The PRIMERA Project – Parental Mental Health and Family-Focused Interventions

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In this ‘In Conversation’ podcast, Professor Sinéad McGilloway, Founder-Director of the Centre for Mental Health and Community Research, Maynooth University, County Kildare, Ireland, and doctoral fellow Christine Mulligan, provide valuable insight into the PRIMERA programme, which investigated how best to support young families experiencing parental mental illness.

The PRIMERA project team won ACAMH’s prestigious Lionel Hersov Memorial Award in 2022, which recognises practice teams at the forefront of the advancement of child and adolescent mental health research and practice. There is an overview of the PRIMERA programme and insight into the key findings.

Discussion points include;

  • How prevalent parental mental illness is.
  • What the provision of services is like for affected families.
  • How developed is the evidence for family-focussed practice in this area?
  • The Family Talk intervention programme – key findings and evaluation of the programme.
  • Implications of the findings for CAMH professionals, and for mental health professionals working with adult service users.
  • The barriers that could undermine the long-term sustainability of family-focussed practice.
  • The recommendations for policymakers.
  • What is next for the Family Talk intervention?

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Professor Sinéad McGilloway
Professor Sinéad McGilloway

Prof. Sinéad McGilloway is Director of the Centre for Mental Health and Community Research at Maynooth University.

Christine Mulligan
Christine Mulligan

Christine Mulligan is a Doctoral Fellow on the PRIMERA research programme and her PhD centres on a process evaluation of the Family Talk intervention (Principal Supervisor, Professor Sinéad McGilloway and Co-Supervisor, Dr. Mairead Furlong). Christine completed her BA (Hons) degree in Psychology at Maynooth in 2017, achieving a First Class Honours and second place in her year. She has a Certificate in Social Studies and a COSCA accredited diploma in Counselling. She also has many years’ experience of working with NGOs and in the commercial and public sectors. She now lives in North Carolina with her husband and 17-month-old daughter.

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[00:00:01.400] Jo Carlowe: Hello, welcome to the In Conversation podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short.  I’m Jo Carlowe, a Freelance Journalist with a specialism in psychology. Today I’m interviewing Professor Sinéad McGilloway, Founder Director of the Centre for Mental Health and Community Research, Maynooth University in County Kildare, Ireland, and Doctoral Fellow, Christine Mulligan.

Sinéad and Christine will be talking today about the PRIMERA programme, which investigated how best to support young families experiencing parental mental illness. The PRIMERA Project Team recently won ACAMH’s prestigious Lionel Hersov Memorial Award, which recognises practice teams at the forefront of the advancement of child and adolescent mental health research and practice.

If you’re a fan of our In Conversation series, please subscribe on your preferred streaming platform, let us know how we did, with a rating or review and do share with friends and colleagues. Sinéad and Christine, welcome, thank you for joining me. Can you each start with an introduction?

[00:01:06.830] Professor Sinéad McGilloway: Hi, Jo, I’m delighted to be here today to talk to you about our research project.  I’m a Professor of Family and Community Mental Health at the Department of Psychology and Social Sciences Institute at Maynooth University in Ireland, which is located approximately 25 kilometres west of Dublin. As you mentioned, I’m Founder Director there of the Centre for Mental Health and Community Research. We have around 30 members of academic and research staff and postgraduate students, who are engaged in research and a very large portfolio of projects, in fact, across the lifespan and all with a focus on mental health and wellbeing in the community.

[00:01:42.230] Jo Carlowe: Thank you, and Christine?

[00:01:43.470] Christine Mulligan: Thank you, Jo. Yeah, I started my PhD with Sinéad after completing an undergrad in Maynooth University. If you had have asked me to describe myself when I started the PhD, I was single, living in Dublin, living just outside of – living in Kildare, actually and now, I’m living in North Carolina, finishing my PhD and I have a little baby. But I came to education late in life, in part, because I grew up in a home, with a number of difficulties, one of them being parental mental illness.

[00:02:15.310] Jo Carlowe: Let’s come to that. I was going to ask you – each of you, what motivated your interest in parental and family mental health issues. So, Christine, I expect you’ve hinted at that, so can you both say a little bit about your motivation?

[00:02:28.310] Christine Mulligan: Yeah, I mean, I would not have probably known to research the area, but it was really just connecting with Sinéad in Maynooth and in the Centre for Mental Health. I suppose, having researched it for a number of years, I probably, too, wouldn’t have discussed it openly, wouldn’t have talked about it. I wouldn’t have really talked about the impact that it had in my life, even into my late 40s. So, my involvement in the research was really just being part of Maynooth University and working with Sinéad in the centre.

