Parenting is tough. Every parent has to cope with challenges of one kind or another, but if you have a mental health issue, it may be harder to care for your child in a safe and loving way without help from support networks. Here, in the second instalment of our online series about different aspects of mental health and the impact they have on children and parents, we hear from two Hong Kong-based experts on the topic. They discuss parenting styles and mental health – from how to manage bipolar as a parent or cope with an anxiety disorder, to how the court determines a parent’s capacity to look after their kids.
DR QURATULAIN ZAIDI is a British- and HK-registered clinical psychologist who works with individuals, couples and families in a private practice in Central.
How can a mental health condition such as depression, anxiety or bipolar disorder affect a person’s ability to parent and parenting styles?
#1 Depression
Research shows parents experiencing depression may exhibit reduced energy, diminished interest in activities, and impaired concentration. These symptoms can lead to less engagement with their children, affecting the quality of parent-child interactions. When children have to rely on themselves to take care of themselves due to low engagement or uncertain engagement from the parent, this in turn can impact the attachment of the child with parent.
Research also shows that children raised in an environment with unmanaged mental health issues often develop emotional challenges such as anxiety, depression and low self-esteem. Behavioural issues, including aggression and defiance, are also common. Academically, these children can struggle due to difficulties in concentration and motivation. The lack of parental engagement can hinder the development of a secure bond, further impacting the child’s social and emotional growth.
#2 Anxiety
Anxious parents may inadvertently model fearful or avoidant behaviours. Children can internalise these, leading to their own anxiety issues. Overprotectiveness, a common trait among anxious parents, limits a child’s opportunities to develop independence and problem-solving skills. This dynamic may result in children experiencing heightened anxiety, reduced self-confidence and social withdrawal. Research shows the constant exposure to a parent’s anxious behaviours can create an environment of uncertainty, further exacerbating the child’s own anxiety levels.
#3 Bipolar Disorder
Bipolar disorder is characterised by extreme mood swings, from manic highs to depressive lows. Children of parents with bipolar disorder often experience an unpredictable home environment due to these fluctuations. This instability can lead to feelings of insecurity, anxiety and confusion. Research studies show there is also an increased risk of the child developing mood disorders themselves; behavioural challenges, such as oppositional defiant disorder and conduct disorder, are more prevalent in these children. The inconsistency in parental behaviour can make it challenging for children to form secure attachments and develop trust.
#4 Dissociative Identity Disorder (DID)
This is a serious mental health condition. If it’s not medically managed and these parents are left unsupported, it can have a detrimental impact on a child’s development. Parents with DID, characterised by the presence of two or more distinct personality states, may exhibit unpredictable behaviours and emotional responses. This unpredictability can cause confusion and fear in children, leading to emotional distress and difficulties in forming a stable sense of self. The inconsistent parenting styles associated with different personality states can result in a lack of clear boundaries and expectations, further complicating the child’s emotional and behavioural development. These children may also feel isolated, as the unique challenges of their home environment can be difficult for others to understand.
How are children affected when one or both parents have a mood disorder, bipolar disorder or anxiety disorder?
Children are particularly vulnerable to the effects of parental mental illnesses, such as depression, anxiety, bipolar disorder and dissociative identity disorder, during specific stages of their development. The two most vulnerable stages are early childhood development (age zero to five years) and adolescence.
Early life is a crucial period of biological, emotional and mental development. The plasticity of this period makes individuals extremely vulnerable to the impact of stressors. This is why it has been referred to as a sensitive period. Early childhood is the crucial period for attachment and development sense of security, safety and trust.
Research shows parental mental health problems act as a stressor for children during a sensitive period because parents are central to the lives of their children and provide an essential source of social control, self-esteem and sense of belonging. Parents with mental health challenges that are not being managed well through support may struggle to provide the necessary bonding experiences, leading to difficulties in children regulating their emotions and behaviour. This can often result in episodes of tantrums, nightmares and sleep problems, regression in potty training, or bedwetting.
During adolescence, children depend on their parents for structure and positive reinforcement. A parent dealing with unmanaged and unsupported mental illness might become less attentive or overly critical, potentially causing teenagers to exhibit disruptive behaviours. Research shows that parental mental health issues can lead to increased family stress, which has been linked to higher risks of depression, anxiety, and other mental health disorders in adolescents.
The lack of energy that depressed parents often experience may also affect their ability to pay attention to their child’s school routines. Without a parent’s support, school-aged children can struggle to get to school or after-school activities on time. Completing homework can become an overwhelming challenge. A parent dealing with an anxiety disorder can be overprotective, depriving their child of the chance to learn problem-solving skills. Research shows a child who witnesses their parent’s anxious behaviour may in turn develop fears and worries .
Regardless of the specific disorder, children of parents with significant mental health challenges often face the following:
- Emotional distress. Feelings of insecurity, anxiety, and depression are common.
