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ObjectiveTo describe the health and well-being of children and young people (CYP) seeking asylum subjected to Australia’s immigration policy of indefinite mandatory detention on Nauru.DesignCross-sectional analysis of a cohort of CYP seeking asylum.SettingAustralian paediatric clinicians from 10 health services completed detailed health assessments around the time of transfer from Nauru, mostly to Australia.ParticipantsSixty-two CYP who were ≤18 years on entry into offshore immigration detention on Nauru between 2013 and 2019. Mean age at health assessment was 9 years.Main measuresHealth outcomes were categorised as physical, mental or neurodevelopmental concerns/conditions. Risk and protective factor data were collected using the adverse childhood experiences and refugee-specific adverse childhood experiences tools.ResultsOver half of the CYP (n=32, 52%) were held on Nauru for ≥4 years. The vast majority of CYP had physical health (n=55, 89%) and mental health (n=49, 79%) concerns including self-harm or suicidal ideation/attempt (n=28, 45%). Mental health concerns were more likely in CYP who were school-aged (p=0.001), had been held on Nauru for ≥1 year (p=0.01); originated from the Eastern Mediterranean region (pConclusionsThis study highlights the almost universal physical and mental health difficulties in a sample of CYP who experienced forced migration and were subjected to Australia’s offshore immigration detention policy. Immigration detention in recipient countries, a known adverse childhood experience, may contribute to or exacerbate harmful outcomes in CYP seeking asylum.

Almost 80 million people globally are forcibly displaced. A small number reach wealthy western countries and seek asylum. Over half are children. Wealthy reception countries have increasingly adopted restrictive reception practices including immigration detention. There is an expanding literature on the mental health impacts of immigration detention for adults, but less about children. This scoping review identified 22 studies of children detained by 6 countries (Australia, Canada, Hong Kong, Netherlands, the UK and the US) through searches of Medline, PsychINFO, Emcare, CINAHL and Scopus data bases for the period January 1992-May 2019. The results are presented thematically. There is quantitative data about the mental health of children and parents who are detained and qualitative evidence includes the words and drawings of detained children. The papers are predominantly small cross-sectional studies using mixed methodologies with convenience samples. Despite weaknesses in individual studies the review provides a rich and consistent picture of the experience and impact of immigration detention on children's wellbeing, parental mental health and parenting. Displaced children are exposed to peri-migration trauma and loss compounded by further adversity while held detained. There are high rates of distress, mental disorder, physical health and developmental problems in children aged from infancy to adolescence which persist after resettlement. Restrictive detention is a particularly adverse reception experience and children and parents should not be detained or separated for immigration purposes. The findings have implications for policy and practice. Clinicians and researchers have a role in advocacy for reception polices that support the wellbeing of accompanied and unaccompanied children who seek asylum.

Reducing the rate of over-representation of Aboriginal and Torres Strait Islander children in out-of- home care (OOHC) is a key Closing the Gap target committed to by all Australian governments. Current strategies are failing. The ���gap��� is widening, with the rate of Aboriginal and Torres Strait Islander children in OOHC at 30 June 2020 being 11 times that of non- Indigenous children. Approximately, one in five Aboriginal and Torres Strait Islander children entering OOHC each year are younger than one year. These figures represent compound-ing intergenerational trauma and institutional harm to Aboriginal and Torres Strait Islander families and communities. This article outlines systemic failures to address the needs of Aboriginal and Torres Strait Islander parents during pregnancy and following birth, causing cumulative harm and trauma to families, communities and cultures. Major reform to child and family notification and service systems, and significant investment to address this crisis, is urgently needed. The Family Matters Building Blocks and five elements of the Aboriginal and Torres Strait Islander Child Placement Principle (Prevention, Participation, Partnership, Placement and Connection) provide a trans-formative foundation to address historical, institutional, well- being and socioeconomic drivers of current catastrophic trajectories. The time for action is now.