[00:02:58.390] Jo Carlowe: And Sinéad?

[00:02:59.390] Professor Sinéad McGilloway: For me, I suppose I’ve both a professional and a personal interest. Professionally, I’ve been involved in parenting research for, gosh, probably the last 15 years or so. And we know from that work and from the international research literature, that there are gaps in knowledge and service provision, particularly for, if you like, more vulnerable parents, and including those parents who have mental health illnesses and who are in contact with mental health services, specifically within a family context. So, it was that, I suppose, for me, that was the impetus for the research at a professional level.

At a personal level, tragically, I had a schoolfriend who, almost 20 years ago, took her own life and she also took the life of her only child, her nine-year-old daughter. That happened in Northern Ireland, from there – I’m from there originally, and was a very tragic case. It was a huge impetus and the significant catalyst, actually, in the development of what became known as Think Family Practice in Northern Ireland and, you know, up there now, we’re seeing that they’re quite well advanced, actually, with regard to Think Family or family-focused practices in mental health.

[00:04:10.310] Jo Carlowe: Can you set the scene for us further, Sinéad, by telling us how prevalent parental mental illness is and what the provision of services is like for affected families?

[00:04:21.920] Professor Sinéad McGilloway: It’s a very good question. The statistics on prevalence are imprecise, because most services, including those in Ireland and the Republic of Ireland, in particular, don’t actually collect information or data on the parenting status of mental health service users. What it’s estimated, from research that’s conducted internationally, that almost one in four children, so around 23%, in fact, live with at least one parent who has, or has had, a mental health illness. We estimate that about two thirds of service users in Adult Mental Health Services are parents and up to 60% of children in CAMHS might also have a parent with mental health challenges.

So, the key issue here is not only, I suppose, the hugely negative impact of parental mental health illness on families in the here and now, but also really, we know that it vastly increases a child’s lifetime risk of developing a mental health problem, but also, issues around physical illness, as well as impaired and educational and occupational outcomes. And important in child welfare, it’s just not considered, often, in the treatment of the service user parents. So, you know, aside from those kids who are in CAMHS, many of these young children and young people are actually invisible in the system, and that’s a really serious problem for these kids, who really do need support.

[00:05:42.210] Jo Carlowe: I want to return to that in a moment, but I’m also wondering how developed the evidence is for family-focused practice in this area.

[00:05:49.900] Christine Mulligan: Yeah, I mean, it’s one of the areas that I’ve been researching over the last number of years. It’s definitely a growing area and I think a number of policy documents are driving that. It’s now a public health issue, the issue of parental mental illness, so the – but the evidence is growing, it’s still in its early days. There’s a number of different types of programmes have been developed, so you might have parent-only, parent-child, family-focused. What the overall evidence is suggesting, it is helpful. Talking about mental illness is critically important in the lives of the service user, in terms of reducing stigma, reducing the shame that, kind of, comes along with trying to hide something that’s very – having a very, potentially, negative effect on your everyday life. And also, within a family context, it’s like, you know, not talking about it is ignoring the elephant in the room.

As part of the research, we conducted interviews with a number of individuals, like myself, with lived experience of growing up with a parent who’s mentally ill and, you know, stories which wouldn’t surprise your listeners, I’m sure. I went to the bedroom to give my mother a cup of tea and she asked me, “What’s it like to be dead?” or “I wonder, what would it be like to be dead?” And so, just the hearing stories from grown adults, who remember vividly these recollections from parents who’ve been depressed, who’ve taken to their bed, who just haven’t been able to function, who’ve been – you know, children who’ve been parentified.

So, the evidence is in the early days, really, but it’s very, very promising. In terms of preventative, it’s preventative work. A number of programmes have been shown to reduce the impact of children of parents developing either the same or another mental health difficulty by between 40 and 47%. That’s a significant, potentially promising, in – figure for children with parents who’ve grown up with mental illness. But more work needs to be done, more research, but it’s certainly very, very promising, not just for the children, but also for the service user themselves.

[00:07:50.039] Jo Carlowe: But, of course, you’ve actually got to recognise and identify those who would benefit, and it comes back to a point you raised, Sinéad, in describing – you used the word ‘invisible’ to describe this particular group.  And I’m wondering why, in your view, do these vulnerable families remain invisible, even to mental health professionals?