- The burden of a care-taker role. Taking on caregiving responsibilities can lead to parentification, where the child assumes adult roles prematurely.
- Social isolation. The stigma associated with mental health disorders may cause children to withdraw from peers and social activities.
- Developmental delays. Emotional and cognitive development may be hindered due to the unstable environment.
What are some strategies parents can use for the difficult days?
Just because a parent has a mental health challenge doesn’t mean they’re not able to parent their children effectively. Having awareness of the ups and downs and acting proactively as much as you can to manage mental health issues through medical, psychological or social support networks is important.
Depending on the severity of the challenges, it’s important to put in a support framework in place and keep the focus on what’s in the best interest of the children. It’s advisable for parents to maintain honesty and transparency in co-parenting their children, to protect them from the worst impact of the mental health challenges on their development.
Mental illness does not define a parent; it’s a part of parenting that needs to be recognised and managed with support, self-care, transparency and honesty to minimise the impact on the children’s wellbeing and development. Separation and divorce is hard enough for them without the parents fighting and weaponising mental health against each other.
What specialised or general support is available for parents who find themselves in this situation? What about children?
Qualified mental health practitioners and psychiatrists are available – and again, the key is to focus on the children. It’s important for parents to set aside personal feelings and work with each other to create a stable environment for the children. Basic values like respect, flexibility and clear communication help in maintaining a consistent environment for the children.
Live-in helpers can be a major channel of support for families in Hong Kong, depending on the severity of the mental health challenges, if the parent’s condition is stable, and if it’s safe for the child. However, if the condition is not stable and is not being communicated between parents with transparency, sometimes it’s in the best interest for children to have supervised access.
Dr Quratulain Zaidi
WhatsApp +852 9700 2786 | mindnlife.com
VANESSA DUFF is a specialist family/divorce lawyer and Partner at Charles Russell Speechlys LLP.
What are some of the legal ramifications of a parent having a mental health condition in child custody proceedings or other family law matters?
Capacity to litigate
The first question in any family law matter involving a parent with mental health concerns is whether they have the capacity to provide instructions and make decisions about important matters relating to any court proceedings.
If there are doubts about capacity, that parent’s welfare must be protected, and a “next friend” may need to act as the parent’s representative. Such a person can be a friend, parent or family member, as long as they do not have a conflicting interest. If no one else is willing or able to take on the role, an Official Solicitor (a public officer) can be appointed to act and make decisions about any litigation on the individual’s behalf.
If the parent is unwell to the point that they are mentally incapable of making decisions, a guardian may also be appointed to manage their affairs.
Child custody and care/access
With regard to proceedings concerning custody and care and control/access, the court’s paramount consideration will be what is in the best interests of the child. The need to protect the child is weighed against the importance of a parent’s right to a meaningful relationship with their child, taking into account the mental health of the parent.
The court will assess if the parent can provide a consistent and secure home setting, whether their condition hinders them from performing essential duties of care for the child, and whether the illness may lead to a pattern of harmful or violent behaviour. It will also consider the possible risk of emotional harm, as well as physical harm, and whether the mental health condition may result in one parent engaging in alienating behaviour (that is, alienating the child from the other parent). Whether that parent has proper support in caring for the child will also be considered.
It may also be necessary for the court to evaluate issues such as alcohol or substance misuse or addiction; access between parent and child may need to be supervised (by an independent third party, or at a contact centre), and there may need to be regular drug and/or alcohol testing, with the provision of the test results to the other parent and the court. In some cases, the court may require the parent to take a breathalyser test prior to having access with their child.
If another addiction, such as online gambling, has a direct impact on the quality of care, the court will also look at whether there is a treatment plan in place, and whether the parent is taking positive steps to treat any addictions. If a parent is receiving psychiatric treatment, the court may require supervised access to ensure that the child can maintain contact with the parent in a safe environment. It may mandate that a parent receive treatment as a condition of maintaining access with their child and may also require updates to be provided by the treating psychiatrist.
Each case is unique, and the court will consider a range of factors, including the specifics of the mental health condition, overall parenting capacity of the individual and the presence of a support system that can help the parent manage their condition whilst caring for their child. Matters such as medication compliance and contingency plans in case the parent’s health deteriorates need to be considered, as well as practical considerations, such as the need to accommodate therapy sessions or hospital visits. The court’s paramount concern is whether a child’s physical, emotional and developmental needs can be properly met.
If necessary, in complex cases, the court may appoint a guardian to represent the interests of the child, and in extreme cases, where neither parent is able to care for the child due to mental health or other issues, the court may award custody and care or guardianship to another family member or a government agency.
How are claims of such a condition assessed by the court? Is specific evidence required?
If concerns are raised by a parent about the other parent’s mental health, the court will consider the seriousness and relevance of the allegations. Often the first piece of evidence comes in the form of Affidavit evidence by the concerned parent, usually as part of an application to the court for care and control, or a change to the existing arrangements.
