular reporting more satisfaction in their relationships with their children as a result of more time spent together, among other factors.

There is nothing new about the statement that the quality of parenting that children receive significantly affects their long-term mental health. Decades of research has highlighted the role of parenting-focused intervention programmes and associated positive outcomes for children and adolescents across all ages. More recent evidence has highlighted, however, that where discord between parents that is frequent, intense, child-related and poorly resolved is a factor in children’s lives, there is an increased risk of poor outcomes for children and adolescents. There is also a reduced likelihood that parenting-focused intervention programmes may lead to sustained positive or improved effects.

Building on innovative UK and international research evidence (1), it is increasingly apparent that when parents’ own relationships with other adults are supported, positive impacts for adult mental health, parent-child relationship quality and child mental health outcomes follow. Further, this research addresses a key question that has historically challenged the purported efficacy of family-focused interventions in promoting positive outcomes for children; the nature-nurture debate.

The nature of nurture: Disentangling genetic from environmental factors in research

Interventions (2) that target environmental factors (e.g. family environments) that are associated with mental health or related outcomes for children and adolescents are underpinned by a core assertion: nurture-based experiences (positive or negative rearing environments) affect individual differences in mental health and development, and by promoting positive environments in place of negative environments, more positive developmental outcomes are promoted for children and adolescents.

This assertion is challenged by the proposal that a core mechanism through which mental health outcomes in children and adolescents is transmitted is through genetic factors passed on from parents to offspring (children). It is further challenged by the notion that the environments that children experience are in part influenced by their own genetic dispositions. These assertions have significant implications for what behaviours family-focused interventions should target, particularly for children who may be at high genetic risk for poor mental health.

Research studies that include biologically related families (parents and children) are unable to disentangle the relative role of genetic factors from environmental factors because parents and children share genes. In order to illuminate the role of rearing environmental influences (e.g. inter-parental relationship quality, parent-child relationship quality) on children’s outcomes, including mental health, that are independent of shared genetic effects, we need to examine associations between family environmental factors and child related outcomes among genetically unrelated parent-child groupings.

Two novel approaches led by researchers in the United States and the United Kingdom have allowed significant insights into this important question. The first employs a longitudinal adoption-at-birth research design, the second focused on children who have been conceived through assisted reproductive technology (e.g. IVF). Together, these respective research designs uniquely allow examination of associations between measures of family environment and child-related outcomes where children and rearing parents are genetically unrelated.

This method enables conclusions about the role of specific family environmental factors relative to genetic factors that are not possible using more traditional approaches where parents and children are genetically related. In a nutshell, multiple studies using these research designs, and replicated by other studies, provide evidence of the adverse effects of inter-parental conflict for children across all ages. Specifically, conflict between parents that is frequent, intense and poorly resolved places children at elevated risk for multiple poor outcomes including anxiety, depression, conduct problems, academic failure, substance misuse, criminality, homelessness, self-harming behaviours and suicidality.

These outcomes are evident whether parents are living together or not, and also whether parents are biologically related to the child or not (e.g. adoptive families). Furthermore, these adverse outcomes can converge and accumulate over time, and ultimately lead to negative outcomes in future generations. Intervention studies highlight that supporting the inter-parental relationship improves outcomes for children and promotes more positive parent-child relationships as well as enhancing additional positive outcomes for adults (e.g. adult/parent mental health).

Applying research to policy: The reducing parental conflict programme

Based on an accumulation of evidence highlighting the extensive and pervasive harm of parental conflict on child outcomes, the Department for Work and Pensions (DWP) in the UK funded the Reducing Parental Conflict Programme (RPC), which provides support for couples in conflict below the threshold of domestic violence.

The RPC Programme is an internationally significant policy initiative seeking to convert the robust evidence described above into practical policy. The programme started in England in 2018 and is currently due to end in March 2022. The ‘Interventions Delivery’ strand of the programme involves testing eight different parenting and relationship interventions in four different areas, covering a total of 31 local authorities.

RPC is based on the strong evidence that conflict between parents – whether together or separated – can have significant adverse impacts on children’s mental health and long-term life chances. The RPC programme aims to promote improved outcomes for children, with a focus on disadvantaged families. Its core objectives are to:

develop the evidence base on what works to reduce parental conflict, to inform future commissioning practice; and
help local areas integrate support to reduce parental conflict in local family services.

The RPC programme aims to reduce the adverse impacts that parental conflict causes to children through the provision of new support for parents, training for family practitioners and better awareness, understanding and coordination of parental conflict related services delivered by local authorities and their partners; all with one core aim – to promote improved mental health outcomes for at-risk children and adolescents.

Moving from late intervention to early prevention: The promise and prospect of a prevention science framework to promote child-adolescent mental health

As we discussed in the previous post, mental health is not synonymous with mental disorder. Infants and young children are very rarely diagnosed with mental “disorders” – they typically start life as mentally healthy young beings. It is essential to the wellbeing of society that parents are supported from very early in their child’s development to support their child’s mental health (and prevent mental disorder). Within this preventative framework, if all families have improved access to evidence-based programmes such as RPC that support parents and also support the inter-parental relationship, we would be able to substantially reduce the incidence of mental health disorders in future generations.

Now is the time to promote child and adolescent mental health; disparities in emotional wellbeing have never been greater than they are today. The Covid-19 pandemic has fuelled a critical mental health crisis, with schools and existing mental health providers under-prepared for the influx of mental health challenges experienced by an increasing number of children and adolescents. But we have hope because we know that supporting parents matters, and programmes such as those that are part of the RPC programme are available and can fill a critical role in promoting child and adolescent mental health, and preventing future mental disorder.

The first of this two-part blog series describes the scale of the challenge in understanding what contributes to mental health and the policy needed to support parents to support their children.

(1) Harold, G. T., Sellers, R. (2018). Interparental Conflict and Youth Psychopathology: An Evidence Review and Practice Focused Update. The Journal of Child Psychology and Psychiatry, 59 (4). pp. 374-402. ISSN 00219630.

(2) Harold, G. T., Leve, L. D., Sellers, R. (2017). How can genetically-informed research help inform the next generation of interparental and parenting interventions? Child Development. ISSN 0009-3920.

Authors
Professor Gordon Harold
Professor of the Psychology of Education and Mental Health
Faculty of Education, University of Cambridge, UK.

Professor Leslie Leve
Lorry Lokey Chair
College of Education, University of Oregon, USA
Visiting Scholar, Faculty of Education, University of Cambridge, UK

With helpful contributions from: Ruth Sellers, Saul Becker, Ashton Brown, Wendy Browne, Anita Thapar and Sui-Mee Chan.

This text was originally published on the Bennett Institute Blog and has been re-posted with permission