[00:08:10.780] Christine Mulligan: Our system is – has been set up to be an individualised, medicalised model on – and the services that were particularly siloed. So, adult service users are treated separate from children and so, they – these children who are potentially vulnerable, growing up, maybe the service user is receiving treatment, but there is no – less of the legislation and practice guidelines to require children of parents to be treated. They’re falling through the gaps, so as Sinéad says, they’re ‘invisible’.

[00:08:41.219] Jo Carlowe: Now, you’re both part of the PRIMERA programme of research, which recently won ACAMH’s Lionel Hersov Memorial Award. What is PRIMERA?  What is the programme?  Can you give us an overview?

[00:08:53.890] Professor Sinéad McGilloway: Yes, PRIMERA is an acronym for Promoting Research and Innovation in Mental hEalth seRvices for fAmilies, a rather long one. It was a five-year mixed methods and community engaged research programme funded by the Health Service Executive in Ireland, for about €500,000. Wasn’t meant to be five years at the beginning, but because of COVID, it, obviously, took us much longer.

So, we set out to do a number of things. Broadly speaking, we wanted to help promote, for the first time in Ireland, a Think Family care delivery agenda in Ireland. So, to initiate conversations, increase awareness, increase understanding and improve knowledge, but practically, try to change how services think about and work with these vulnerable families. So, that was the broad goal, if you like, but more specifically, we wanted to, first of all, scope out what was actually happening in Ireland in this space. And we found out, in fact, there was very little. Anything that was available was very ad hoc and patchy. But when we started the research and we put out an expressive interest to service providers, and so on, in the field, we had a very high level of interest. I mean, the Clinicians, Social Workers, Family Therapists, Psychologists and others, they were aware that there were clear gaps in this space.

So, we then set out to identify and critically appraise an evidence-based family-focused intervention from the international literature, that we could encourage others to use to support these families in Ireland. Next, we set out, and this was the hard bit, trying to implement, I suppose, or help implement, the programme and to work closely with and secure buy-in from up to 15 sites, actually, across the country. First of all, to train up and deliver the programme and also to take part in our research.

Now, that intervention that we identified was called “Family Talk.” We did over 100 site visits, led mainly by Christine and the Project Manager, Dr. Mairead Furlong, with help from Siobhan – Dr. Siobhan O’Connor, all of whom were engaged in liaising with sites and really trying to get them to buy into this programme to deliver it to families, and then, also, as an additional ask, if you like, to take part in our research. And then, of course, our last step was to evaluate this programme using both quantitative and qualitative methods.

[00:11:10.890] Jo Carlowe: It sounds like a huge undertaking, but before we go into some of the findings and so on, Christine, what – can you tell us about Family Talk?  What did the intervention entail?

[00:11:20.380] Christine Mulligan: It was definitely a large project and involved – the team was such an important part of it, which is it’s wonderful to have won that award. We couldn’t have done any of it without the team that was involved. So, Family Talk was developed in the US by Dr. William Beardslee and a number of his colleagues in the late 80s/90s, initially to target affective disorders. It’s a very well evidence-based programme that’s Clinician led. It’s strength-based preventative programme, but it’s – involves the whole family and it’s made up of between six to eight sessions.

The first two sessions, the Clinician will meet with the parents, then the Clinician will meet individually with each of the children within the home, children that can maybe have a conversation, so over the age of five or six. And then, the whole family is brought together, over the next couple of sessions, to discuss what the family decide themselves that they want to discuss and how they want to use the language around mental health and mental illness.

And that’s an important part of it. It’s very much based on a partnership model. It’s not about Clinicians going in and telling the family what they have to do. We know that children are – and family members are affected when a parent has a mental illness. This programme has been shown to help reduce stigma, shame, increase conversations around parental mental illness and mental illness in general. So, within the family, it’s been shown to have very positive outcomes, improving communication, but it was initially developed in the 1980s.

[00:12:42.620] Jo Carlowe: And how did you evaluate the intervention and what were the findings?

[00:12:46.930] Professor Sinéad McGilloway: Well, there were several elements to our evaluation. First of all, we did a randomised controlled trial, a pre/post six-month follow-up study of families. So, we had 360 parents and children in the study, 86 families in total, and these were kids and young people aged five to 18 and they were parents who were in contact with the Adult Mental Health Services. And this, in fact, was one of the first randomised controlled trials of Family Talk in Europe, because quite a lot of the work had been done in America. As Christine mentioned, it was an American-based programme.

