Children of parents with mental illness — structured clinical viva

This is a COPMI case with parental depression, parentification, and adolescent self-harm. It tests family-inclusive adult practice, multi-pathway risk, prevention evidence, and safeguarding without collapsing into either removal-first or collusion-first extremes.[1][2]

Epidemiology and risk. COPMI is common (Australian order of magnitude ~1 in 5). Offspring of parents with major mood and psychotic disorders have elevated multi-disorder risk in high-risk meta-analysis — elevated, not certain.[1][2]

Mechanisms. Goodman and Gotlib multi-pathway model: genetics, exposure to parental symptoms/cognitions, stress generation, family disruption — not a single gene story.[6]

Assessment. Optimise mother's depression treatment; assess multi-dimensional parenting capacity; see the 12-year-old alone for mood, self-harm, food/safety, caregiving burden, school. Map supports. Document dual loyalty explicitly.[1]

Evidence anchors. STAR*D-child: maternal depression remission associated with improved child psychopathology trajectories.[3] Beardslee family-based prevention and Siegenthaler meta-analysis support structured family preventive intervention.[4][5]

Thresholds. Parentification plus self-harm plus inadequate care may meet significant-harm/neglect thresholds — escalate multi-agency response on reasonable suspicion; child's welfare paramount; no invented legal sections. Continue treating mother.[1]