A meeting of the APPG for Strengthening Couple Relationships and the APPG for Mental Health took place on 17th March 2015, on the subject of couple relationships and mental health.
Presentations were given by:
- Professor Gordon Harold (Director of the Rudd Centre for Adoption Research and Practice, University of Sussex)
- Susanna Abse (Psychoanalytic psychotherapist, and Chief executive, Tavistock Centre for Couple Relationships)
- Professor Stefan Priebe (Professor of Social and Community Psychiatry, Queen Mary University of London, and Director of WHO Collaborating Centre for Mental Health Services Development).
Professor Gordon Harold's presentation, entitled Family Relationship Influences on Children’s Mental Health: Bridging the Causes versus Outcomes Divide, began by exploring the size of the challenge faced in relation to childhood depression and conduct disorder, before looking at the family factors linked to these child mental health conditions. It was of the last of these, toxic family stress, which the presentation focused on primarily, in particular the importance of research being able to disentangle genetic factors from rearing environment factors.
Two research studies were then described – The Early Growth and Development Study (US), a longitudinal adoption-at-birth study (involving more than 500 children, biological and adoptive parents), and the Cardiff In vitro fertilisation Study (UK), an adoption at conception study (of genetically unrelated mothers and fathers, involving more than 1000 children and their parents). Findings from these studies conclusively demonstrate that the associations between parental behaviour (e.g. inter-parental, parent-child conflict) and child behaviour cannot be due to common genes shared between rearing parents and children.
Professor Harold concluded his presentation by summarising the state of current knowledge as well as some recommendation for policy:
Children of all ages (6 months to 16 years) are affected by acrimonious inter-parental and parent-child relationship (silence to violence continuum)
Family relationship experiences affect children’s mental health (e.g. depression, conduct problems, self-harm, substance misuse, psychosis, suicidality (and others))
The UK is one of the riskiest nations in the world (OECD) in terms of child and adolescent mental health welfare and well-being
There needs to be a shift in focus from late intervention to early intervention/prevention
This is an issue of public health (given that more than 50% of marriage end in divorce, we need to do more to ensure that fewer children are exposed to toxic interparental conflict)
Helping parents can improve outcomes for children, can reduce costs (e.g. depression, conduct problems), can improve future relationship quality and reduce future rates of family breakdown.
Susanna Abse spoke from the perspective of a couple therapist, desribing how no couple therapist can ignore the great weight of emotional pain, depression and disturbance that is brought daily into their consulting rooms or the constant stories of children wetting beds, refusing to go to school or presenting with myriad kinds of symptomology. Susanna Abse then summarised research evidence regarding the links between depression, anxiety and personality disorders and relationship quality. Despite such research, NHS provision, Ms Abse stated, is almost entirely unrelational in its approach to treating mental health, with services focusing almost exclusively on the individual as though their difficulties have arisen in isolation, with little or no thinking given to the family context of their illness. She acknowledged that the IAPT programme should be one exception because it is designed to follow NICE guidelines which suggest that couple therapy should be offered to patients with mild to moderate depression where the relationship is a precipitating or maintaining element in the illness. However, Susanna noted, despite IAPT now being in its 6th year of roll out, official NHS statistics indicate that only one in every 250 sessions delivered in IAPT is actually couple therapy. The remainder of the presentation discussed the lack of focus on the parental relationship in CAMHS, and concluded by highlighting the need for the evidence base in this area to be developed.
The final presentation, from Professor Stefan Priebe, was entitled Personal relationships: their role in shaping both cause and cure of mental health disorders. The presentation began with Professor Priebe outlining the main factors associated with mental disorders, namely adverse childhood conditions, poverty, war experience and torture, social isolation and social inequality. He continued by emphasising the fact that mental disorders were all defined; occur; relate to; are diagnosed in; and are treated in: social interactions, before outlining the evidence for the benefits of direct social support, larger social networks, more supportive relationships in networks, and family interventions. Professor Priebe's presentation then highlighted the importance of the therapeutic relationship to mental health care before summarising a range of resource- (rather than deficit-) oriented models, including befriending, peer support workers, self help groups, solution focused therapy, systemic family therapy and therapeutic communities. Professor Priebe presentation ended with a slide summarising the role of personal relationships as being central to our quality of life, contributing to our mental health, and being crucial to overcoming distress.