So, that was the, if you like, the quantitative part of the study. We also then conducted detailed interviews and Christine was involved in the vast majority of these. 86 interviews, to be precise, which, in qualitative terms, is huge, and those interviews enabled us to really do a deep dive, if you like, to explore the experiences of families, both parents and children, of actually being involved in the Family Talk intervention and programme. And also, of course, we wanted to ask the Clinicians and practitioners what they thought, ‘cause they were clearly involved in training of them and delivering the programme. And this was a really important study, because it was only the second qualitative study of Family Talk and certainly the largest qualitative study ever undertaken of Family Talk in the world.

We did collect, also, some cost status. That’s always important an consideration for policymakers. So, we collected some rudimentary cost data to get an idea about, you know, how much this programme is costing. We hadn’t planned to do the very final element, but it was a small spinoff study, again, led by Christine, which investigated the experience of 18 adults who had experienced parental mental illness. And that was really important in terms of providing us with insights into what we know from the literature, also, is this significant intergenerational impact of parental mental health illness across the years, repeating from one generation to the next. So, that was how we did it.

So, with regard to the randomised controlled trial, and I should’ve mentioned that we had planned a 12-month follow-up assessment as well, but just with COVID-19, we were not able to do it, very unfortunately. And it also affected our numbers, ‘cause we were doing extremely well in recruiting families into the study.  But anyway, what did we find? We found that the families who had taken part in Family Talk, when compared to a services as usual group, had improved at a statistically significant level on a number of different dimensions.

So, the kids in these families were found to be reporting fewer behavioural problems. We were seeing enhanced family relationships, better family functioning. We observed improvements in the mental health literacy amongst the parents, in particular. There were some improvements in parental mental health, but only in certain circumstances. Only when the partner didn’t have mental challenges and also when the families were less socially disadvantaged. So, obviously, that reflects – again, really complex interplay of factors that come into play when it comes to mental health. It worked for, we reckon, about two thirds of the families and that’s pretty good.

Now, the qualitative findings were easily the most interesting part of the study, in the sense, as I mentioned, these provided us with more detailed insights into the experiences of the families, and the families reported huge benefits. So, they improved – as I mentioned, improved family relationships, so that backed up our quantitative data, reduced stigma, giving partners and children a voice. That’s really important and that comes back to that issue that we mentioned earlier around invisibility. Opening up those family conversations was really important. For example, one partner said, and I quote, “There was nothing out there for me and the kids. It’s just the best thing that happened.” Another said, “Family life has got a lot easier. We’re not arguing as much, we’re not shouting.” And we had lots and lots of those kinds of comments from the families who took part in the intervention.

But there were challenges, as you might expect. Stigma is always a source of concern in mental health research. If the parent goes into a crisis, or a relapse, that can cause problems for interventions like these. And there were clearly services constraints, as well, along the way and a lot of our families said that they would like some follow-up, and that just illustrates what we know already to be the case, is that these once-off interventions can be very effective and very useful, but they really need to be provided in the context of many other things.

And likewise, the Clinicians, when we spoke to them, we saw, kind of, a similar picture, lots of positives. They talked about their involvement in delivering this intervention and helping to build their skills. They saw clear benefits for the families, in their interactions with them and for their service, particularly if they had managerial support. That was really important. They liked the structured nature of the intervention. They enjoyed the training. So, it’s ten hours training online. It’s free and reassuringly for us, as Researchers, they actually specifically alluded to their enjoyment in being involved in the research, which was really great.

But again, it wasn’t all plain sailing. You know, there were challenges. They had difficulties in engaging families. There were resource issues. There were staff turnover issues. There – some – there were some ideological barriers, whereby some of the Clinicians thought that maybe this was a luxury to deliver family-focused practice, rather than an essential part of their day-to-day work. Yeah, really interesting, and of course, there are also questions around sustainability, which is always an issue in – with interventions of this kind.

And in terms of the costs, as I said, we collected some rudimentary costs, but this is a cheap intervention. We found that this costs in the region of something like €750, so per family and it reduces further when you take out those once-off costs, like training and buy-in, and so on. So, as interventions go, this is super cheap and that is really important from a service provider or a practice and policy perspective.