Objective: Children in asylum-seeking families are increasingly subject to deterrent host nation policies that undermine security in the post-migration context, however, little is known on the mental health consequences of such policy. This study examined the impact of prolonged visa insecurity on child mental health, by comparing two cohorts of refugee children entering Australia between 2010 and 2013, distinguished by visa security. Methods: The insecure visa sample comprised children from Tamil asylum-seeking families, while the secure visa sample was drawn from refugee families participating in the multi-ethnic ‘Building a New Life in Australia’ cohort study. Children in each sample were assessed for current mental health problems and trauma exposure. Mothers were assessed for trauma exposure, post-migration family stressors and post-traumatic stress disorder (PTSD). The effects of prolonged visa insecurity on child mental health via family-and child-level variables were modelled using multi-level path analysis. Results: Data comprised 361 children, aged 10–18, and 242 mothers across three levels of visa insecurity: permanent protection ( n = 293), temporary protection ( n = 40) and bridging visa ( n = 28). Modelling showed that (1) visa insecurity was associated with poorer child mental health, (2) the association was mediated sequentially by post-migration family stressors and maternal PTSD and (3) the association was moderated by maternal PTSD. Conclusion: Our findings suggest that when government policy persistently undermines post-migration security, the capacity of families to protect children from accrued stressors is lowered, leaving a significantly higher proportion of children developing along trajectories of risk rather than resilience.

Objective: This paper highlights the significant mental health vulnerabilities of people who have sought asylum in Australia and their additional adversities as a result of the Covid-19 pandemic. Conclusions: Australia’s policies in relation to asylum seekers result in multiple human rights violations and add significantly to mental health vulnerabilities. Despite a majority being identified as refugees, people spend years in personal and administrative limbo and are denied resettlement in Australia. Social isolation and other restrictions associated with Covid-19 and recent reductions in welfare and housing support compound their difficulties. The clinical challenges in working with people impacted by these circumstances and the role of psychiatrists and the RANZCP in advocacy are identified.

A primary task for parents and infants in the early years is the development of attachment relationships. Parents are first teachers for a child in the very broadest sense. The child learns, through early experiences in the family, about the safety of the world; about relationships; about how to manage themselves with others, in both safe and in challenging interactions; and about the risks associated with play and exploration. School readiness involves considerably more than an interest in letters and numbers. It includes social and emotional competence, curiosity and flexibility and a capacity to engage and use the support of other children and adults in the learning process. All of this is supported by security in early care giving relationships. This chapter will review the evidence that the quality of early relationships shapes neuro-biological development which in turn influences social and psychological functioning throughout life; that early attachment security and self-regulation, executive functioning, information processing, cognitive and language development lay the foundation for engagement and success at school; and that attachment style influences help seeking behaviours, in medical as well as educational settings. This evidence indicates that those infants and children most at risk of adverse developmental and educational outcomes are those who experience an accumulation of risk factors, including insecurity in their early relationships. The chapter will also consider evidence from longitudinal studies of attachment and development and studies of at-risk groups, including children of parents with mental illness and children exposed to maltreatment. Here the intention is to assess the impact of early experiences on development across the life span. The chapter concludes by outlining the importance of this information for early intervention and support for caregivers with infants and young children, and for workers in child-care and preschool settings.

Following experiences of war, the remaking of home in a host country entails a post-war context of uncertainty. This chapter explores how young forced migrants cope as they resettle in new homes in Australia. Attachment theory is used to examine the range of self-protective strategies used by Sri Lankan Tamil refugee and asylum-seeker adolescents to navigate loss and trauma, and how this relates to their sense of home and the world around them in later life. By employing attachment research methods, this chapter builds an account of how Tamil adolescents represent past experiences of loss and trauma and how these relate to their present world as children of families now permanently or precariously resettled in Australia.

This article considers what successful working relationships between fly-in professionals and Aboriginal community workers involve. Interviews with six Aboriginal workers and the experience of the jointly delivered Let’s Start parent–child programme in remote north Australian Indigenous communities confirm the importance of developing positive relationships within a both-ways learning approach, drawing on each other’s strengths, and the significance of reflection on practice. Working cooperatively enables effective programme implementation, supports incorporation of new learning into practice, and benefits local Aboriginal community members through employment and development opportunities. This model has relevance for health and community programmes delivered in remote Aboriginal communities.

There are more displaced people around the world than ever before, and over half are children. Australia and other wealthy nations have implemented increasingly harsh policies, justified as ‘humane deterrence’, and aimed at preventing asylum seekers (persons without preestablished resettlement visas) from entering their borders and gaining protection. Australian psychiatrists and other health professionals have documented the impact of these harsh policies since their inception. Their experience in identifying and challenging the effects of these policies on the mental health of asylum seekers may prove instructive to others facing similar issues. In outlining the Australian experience, we draw selectively on personal experience, research, witness account issues, reports by human rights organisations, clinical observations and commentaries. Australia’s harsh response to asylum seekers, including indefinite mandatory detention and denial of permanent protection for those found to be refugees, starkly demonstrates the ineluctable intersection of mental health, human rights, ethics and social policy, a complexity that the profession is uniquely positioned to understand and hence reflect back to government and the wider society.

