Appendix 1: Literature review For children and young people, it usually falls to parents and carers to identify possible emotional or mental health concerns and help children and young people access the help that they need.142 The referral pathways between general practitioners, paediatricians and mental health professionals are critical for accessing appropriate help and support, especially for younger children. A survey of Australian children found that 22.5% of children and 19.2% of young people with a mental health diagnosis had seen a paediatrician within the previous 12 months in relation to their diagnosis.143 The Royal Children’s Hospital National Child Health Poll found that the majority of parents in Australia are not confident in identifying or responding to signs of a mental health problem in their child.144 For example, 65% of parents in Australia lack confidence in recognising the signs of social and emotional problems in their child and less than half know where to go to find help for social, emotional or behavioural difficulties in their child. Parents showed less knowledge about depression in younger children with a third (33%) not being aware that primary schoolaged children can get depression. A further third of parents (33%) did not recognise that persistent sadness, frequent tearfulness and crying is not normal in children. One in five (21%) parents agreed that it is normal for children to have ongoing guilty or negative feelings about themselves or their life. A third of parents (35%) felt these problems may be better left to work themselves out over time rather than seeking professional help.145 This is not new information. The second and most recent Australian Child and Adolescent Survey of Mental Health and Wellbeing, conducted in 2013–14 with over 6,300 families with children aged 4–17 years, reported that less than onethird of parents called on services to help their child with mental health when needed and only half of all children who experienced mental health problems in the 12 months prior accessed help.146 Even when they do seek support, the majority of children in Australia do not engage with these services frequently enough to receive adequate treatment.147 138 | In the AHRC’s 2021 consultations for Safe and Supported: The National Framework for Protecting Australia’s Children 2021-2031, children and young people frequently spoke about parental failure to understand their mental health issues. Some linked their parent’s inability to understand their needs to cultural and linguistic factors, while others attributed it to parental lack of agency and knowledge about mental health. The AHRC was also told about barriers impacting on the ability to access help, including long waitlists, fear of stigma and discrimination, thresholds of risk being set critically high to obtain help, and the affordability of services.148 A priority of the National Children’s Mental Health and Wellbeing Strategy is increased attention on improving parents’ mental health literacy to help them recognise the signs of poor mental health in their children.149 Focus Area 1 of this Strategy concentrates on family and community. It talks about promoting mental health and wellbeing as part of parenting and how services can better connect with families and communities. It’s objectives include ensuring families are supported with an increase in mental health literacy and community driven approaches.150 It is also important to recognise intergenerational mental illness, given its established impact on the parent-child relationship and children’s and young people’s wellbeing.151 A significant proportion of children in Australia already have a parent or carer with mental illness. Estimates of the prevalence of parental mental illness vary, but Australian research has found that up to one in four children are being raised by a parent with mental illness.152 International data suggests that 36% of children attending child mental health services have a parent with a mental illness.153 One of the reasons for the ambiguity in exact figures is that many adult mental health service providers do not, or have only recently begun to, record whether their clients have children. Mental health service providers for children and young people similarly have low rates of reliably recording whether their clients have parents with a mental illness and how their needs are addressed.154 Parental mental illness can impede their parenting capacity, including their ability to care and be responsive to their children, which can impact on overall family functioning.155 This in turn may impact on the development of children and young people, increasing their risk of experiencing neglect, and physical and emotional abuse. Of children in Australia aged 4–11 years with diagnosed mental disorders, 34% live in families with poor family functioning compared to 11% with very good family functioning.156 Parental mental illness affects children and young people in different ways. One frequent outcome for them, regardless of parental diagnosis, is the onerous caring responsibilities they might assume for their parent and/or siblings, which can conflict with age-appropriate activities or attending school. It is also important to recognise that parental mental health difficulties do not always predict poor outcomes for children and young people. The relationship between parental mental illness and the impact on child development is not clear-cut. It is mitigated by a range of factors including the severity of the parent mental illness, comorbidity with other disorders (especially substance use), the child’s surrounding social supports, the child’s age and individual factors such as temperament and level of resilience, and the parent’s engagement in treatment. For example, a child with multiple familial and social supports and a high functioning parent will be exposed to less risk than a child whose parent has a severely disabling psychiatric disorder, with few social supports.157 Even during times of acute distress, some parents with mental illness can parent well, and the impact on their children can be minimised with the right combination of family and social support to keep children emotionally well.158 Further, parents with mental health problems sometimes find their own adversity can act as a motivator for them to make positive changes to support their parenting.159 Data suggests that family centred, strengthbased approaches hold promise for improving parent-child relationships when a parent has mental illness, and services that support families as a holistic unit are also more effective than those that treat children in isolation. However, the availability of interventions and support services that target both parents and children are limited.160 Family focused practice can ‘improve outcomes for the parents with mental illness, reduce the subjective and objective burden of care for families, and provide a preventive and supportive function for children’.161 Attention on the quality of relationships, particularly the parent-child relationship, may provide an important opportunity to improve outcomes for children and the mental health of parents. 1.9 Key national frameworks and strategies focused on children in Australia At present, there are at least 11 national plans and strategies that address critical issues facing children and young people in Australia. Mental health initiatives are included in many of them. For example, understanding the impacts of the pandemic is the first objective of Australia’s Youth Policy Framework (2021), which acknowledges young people as the most significantly affected cohort of the pandemic through changes to their education, job opportunities, and social opportunities which impact on their mental health. While this project is mainly focused on the National Mental Health and Wellbeing Pandemic Response Plan, and the National Children’s Mental Health and Wellbeing Strategy, it also takes into account the other national frameworks and strategies that are currently being implemented. ‘Mental health shapes my life’: COVID-19 & kids’ wellbeing • 2022 | 139