[00:18:28.910] Christine Mulligan: Just to reiterate, Sinéad mentioned there it is free, it’s on a number of websites. It’s on the excellent – the Emerging Minds, an excellent, excellent website in the – in Australia, formerly COPMI. It’s also on the Centre for Mental Health website, as well. So, it’s a really easily accessible resource for any Clinician who’d like to consider doing work, which is one of the main reasons why we looked at Family Talk, in particular.

[00:18:55.250] Jo Carlowe: There’s an awful lot there and I want to dig into different aspects of it. I want to start with the implications of the findings for CAMH professionals.

[00:19:04.720] Christine Mulligan: We found, from our scoping study, that there was interest from both adult and CAMHS workers in family-focused practice and in some ways, CAMH practitioners are seen as more family-focused by nature, because they’re readily, maybe, dealing with the whole family, or at least the parents and the child service user. They have an additional barrier that maybe adult services don’t have, in that the parents might find it easier to talk about their child’s mental health difficulty without actually acknowledging that they, themselves, have a mental health difficulty.

We had one family who didn’t want to be part of the RCT, but were offered the intervention anyway and later, after receiving the intervention, they asked to be interviewed because they were finally willing to actually own up and say, “I have mental health difficulties.” And so, the programme, kind of, gave them a language around it. So, that’s one of the challenges that maybe CAMHS practitioners might experience that the Adult Mental Health Services won’t.

I think what’s great about this particular intervention, and there are other ones out there, but this particular one, it gives a structured programme for them to follow and in the site – I think four out of the ten sites who successfully implemented it in terms of identifying and recruiting families, four of them were interagency collaborations. So, where adults and CAMHS came together, and they just worked together as practitioners to help family members. I think it’s easier, in some ways, for CAMHS practitioners, because they may be seeing the intergenerational impact. They’re seeing the children of, maybe, historic service users. So, in some ways, it’s an easier buy-in, but they maybe have a different barrier in terms of helping the parent identify their own mental health difficulties and then saying, “How can we help the family?”

Another thing, maybe, is that if the child is receiving treatment and then, we’re trying to help the parent, we really don’t want to lose the needs of the child in that instance. So, it’s – I mean, it is a challenging thing involving more than one family member and it does require a certain level of skill and training, and I think it was one of the things, the skill and confidence a practitioner has in their ability to work with the whole family is one of the key factors in their success of being able to actually do it.

[00:21:16.480] Jo Carlowe: I wanted to look again at the barriers, because you’ve both highlighted that the research suggested that they were resource-related and ideological barriers that you said could undermine the long-term sustainability of family-focused practice, particularly in the absence of appropriate policy guidance. Can you elaborate on these challenges?

[00:21:36.620] Christine Mulligan: We identified the six key areas where we made, kind of, recommendations, and many of them have been said before in the literature. So, they’re not new in terms of the underfunding of mental health services. So, from the societal level, down, you know, is there political pressure to actually address this issue? In some ways, particularly post-COVID, it’s been such a crisis on services. You know, is there funding, political interest in actually addressing the needs of children whose parents have parental mental illness? We’re not even requiring services to identify them.

So, I mean, step one is let’s get the prevalence rates, let’s actually require that when a service user is getting treatment, that we identify children. That’s – in Nordic countries, there – that’s required by law. It’s not required by law in many other jurisdictions. So, from a societal level, is there political will and power and funding to support this? At an organisational level, there is definitely a shift towards psychosocial interventions and less focus on the medicalised model, but we need more of a open door approach and a family-focused approach, a Think Family approach to actually addressing it. Of course, a parent who’s a service user and if we think about it, we – are we going to go to treat them as a service user? But if they’re parents for seven days out of the week, that’s obviously going to affect their parenting.

And it’s not about shaming. It’s about supporting them in their role as a parent. Many of the parents we talked to talked about this “hidden shame” of not being good and not a good enough parent. They’re fearful of services intervening in any way, because then, they’re fearful will they take the kids away? It’s not about that, it’s about facilitating them and supporting them in their parenting role while they’re living and dealing with their own mental health difficulties. So, at an organisational level, we need to be more interagency collaboration, more Think Family focused, so more policies requiring the identification and support of children of parents with a difficulty.

And then, practitioners, many of them, you know, they get trained, they get their qualification and then, they maybe stay in, you know, adult or mental, because it’s a siloed system. Definitely, the practitioners who worked across and had history across many adult, child and even child protection services, were more confident in actually doing family-focused training. So, incorporating that into the undergrad and postgrad training, interagency working, working across the generations, will be more effective, as well.