Over the last decade there has been at best limited implementation of preventive interventions for vulnerable Aboriginal and Torres Strait Islander children and their families in remote communities of northern Australia despite growing involvement in the child protection system. This paper describes challenges for services seeking to engage parents who are subject to child protection measures. Brief case studies from an early intervention program in a remote community illustrate that responsiveness and continuity of engagement of parents over time is a necessary basis for an integrated approach to meeting the needs of vulnerable children and families in very remote settings. Refereed/Peer-reviewed

IntroductionImmigration detention has a profound and negative impact on the physical health, mental health, development and social-emotional well-being of children, adolescents and their families. Australian clinicians will report results from detailed health and well-being assessments of asylum seeking children and adolescents who have experienced prolonged immigration detention.Methods and analysisThis is a national, multicentre study with a longitudinal cohort design that will document health and well-being outcomes of the children and adolescents who have been detained in offshore detention on the remote island of Nauru. Outcome measures will be reported from the time arrival in Australia and repeated over a 5-year follow-up period. Measures include demographics, residency history and refugee status, physical health and well-being outcomes (including mental health, development and social-emotional well-being), clinical service utilisation and psychosocial risk and protective factors for health and well-being (eg, adverse childhood experiences). Longitudinal follow-up will capture outcomes over a 5-year period after arrival in Australia. Analysis will be undertaken to explore baseline risk and protective factors, with regression analyses to assess their impact on health and well-being outcomes. To understand how children’s outcomes change over time, multilevel regression analysis will be utilised. Structural equation modelling will be conducted to explore the correlation between baseline factors, mediational factors and outcomes to assess trajectories over time.Ethics and disseminationThis research project was approved by the Sydney Children’s Hospitals Network Human Research Ethics Committee. Subsequent site-specific approvals have been approved in 5 of the 11 governing bodies where the clinical consultations took place. In order to ensure this research is relevant and sensitive to the needs of the cohort, our research team includes an asylum seeker who has spent time in Australian immigration detention. Results will be presented at conferences and published in peer-reviewed Medline-indexed journals.

In March 2014 we spent a week on Christmas Island as medical consultants to the Australian Human Rights Commission (AHRC) Inquiry into the Impact of Immigration Detention on Children. The visit involved three Human Rights Commission staff as well as the authors, paediatrician Karen Zwi and child psychiatrist Sarah Mares, representing the Royal Australasian College of Physicians and the Royal Australian and New Zealand College of Psychiatrists respectively. Using interpreters, we spoke to over 40 unaccompanied children and service providers to ascertain processes and policies and to give feedback about detainees of immediate concern. We would like to honour the voices of the detainees; we have used their exact words where possible. In a separate paper, we focus on the families and children detained in immigration acilities on Christmas Island. Unaccompanied children are children under the age of 18 years who are seeking asylum from threatened or experienced danger. They arrive unaccompanied by a parent, legal guardian or adult relative over the age of 21 years. On arrival to Australia, unaccompanied children by law become the legal wards of the Department of Immigration and Border Protection (DIBP). The role of a legal guardian is commonly regarded internationally as one who ‘stands in loco parentis to the child’, which includes making decisions regarding the best interests of the child and providing for the child’s emotional and material needs. In Australia, the Minister’s role tends to be nominal without practical assistance offered to the children, which has been described as leaving them not only unaccompanied but also unrepresented. A DIPB officer is appointed locally as the children’s ‘Delegated Guardian’ as discussed below. Most unaccompanied children leave their homes as a desperate measure in search of protection, education and employ ment, and to contribute to the welfare of their family. They have often embarked on dangerous journeys, experienced war, the death of family members, persecution, violence, sexual abuse, escape from forced recruitment into armed organisations and forced domestic labour. These experiences occur during critical developmental periods, thus placing them at risk of mental health problems. Research is limited to a few cross-sectional or on-arrival studies, which have shown that around 25–50% have emotional and behavioural problems, anxiety, depression and post-traumatic stress disorder (PTSD), at higher rates than in accompanied asylum seeker children. However, consistent with other studies on refugee children, the majority of unaccompanied children score below clinical cut-offs for psychiatric disorder, thus displaying a marked resilience. The severity of psychiatric symptoms is likely to increase with more traumatic events experienced prior to forced migration, demonstrating the cumulative impact on well-being of traumatic exposure. Children exposed to adversity following migration, particularly those placed in prolonged detention, are more severely affected. Studies show increased symptoms for those exposed to rioting, fires, violence and self-harm attempts by parents or others in detention. Rapid resolution of asylum claims reduces the duration of uncertainty and associated distress for children, whereas insecure asylum status is associated with a range of psychological problems that can have long-lasting effects. Prompt access to services catering for physical and psychological health is important, as are long-term stability of residence and socially supportive environments. It is also known that PTSD symptoms are increased in lower-support living arrangements suggesting that foster family living and high support may improve outcomes.

