Postnatal depression is now fairly well-known – but what happens when your child starts to grow up?
The joys of the threenager, the tween and the teen can place overwhelming stress on families.
Research shows that parents can continue to struggle with depression way beyond the early years of caring for a tiny baby. Parenting can become even more challenging as children grow older, and a whole range of emotional issues may come to the fore.
A study by the Medical Research Council found that 13 by the time children reached the age of 12.
For fathers, too, the numbers continue to rise – three per cent will experience depression in the first year, rising to 21% by the time their child is at secondary school.
Obviously the earlier these issues are picked up the better – but often depression is overlooked when it comes to examining other family problems. Your GP may hand out tablets and even counselling, but this may not get to the root of the problem.
As children get older, for example, they may have behavioural problems, and the parents may be depressed – but can the family get help to address this as a joint issue? Very rarely.
Adrienne Burgess, joint CEO of the The Fatherhood Institute, says: "This whole family approach, looking at the strengths and weaknesses of all family members - it doesn't take a huge effort, it doesn't take a lot more resources, it just takes a change of perspective."
The Fatherhood Institute is battling for a more all-round perspective on family wellbeing; so is Family Links, a charity which trains family support workers.
But the overall picture for mental health services is not looking great at the moment.
Kathy Peto, Parenting Programme Lead for Family Links, says: "A lot of mental health services are being cut all the time. The adult services and children's services in some places are well connected but in other places it's not so good.
"The brief won't necessarily be to look at the whole family and the needs of the children. Children are sometimes even acting as carers for their parents or not having all their needs met. I think some of that joined up thinking has got better in lots of places, but it's an area that still needs more work.
"Schools might be aware of children acting up in school but not be aware of how that might relate to what's going on at home."
Kathy says sometimes parents' mental health and children's behaviour can create a vicious circle.
"Parents might have mental health problems and the interaction with the young children is not very good, therefore the children feel insecure and their behaviour might become more difficult, which in turn is more difficult for the parent to cope with," she says.
Often depression and other problems may have started much earlier – but it's only as the children get older that things come to a head. Ruth, from Bluebell, says: "We see a lot of women who may have been suffering with PND, they may have been struggling antenatally, but they didn't tell anyone and let it fester. It carries on and on and it's not until the child gets much older that they realise, 'I need to do something about this'. The sooner you get treatment and help, the sooner you will recover."
Family Links provides training in The Nurture Programme, which is aimed at parents with children aged between two and 11.
"A large part of the programme is about building the parent's self-confidence, their self-esteem and self-awareness," says Kathy. "What we often find is that parents who come on the programme, who are depressed, can think about small changes they can make in their own life which will help them to feel better about themselves and help their children to be better supported."
Lisa joined a Nurturing Programme parenting group after struggling to come to terms with her past. Abused and rejected by her mother, she left home at 16 with a man who abused her for 12 years before she found safety in a women's refuge.
Years later, married with two children, she still struggled with her confidence as a parent.
"I have always feared that somehow I would turn into my mother and that I would do to my children what I have had done to me," she said.
The Nurturing Programme helped her realise that she needed to nurture herself and make positive changes in order to nurture her children.
"I have now come through this course and I feel different, I feel I am a good mum, but I also feel I'm a good person and I like who I am now," she says.
Lisa's story shows that there is hope; a cycle of mental illness can be broken.
"My goal is that my family will gain in strength, have a deep and meaningful relationship with each other, and my grandchildren will have the loving and nurturing environment that we have worked so hard for," she says.
Kathy says even small changes can help a family live together more happily. "A depressed parent might love their child very, very much, but not be able to show them that they love them. Just helping them to smile and play with their child a little bit more can make a difference," she says.
"Some parents may never have been played with themselves or they find play impossible. Just helping them to think about the little things they can do, just sitting with their child and gently cuddling them. It's about starting with what a parent is able to do and building on that."
So where can you find a Nurturing Programme? Well, they can usually be found at children's centres or schools – although as children's centres' services get cut back they may be harder to find, or restricted to certain target groups.
But if you are struggling, these groups really can help – alongside medical assistance such as antidepressants and other forms of counselling. And there's no shame in asking for help to be a better parent. We all take driving lessons to learn to drive. We take Spanish lessons to learn to speak Spanish. Why shouldn't we take parenting lessons to learn the most important job of all?
As Adrienne says: "We all have our crosses to bear. Most of us do not live in ideal families."
Useful contacts for advice and support:
The Samaritans: 08457 90 90 90 (UK)
Action on Post Partum Psychosis
The Birth Trauma Association
Bluebell: 0773 8628 842
The Fatherhood Institute
Family Lives: 0808 800 2222
Family Links: 01865 401800
Maternal Mental Health Alliance
Pandas Foundation: 0843 2898 401
Royal College of Midwives