And then, there’s – looking at the interventions themselves, establishing a six to eight-week intervention within an already complex system is quite a challenge. So without organisational support, without these champions – we’ve many, many champions on our project, who are very much part of the team, but they wouldn’t have been able to do it without the support of upper management. So, practitioners who are champions of this area, but actually given support in actually implementing it and allowed time to do the training, would be key.

Then, for the families themselves, most of the families we – the practitioners approached needed a little bit of time to come around to the idea of involving the family in, because it’s a new way of helping. But once they did and those families that did take part in the programme, really found that they benefitted from it. One of the recommendations we’ve suggested is actually making some of the literature for Family Talk more child-focused, because we relied on the service user to talk to their children about the intervention, and sometimes that didn’t happen as well as it should’ve. There’s many different barriers, as there is in implementing any new intervention in the system.

[00:25:16.049] Jo Carlowe: I just want to touch on the ideological barriers and Sinéad, you mentioned some of the attitudes, then, of some of the clinicians. And it’s interesting, ‘cause I asked the question, “What are the implications for CAMH professionals?” But perhaps I should’ve asked, what are the implications for mental health professionals working with adult service users?

[00:25:33.460] Professor Sinéad McGilloway: And yeah, what I think it comes down to, some of those barriers, as well, that Christine mentioned, the fact that maybe a lot of these practitioners don’t feel that they are competent to deal with it, or that there may be some kind of litigious issues that might arise if they try to involve the family. There are workload concerns, so, you know, they may say, “Well, look, our job is only to deal with adults. We’re” – you know, “It’s not part of our workload, our remit, to actually deal with families,” when in fact, the two are obviously inextricably linked.

And Christine’s already mentioned that siloed approach within mental health services and the need for interagency working, but that’s been – as long as I’ve been doing mental health research, that’s been an issue. And I think what was really nice about this study was that we did manage to bring together CAMHS and AMHS staff to co-deliver and be involved in delivering the intervention, which is one way of trying to overcome, if you like, those ideological barriers. And I know Christine and Mairead worked particularly hard with the sites in terms of selling them the benefits of this intervention and how it could enhance their skills, and indeed, we – that emerged, as I mentioned, from the qualitative findings. They upskilled and they saw this as advantageous.

So, it’s just about us getting out that message, increasing awareness, increasing knowledge and understanding, all of those things that we need to do to maybe scale up, but recognising at the same time that it’s not a one size fits all and that it, ideally, and one of our recommendations is this, that it should be delivered as a suite of different levels of interventions, lower, medium and higher level.

[00:27:09.650] Jo Carlowe: But can you talk about your recommendations and in particular, the message that you have for policymakers?

[00:27:15.659] Professor Sinéad McGilloway: First of all, we’re – Christine’s already mentioned funding and resourcing. That’s always an issue, isn’t it, in the – in mental health service, which has always been the Cinderella service in terms of funding and so on. But specifically with regard to policy and practice, there are simple steps, although is anything simple within mental health services? I’m not sure, but even auditing the parenting status of Adult Mental Health Service users, as Christine mentioned, this is mandatory in some Nordic countries. Even that in itself would be an important first step, policy step, practice step.

Also, there are issues around patient confidentiality, not involving the family members fully of the issues and that, unfortunately, can lead, at its worst, to things like filicide and familicide. So, it’s about maybe balancing the priority given to patient confidentiality and the needs of the family, and that’s a very sensitive and controversial issue. Obviously, the increased collaboration, well, that’s a given, isn’t it? We really do need to increase collaboration between AMHS and CAMHS. But as I mentioned, this intervention provided a nice vehicle for that, and time, resources, training, all of these things are really important.

Now, it’s interesting that during our study, one of our lead sites, in Galway-Roscommon, led by Mary G Killion, she’s a Principal Social Worker over there, they developed a guidance document on family-focused practice and I really don’t think that would’ve happened without our research. It was the first attempt by anyone, really, to put something down on paper around family-focused practice in Ireland, and that’s really the first step toward having proper policy guidance in this area and, obviously, funding and resources to match.

But I think, you know, one of the recommendations at a more broad level, from our study, really, is that we need that multilevel public health response and not just delivering the intervention at the service user level and taking into account the partner and the children and matching the intervention to the family needs. You know, but also ensuring that professionals are appropriately trained, and it would be fantastic to get something like this into the undergraduate and postgraduate curriculum in universities and elsewhere.