Typically, in child proceedings, the court will request a social welfare report which involves a comprehensive assessment of the family’s situation by a social welfare officer. They will assess the parents and prepare a report to the court, with recommendations on the care and access arrangements between the parents and child.
However, where there are significant mental health concerns, it’s common for a clinical psychologist or other mental health professional to also be appointed by the court to conduct a psychological evaluation of the parent. They may speak to third parties, such as family members, to get additional insight into the condition of the parent. The expert will assess the parent and provide a report on their mental health status, including any diagnosis, the prognosis, and recommendations for treatment.
They may also be asked to provide their professional opinion on the impact of the mental health condition upon the parent’s day-to-day functioning and their parenting capacity.
Parties to divorce proceedings may undertake psychologist assessments on parenting capacity and mental health conditions on a voluntary basis. In some cases, this may be a suitable response to unfair and baseless allegations made by the other parent.
Is there a presumption that a parent with a mental health condition has a diminished capacity to parent?
There is no presumption that a parent who suffers from mental illness is incapable of being a fit and responsible parent. Suffering from a mental health condition does not automatically disqualify a parent from having custody, care and control, or generous access to their child.
A parent’s mental health only gains significance in the eyes of the court if there is evidence indicating that it has caused, or has the potential to cause, harm or negatively impact the child. The court will consider the specific nature and severity of the condition to assess the parenting capacity of the individual. Mental health conditions can range from mild and manageable with treatment, to severe and debilitating and the court’s primary concern will be whether the parent can provide a safe and stable environment for their child.
If a parent with a mental health condition can demonstrate they are managing their condition effectively and it does not adversely affect their parenting, the court is unlikely to view their capacity as diminished solely because of their condition. The focus is the actual impact on the parenting capacity rather than the mere presence of mental illness.
How do mental health issues impact financial matters?
The court will look to achieve a fair and equitable division of the assets between the parties taking into account all the circumstances of the case. When mental health issues are involved, the court will carefully consider the needs and capabilities of the parties, and how the condition may impact their financial needs.
Earning capacity and division of assets
A parent’s mental health may impact their ability to work and earn an income, and thereby affect whether they are capable of being financially self-supporting. This will have a direct impact on questions of spousal and child maintenance. The court may need to consider the needs of a party with mental health concerns more extensively, potentially awarding a larger share of any assets to cover future care needs or a reduced earning capacity.
Costs of treatment
The court has a duty to consider any mental disability of either party to the marriage and that of any children when deciding on financial relief. The required costs associated with mental health treatment (therapy, medication or inpatient care, for example) can be significant financial needs and may need to be factored into any financial settlement or spousal maintenance assessment.
Capacity to manage finances
Mental illness may result in a party being unable to fully understand the terms of any agreement they reach with their spouse/other parent. The court will scrutinise any agreement reached between parties to ensure it is just and reasonable, and that the individual with the mental health condition has not been under pressure or undue influence.
If a party to proceedings is suffering from mental health issues that affect their capacity to manage their finances or make decisions, the court may need to consider this when making financial orders.
If there are payments to be made under a court order in favour of a person suffering from a mental illness, the court may direct that such payment be made to such persons having charge of the mentally incapable person’s finances, for example a guardian or an attorney appointed through an Enduring Power of Attorney.
How can ongoing treatment and outcome affect legal decisions – for example, the variation of maintenance orders?
The expected duration of treatment can influence the length of time for which maintenance is awarded. If a mental health condition is likely to be long-term or permanent, this may justify a longer maintenance term. The court may also consider whether the individual is complying with treatment recommendations and how this affects their condition and financial needs. Non-compliance with ongoing treatment without good reason could potentially impact the court’s view on maintenance. Comparatively, commitment to ongoing treatment demonstrates the willingness of the individual to manage their condition responsibly which could influence the court to maintain or adjust maintenance orders in a way that supports the parent’s recovery and stability.
The court recognises that circumstances can change, and court orders for maintenance can be changed. If a parent’s mental health changes, it may be grounds for either party to seek a variation of a spousal or child maintenance order. If a parent’s mental health deteriorates, they may seek an increase in support to cover additional treatment costs or because their condition affects their ability to support themselves. Conversely, if their condition improves, the paying party may apply to reduce payments arguing that the recipient’s financial needs have decreased. Similar changes may also impact child arrangements if a parent’s capacity to care for their child changes – for example, adjusting more towards shared care if the parent’s mental health improves and there is no risk of relapse. The court will reassess the situation and make a new determination based on the current circumstances.
The court may also consider the need for financial planning, including the creation of trusts or other mechanisms to manage financial support, particularly if the mental health condition affects the individual’s ability to manage their finances.
Vanessa Duff
+852 2531 3438 | charlesrussellspeechlys.com
This article covering the challenges around mental health and parenting, from how to manage bipolar disorder and anxiety disorder to the legal ramifications, is part of an online series. See the first instalment of the series here, and find more pieces like this in our Wellness section.