Objective:To build an account of how bereaved Tamil refugee and asylum seeker children, resettled in Australia, had processed the loss of their dead or missing fathers.Method:Phenomenological and discourse analysis was applied to attachment narratives of nine children (aged 11–17 years) and their surviving mothers in families that lost fathers in war-related circumstances. The narratives were analysed through the lens of Crittenden’s Dynamic-Maturational Model of Attachment and Adaptation (DMM) and Klass’ cross-cultural model of grief.Results:Two divergent pathways — ‘burying the past’ and ‘reifying the past’ — emerged, encompassing the children’s contrasting patterns of information processing regarding loss and trauma (dismissing or preoccupying) and representation of the past (distant-buried or rich-reconstructed). Each pathway reflected a strategic compromise between the constraints and resources presented to the child by the circumstances of the loss (ambiguous or confirmed), the response of their surviving parent (stricken or stoic) and the collective narrative surrounding the loss (silenced or valorised).Conclusion:The DMM’s conceptualisation of attachment as self-protective strategies for navigating danger was helpful in explaining the contrasting adaptations of refugee children to loss and trauma. However, to understand the multivalent meanings of these adaptations, there was a need to situate child–parent attachment relationships within the wider sociocultural reconfigurations arising from contexts of political violence.

Australia offers a small but well-regarded refugee programme offering extensive support to the 13 750 refugees settled in the country each year, after the processing of their protection claims by the United Nations. Since 2015, a further 12 000 resettlement places have been allocated to Syrian and Iraqi refugees.1 Globally, there are an estimated 65 million people around the world currently displaced, half of whom are children under 18 years of age.2 These children are exposed to cumulative risks associated with poor developmental and social–emotional health outcomes.3–6 Successful settlement of refugee children and their families is of global importance and presents a challenge to health professionals in implementing known evidence to optimise development and social–emotional health in childhood and to produce a better chance of lifetime good health and success, including mental health, employment and socioeconomic status.7–9 With a well-coordinated and evidence-based response, there is potential to produce excellent outcomes for displaced children. Presented here is a summary of findings from a body of evidence developed in our local setting in regional Australia to inform future service development for displaced children. We argue that there is an urgent need for further investment in long-term outcomes and make recommendations on how we can continue to develop the evidence base to support optimal well-being for displaced children in Australia and other high-income settings. For health professionals to provide safe, high quality, culturally responsive care to refugee populations, an understanding of the multiple barriers to care is required. Specific strategies and tools to empower families can improve clinician–patient relationships, service delivery and health outcomes.10 We have shown that accessible healthcare for refugees is achievable through community-based models that include primary care, refugee health nurses and specialised paediatric refugee referral services and has the added value of integrating the whole family …

Accumulating literature demonstrates that immigration detention is harmful to children. However, there is a scarcity of scientifically rigorous and reliable data about the health of children held in detention facilities. The aim of the study was to compare a community-based population of recently arrived refugee children flown into Australia, not detained, resettled in a non-urban area, with a population of children who arrived by boat seeking asylum, detained since arrival. The parent-version of the strength and difficulties questionnaire (SDQ) of children aged 4–15 years was compared in children living in the community with those held in detention. We compared 86 children who had a parent-completed SDQ performed, 38 (44%) in the community group and 48 (56%) in the detention group. The community sample had been living in Australia for 325 days, with no time in detention. The detention sample had been living in detention for a mean of 221 days. The mean age was similar for the community and detention sample at 8.4 years (P = 0.18). In the total sample, children in the detention group had significantly higher SDQ total difficulties scores than children in the community group (P