So, there – and there’s also that all important organisational level, where, as Christine mentioned, you know, we worked with some fantastic Clinicians who were champions and who had managerial support and who were really happy to, sort of, embrace this intervention and deliver it. But really, without policy, we’re on a hiding to nothing. Really need the government to step up and to support this and to develop more policies around it.

[00:29:48.750] Jo Carlowe: What next for Family Talk?  Is the intervention being rolled out to support more families?

[00:29:53.820] Professor Sinéad McGilloway: Most, if not all, the sites that we work with, wanted to deliver it. We had 15 originally, as I mentioned, ten of which were in a, if you like, a state of readiness to implement the programme, but about five of the ten sites are still delivering Family Talk, and these are sites where there was a clear champion. They had better resources, better infrastructure, all those things that we have already mentioned. But a very significant, I suppose, development – well, we managed the policy practice guidance, so that was, I think, an important output of this research, and of working hand in glove with Clinicians and Social Workers and so on.

But a very significant development with regard to the Family Talk, and this is just hot off the press, if you like, is that we are in discussions with the Early Intervention Foundation in the UK, who are currently considering Family Talk for inclusion in the Early Intervention Foundation, the EIF, guidebook and also, in a What Works evidence hub in Ireland, which is being set up and developed by the Department of Children, Equality, Disability, Integration and Youth. Now, that’s a really important development, but it’s a really important development because that will help with the scale-up of Family Talk. It will increase awareness of the programme. It will give a level of evidence associated with that, because the Early Intervention Foundation has various grades of evidence. So, that, we think, is a very positive development.

[00:31:13.590] Jo Carlowe: Great. Is there anything else about the PRIMERA programme that you would like to highlight?

[00:31:18.649] Christine Mulligan: I think, just picking up one of the things Sinéad mentioned about the suite of interventions, that’s definitely required, just given the range of illnesses that are out there and the range of impacts that it can have on families, whether the illness is short-term or long-term, and there’s some excellent resources out there. Family Talk is the one that we – that really suited our needs, it was ready to go, there’s a manual you can download, the training excellent, the videos are excellent. But there’s other really great programmes out there that have a different focus. Lin, I think, Gatsou and Scott Yates are working on adapting the Think Family for – that’s being used in Northern Ireland. There’s also – at a pan-European level, there’s the CAMILLE training programme online, as well. So, just training resources that are out there.

Think one of the benefits of PRIMERA and having this whole team approach was that we were able to go into sites that were thinking for a long, long time, we need to do this, we need to do this, we need to do this, but having the impetus of a Research Team and the funding to actually say, “Okay, let’s do it.  Let’s pick something, do it, that was already evidence-based.” So, practitioners are so busy, they could spend a lot of time thinking about it. There’s a lot of resources out there you can actually access straightaway, and that’s one of the big takeaways for me, programmes are available out there for practitioners.

And just for the families that might be listening in, as well, there is hope. So many of the families we talked to have been struggling for so long trying to access services and they really found help in this short intervention. Things may be difficult initially, but having that conversation is difficult. Talking to your child about your depression is going to be difficult, but it doesn’t mean that it’s not going to improve things in the home.

[00:33:03.423] Jo Carlowe: And so, you mentioned it’s easy to get access online.  Can you state the web address?

[00:33:08.630] Christine Mulligan: The programme is called Family Talk. If you type in Family Talk and Emerging Minds. So, Emerging Minds is an excellent online resource for mental health. It incorporates a number of other training programmes for professionals, as well, but the Emerging Minds, or the COPMI, C-O-P-M-I, Children of Parents with Mental Illness, website, if you type in any of those with Family Talk, you’ll get access to it. And the pan-European one is CAMILLE, C-A-M-I-L-L-E and this has got some excellent resources for training of professionals, as well. And then, the other one is, you know, the Family Model, which is Adrian Falkov, that’s now online. It wasn’t online when we started, and I know that’s being researched in the UK, as well as in Northern Ireland. So, there is a lot of excellent programmes out there that are effective.

[00:33:59.309] Jo Carlowe: Great, that’s really helpful.  Are you planning any follow-up research, or is there anything else in the pipeline that you would like to mention?

