Consideration of the attachment of children to parents leads to some indicators of the parental contribution to the attachment relationship, and to ways in which this might be threatened by parental mental illness, and what might be protective processes in the face of such threats. In considering the relationship of psychiatric disturbance, parenting and attachment one needs to take account of the context of the parental disorder. First, the factors that have contributed to the risk of parental psychiatric disorder may also directly impinge on the parent-child relationship, and hence on attachment processes. Second, the parental psychiatric disorder together with associated risks may undermine aspects of parent-child attachment. Third, the disorder itself, independently of other factors, may adversely affect attachment. Finally, the parent's capacity to preserve the sensitive and effective responses may be protective in the face of their psychiatric disorder.

This chapter explains how mental illness affects parenting and influences the development of children. It talks about abuse and neglect, the effects of separation and the risk of mental health problems in children. Large numbers of children grow up with a mentally ill parent. A study of parental psychiatric histories of 850 twin pairs in Virginia found that only 26% of families had no lifetime history of psychiatric disorder in either parent. The chapter outlines a developmental framework to help understand the interrelationship of risk variables in the development of the child, the emergence of disturbance and its modification. Clinically, this framework may assist with the developmental assessment of children. The effects of social disadvantage are discussed. The catalogue of risks for children of mentally ill parents described in the chapter emphasizes the need for skilful coordination of professionals involved with both the parents and the children.