This paper describes secondary analysis of previously unreported data collected during the 2014 Australian Human Rights Commission Inquiry into Children in Immigration Detention. The aim was to examine the mental health of asylum-seeking parents and children during prolonged immigration detention and to consider the human rights implications of the findings. The average period of detention was seven months. Data includes 166 Kessler 10 Scales (K10) and 70 Strengths and Difficulties Questionnaires (SDQ) for children aged 3-17 and parental concerns about 48 infants. Extremely high rates of mental disorder in adults and children resemble clinical populations. The K10 indicated severe co-morbid depression and anxiety in 83% of adults and 85.7% of teenagers. On the SDQ, 75.7% of children had a high probability of psychiatric disorder, with lower conduct and hyperactivity scores than clinic populations. Sixty-seven percent of parents had concerns about their infant’s development. Correlations were not found between time detained or parent/child distress. Multiple human rights breaches are identified, including the right to health. This is further evidence of the profound negative consequences for adults and children of prolonged immigration detention. Methodological limitations demonstrate the practical and ethical obstacles to research with this population and the politicized implications of the findings.

Postgraduate training in infant mental health (IMH) was offered by the New South Wales Institute of Psychiatry in Sydney, Australia for the first time in 1998. Since 2002, the program has been offered at the master's level by distance education to a multidisciplinary group of students across Australia and New Zealand. This article considers the various ways that the notion of reflective practice and reflective supervision is used in different disciplines and defines our understanding of its place in IMH training. The program content and delivery emphasize the development of reflective skills in students in a number of ways. These include a supportive relationship-based approach to training; a 12-month infant observation which provides students with the opportunity to understand early development, develop observational skills about infants and families as well as their own responses to the infant and family; ongoing clinical supervision and development of a reflective clinical journal; and study and assessment tasks that require the student to integrate new knowledge into clinical practice.

The Let`s Start Parent-Child Program is a manualised parent-child program which aims to improve educational, social and emotional outcomes for Aboriginal parents and their four- to seven-year-old children. It has been implemented in the Northern Territory, Australia on the Tiwi Islands and in Darwin since 2005. This paper outlines the adaptation of the program to include narrative approaches, the sharing of stories and the use of expressive arts as a way to build understanding between program leaders and participating families. An example from a recent program is used to illustrate how the sharing of stories and expressive use of art engages and binds group participants together. It supports parents to tell their own stories, to speak about their lived experience, to reconsider aspects of their own and their children's experiences and to achieve an increased awareness of their personal resources and a sense of self-empowerment. The program is designed and delivered with sensitivity to individual parents, children and families, where cultural and interpersonal differences and different developmental and family situations can be taken into account.

The present review examines the available literature to consider recent advances in the theories of, and interventions with, disorders of attachment. We discuss the existing evidence to argue that the conceptualization of attachment disorders remains problematic despite their clinical significance.Research into clinical disorders of attachment is limited, but there is some recent evidence that a standardized approach to diagnosis may improve identification. The current classificatory systems do not accommodate all clinical presentations and proposed broader approaches have greater clinical utility. A recent review of interventions for attachment disordered children confirms that 'coercive' interventions have no empirical support and are not biased on coherent principles of attachment theory.Clinical interest in identification and treatment of attachment disorders has remained high. This is despite continuing confusion regarding terminology, phenomenology and diagnosis. The lack of agreed definition and conceptualization of these conditions is reflected in disparate approaches to intervention and limited empirical data. Interventions have little demonstrated benefit and some potential risk.

Objective: To review and summarise the evidence about and consequences of Australia’s policy of mandatory indefinite detention of children and families who arrive by boat to seek asylum. Methods: This paper will summarise the accumulated scientific evidence about the health and mental health impacts of immigration detention on children and compare methodologies and discuss the political reception of the 2004 and 2014 Australian Human Rights Commission (AHRC) Inquiries into Immigration Detention of children. Results: The conclusions of the 2004 and 2014 Inquiries into Immigration Detention of Children are consistent with Australian and international research which demonstrates that immigration detention has harmful health, mental health and developmental consequences for children and negative impacts on parenting. Conclusion: The evidence that prolonged immigration detention causes psychological and developmental harm to children and families and is in breach of Australia’s human rights obligations is consistent. This is now partially acknowledged by the Government. Attempts to limit public scrutiny through reduced access and potential punishment of medical witnesses arguably indicates the potency of their testimony. These harmful and unethical policies should be opposed.

