Abstract
Service delivery for children of parents with mental illness (COPMI) and their families is considered essential in many countries for the prevention of mental illness and addiction in children, and their future resilience. Although types of interventions are well researched, and some risk factors can be identified for children, service delivery for families living with severe and chronic parental mental illness has not been sufficiently distinguished or advanced, and the perspectives of this group of service users have not been well captured. This thesis explores child and parent perspectives on service delivery for COPMI and their families in Aotearoa/New Zealand (A/NZ) who have increased needs due to severe and chronic parental mental illness. Socio–ecological perspectives on resilience are utilised to understand these needs. This perspective moves beyond the level of individual or family understandings of COPMI and resilience, locating their needs for support in the broader ecological context of society and culture.
Socio–ecological perspectives on resilience contribute to discourses of support for this group by providing an alternative rationale to the usual risk discourse for service delivery. Such perspectives enable wider factors which affect these families as much as mental illnesses to be uncovered, and pathways of resilience–focused practice to be identified. Socio–ecological resilience theories are further used to locate COPMI and other NGO service delivery in the socio–political sphere of A/NZ.
A long–term COPMI service, the Caroline Reid Family Support Service (CRFSS) which supports whole families for up to eight years, was studied using a primarily qualitative methodology. Convenience sampling was employed to gather data about service–user perceptions of service delivery. The data consisted of interviews of a maximum variation sample of 10 child or youth service–users; four age−differentiated child or youth service–user focus groups (24 participants); and 32 adult service–user, mixed method surveys. Findings were analysed by thematic analysis and descriptive statistics and compared to CRFSS service goals.
The importance of relationships between service users and workers emerged as the primary theme. The most important elements of this theme were trust, open communication, care of the whole–person, and continuity. Other primary themes included comprehensive family practice, experiences of stigma, peer support, and recreational activities as a conduit for respite and developmental gains. These findings have implications for staff training, support and retention, and support findings from contextually relevant resilience studies in A/NZ and Australia (Bottrell, 2009b), (Munford & Sanders, 2016). Interrelatedness between components of service delivery revealed the scaffolding and probable value–added effects of worker to service–user relationships, and child and youth peer relationships, which raises questions for programme theorisation, delivery, funding and evaluation. Connections in findings add to knowledge of socio–ecological resilience for these families: experiences of stigma and the destigmatising effects of COPMI peer support; and worker to service–user, and child and youth peer relationships, to the enhancement of respite and possibility of developmental gains during recreational activities. The primacy of worker–client relationships within the context of comprehensive family practice contributes to understanding how holistic needs across a family system may be coordinated and enhanced.
Analysis revealed that the long–term, relational and comprehensive nature of the service delivery preferred by service users lacks feasibility in A/NZ and other similar socio–political climates. This is due to the influence of neoliberal ideologies and policies that prevent and resist such service delivery, feed stigma, thwart third sector resilience and capacity, and alter the sector’s values and practices. Strategies which would enable NGOs to resist organisational hybridity and become more resilient are proposed (Walker & Shannon, 2011).