[00:34:08.139] Professor Sinéad McGilloway: Well, while the project has officially ended, Jo, we are actually still in the process of dissemination. We’ve had five peer reviewed papers published to date. There are two or three more in preparation and we’re hoping that they will be submitted and, hopefully, published, anyway, next year. We’re also working on a policy brief with the Irish Association of Social Workers. Christine is finishing her PhD very soon, so that’ll be a really important milestone for her. There’s clearly a need for research, lots of research, here, on things like the longer-term outcomes of these kinds of programmes and their sustained implementation, assessing the views of young people, looking at issues such as family recovery. So, lots of avenues for future research.

There are – have been a number of other developments. We’ve just heard last week that we’ve received funding to run a national, possibly international, conference later this year to promote our work and the whole field of family mental health in general, so that’s really positive. We can keep spreading the word. We’re also speaking soon to the Ombudsman for Children’s Office, who have approached us to ask for information about our research and expressed an interest in this area. Our Minister for Mental Health, Minister Mary Butler, is also very supportive of our research. She opened our launch, which happened last year, and lastly, I suppose, at an international level, I’m pleased to be a new member of the prestigious Prato International Research Collaborative on parental mental illness and the main aim of that group is to try to promote research in parental mental illness across the world.

And by the way, Jo, if anyone would like any further information on our research, you can go to our website, which is and can I also just thank the team. We had a huge team in terms of the many Clinicians and practitioners with whom we worked in the different sites, but the Maynooth University based team comprised of Dr Mairead Furlong, the Project Manager, Sharon McGarr, Fieldwork Co-ordinator, Dr Colm McGuinness, Statistician, Dr Siobhan O’Connor Fieldworker and Dr Nuala Whelan, Trial Co-ordinator. And last, but not least, thanks to our funder, the Health Service Executive and also the Higher Education Authority who provided us with COVID-19 extension funding to complete the project.

[00:36:27.640] Jo Carlowe: Sinéad and Christine, finally, what is your take home messages for our listeners?

[00:36:32.590] Professor Sinéad McGilloway: The huge importance of properly recognising, resourcing and supporting family-focused practice throughout the world, not only in Ireland, but elsewhere, because by so doing, we can prevent those many negative outcomes, especially for the children, in the short and longer-term. And as Christine mentioned earlier in the interview, it – that’s all about applying public pressure to governments to try to fund these services and to develop proper policies around them to increase awareness and provide proper education and training and so on.

[00:37:10.090] Christine Mulligan: For me, you know, my mum and my – both my parents have passed away since I started my research and, I mean, in the initial stages of the research, I shared my story about, you know, waking up and trying to wake my mum, when I was about seven or eight and she had attempted suicide. And the research, for me, gave me an opportunity to talk to her about it, even – before she passed, which was such a blessing, a benefit, and I was able to say to her – like, she – ‘cause she felt embarrassed and, you know, the shame, the generational shame that, kind of, comes with mental illness, and to say to her, as a daughter of a mother who had mental health difficulties, “It wasn’t your fault.  You had no support.”  I mean, we didn’t – at the time, she probably had postnatal depression, left untreated, complicated by other factors and addiction, but if she had of had support at a time when she needed it, her life and our lives would’ve been very, very different.

I still hope, in the families that I talk to, not all of them, the ones that couldn’t access services, especially for – when their children were being impacted, maybe by a parent’s suicide or suicide attempt, but there is hope when you can access services, when you can access friends and support to help you deal with it. But I would – I think the take home is don’t prolong it. Stop kicking it down the road, and in some ways, that’s what they’re – the lack of policies are doing. But that has a long-term negative effect on children who are being left without support when a parent is having a mental health difficulty. So, there’s hope for the service user, but also for the children and the families, as well.

[00:38:46.760] Jo Carlowe: Thank you both so much, very important and moving, and Christine, good luck with the completion of your PhD. For more details on Professor Sinéad McGilloway and Christine Mulligan, please visit the ACAMH website, and Twitter @acamh. ACAMH is spelt A-C-A-M-H, and don’t forget to follow us on your preferred streaming platform. Let us know if you enjoy the podcast, with a rating or review, and do share with friends and colleagues.


Thanks you so much for sharing your research and increasing the visibility of children and young people affected by parental mental health. I have worked for 18 years in a specialist team in CAMHS Scotland that works with infants, children and young people whose lives are impacted by parental or familial mental ill health. We are a very small team who have tried passionately to help recognise , resource and support family based practice using Adrian Falkov’s Family model. I recently completed my Family Therapy Training and my MSC research was ” When working with patients who are parents, How do Adult mental health CPN’s Think about children. It would be lovely to be able to connect around this work.

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