Objective: To record observations made by the authors on a series of visits between December 2001 and March 2002 to two of Australia's immigration detention centers and to consider the mental health consequences of Australia's policy of mandatory immigration detention of asylum seekers for families and children. Conclusions: Parents and children in immigration detention are often vulnerable to mental health problems before they reach Australia. Experiences in prolonged detention add to their burden of trauma, which has an impact not only on the individual adults and children, but on the family process itself. Immigration detention profoundly undermines the parental role, renders the parent impotent and leaves the child without protection or comfort in already unpredictable surroundings where basic needs for safe play and education are unmet. This potentially exposes the child to physical and emotional neglect in a degrading and hostile environment and puts children at high risk of the developmental psychopathology that follows exposure to violence and ongoing parental despair. Psychiatrists have a role in advocating for appropriate treatment of these traumatized and vulnerable parents and children.

Objective: This article outlines an approach to assessing the quality of relationships between young foster children and their carers. These children are at high risk of disorganised attachment relationships and of developmental psychopathology given their relational experiences prior to and in care. During a semi-structured play interaction the emphasis is on identifying behaviours of clinical interest. This can be complex given the likelihood of atypical or unexpected behaviours expressed within relationships. Method: The paper draws on literature on the clinical application of attachment theory to the assessment of relationships and on the authors’ experience of developing and delivering an assessment and intervention service for children aged 0 to 5-years-old within a mental health service for children in foster care. Clinical material is used to illustrate and develop the issues. Conclusion: The case for including a semi-structured observational procedure as part of a comprehensive assessment of foster children and their carers is outlined. This is argued to have more clinical utility than formal approaches to attachment classification. The benefits of including a semi-structured and relational approach to clinical assessment of foster children are outlined along with the need to be cautious in the use of attachment related terminology when formal assessments have not been undertaken.

This article reviews evidence about the impact of immigration detention and other restrictive immigration policies on the mental health of children, young people and the adults who care for them. We review the implications of this for clinicians attempting to assess or work with incarcerated child and adult refugees and asylum seekers.There are increasing numbers of adults and children seeking asylum across the globe and many nations use incarceration and other harsh and interceptive immigration practices. There is mounting evidence of the psychological harm associated with detention of already vulnerable adults and children. Australia is used as a case study.Clinicians are required to consider the intersection of mental health assessment and treatment with human rights violations, and the impact of restrictive immigration policies, not only on asylum seekers and refugees but also on clinicians, clinical practice and professional ethics.

Objective: Little is written about the process of delivering mainstream, evidence-based therapeutic interventions for Aboriginal children and families in remote communities. Patterns of interaction between parents and children and expectations about parenting and professional roles and responsibilities vary across cultural contexts. This can be a challenging experience for professionals accustomed to work in urban settings. Language is only a part of cultural difference, and the outsider in a therapeutic group in an Aboriginal community is outside not only in language but also in access to community relationships and a place within those relationships. Method: This paper uses examples from Let’s Start, a therapeutic parent-child intervention to describe the impact of distance, culture and relationships in a remote Aboriginal community, on the therapeutic framework, group processes and relationships. Results: Cultural and contextual factors influence communication, relationships and group processes in a therapeutic group program for children and parents in a remote Aboriginal community. Group leaders from within and from outside the community, are likely to have complementary skills. Conclusions: Cultural and contextual factors influence communication, relationships and group processes in a therapeutic group program for children and parents in a remote Aboriginal community. Group leaders from within and from outside the community, are likely to have complementary skills. Program adaptation, evaluation and staff training and support need to take these factors into account to ensure cultural accessibility without loss of therapeutic fidelity and efficacy.

One in five young people in Australia, including infants, toddlers and preschoolers, lives in a family with a parent with a mental illness.1 Families affected by mental illness are more likely than other families to experience poverty and social isolation,2 and are more likely to have children taken into care.3 A combination of factors influences the child’s risk of psychopathology. These include psychosocial adversity, the child’s developmental status and age, genetics, family relationships, the severity and chronicity of parental psychiatric disorder, comorbidity, and the involvement of other carers in the child’s life. Not all children whose parents have mental health problems will experience difficulties themselves.4 Parental diagnosis itself does not confer risk, and many parents with severe depression, schizophrenia and other disorders are adequate caregivers.5 Rather, it is the severity and chronicity of psychopathology and the variation in parental personality, genetic characteristics, coping style and social circumstances that confer risk. Children’s characteristics, such as temperament and sex, can also influence the parent–child relationship and parenting behaviour.6 This article outlines the impact of three key mental health disorders on parenting and young offspring, and describes implications for practice.

We write in response to recent comments suggesting a lack of evidence supporting the decision of the College to make public statements about the mental health impact of prolonged immigration detent...