Cultivating A Culture for Parents and Caregivers to Thrive

There are important cultural shifts needed in order to make parenting sustainable and to enable parents and caregivers to thrive. First, it’s time to value and respect time spent parenting on par with time spent working at a paying job, recognizing the critical importance to society of raising children. Many parents and caregivers feel undervalued for prioritizing parenting over employment—whether that means choosing to be a full-time parent or managing the many work tradeoffs involved in being an employed parent. We must recognize the importance of parenting and reflect it in how we prioritize resources, design policy, shape work environments, and approach our conversations with parents.

Simply put, caregivers need care, too.

Second, while parents and caregivers may have the primary responsibility for raising children, they shouldn’t have to do it entirely on their own. Raising healthy, educated, and fulfilled children is at the heart of building a strong future. It benefits all of society. And it is a collective responsibility. Societal support through policies—such as those that invest in the health, education, and safety of children—and community involvement through friendship, practical assistance, and emotional support are vital to the well-being of parents and caregivers and beneficial for children as well.

Third, we need to talk openly about the stress and struggles that come with parenting. The truth is, many parents and caregivers have a tough time with the evolving demands of parenting—from financial strain and family issues to adjusting to life with rapidly changing technology, and managing mental health challenges for themselves and their children. Many parents also struggle with a modern practice of time-intensive parenting and contemporary expectations around childhood achievement that tells them if they are not doing more and more for their children in the escalating race for success, they will fail as parents. Open dialogue about these challenges can combat feelings of shame and guilt and cultivate mutual support. It can also help build the momentum needed to ultimately shift practices and collective expectations to be more consistent with health and well-being.

Fourth, we must foster a culture of connection among parents to combat loneliness and isolation. Parenting is made all the more difficult when we feel lonely—as more than half of parents do.⁴⁹ Creating opportunities for parents and caregivers to come together, share experiences and ideas, and support each other can strengthen parental well-being. Simply put, caregivers need care, too. Through our individual actions and with the support of community groups, schools, faith organizations, employers, health and social service systems, and policymakers, we can create opportunities for parents to come together and build communities of mutual care and connection.

By pursuing these shifts, we can foster a culture that values, supports, and empowers parents and caregivers. We can also address key stressors that drive parental well-being and mental health. Next, this Advisory lays out actionable recommendations and an all-of-society approach that will move us toward the policy, programmatic, and cultural shifts needed to support the well-being of parents and caregivers.

What National, Territorial, State, Local, and Tribal Governments Can Do^f

Promote and expand funding for programs that support parents and caregivers and their families. For example, policymakers should bolster support for child care financial assistance programs such as child care subsidies^g and child income tax credits; universal preschool; early childhood education programs such as Early Head Start and Head Start; programs that help nurture healthy family dynamics such as early childhood home visiting programs funded by the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program; and services and support for family caregivers like Healthy Start Programs and the Lifespan Respite Care Program.

Establish a national paid family and medical leave program and ensure all workers have paid sick time. Paid family and medical leave would allow for employees to attend to long-term family or medical needs, for example to care for oneself, a new child, or an ill family member. Paid sick time would allow for employees to take time for short-term health needs or preventive care for oneself or family members.

Invest in social infrastructure at the local level to bring parents and caregivers together. For example, create more spaces such as community parks and green spaces where parents, caregivers, and families can interact and engage. Invest in programs, policies, and places that cultivate social connection within communities.⁴⁸

Address the economic and social barriers that contribute to the disproportionate impact of mental health conditions for certain parents and caregivers. Priorities should encompass poverty reduction, prevention of adverse childhood experiences, access to affordable neighborhood safety, and improving access to healthy food and affordable housing. Policymakers should also prioritize programs that support eligible households in gaining access to crucial services and supports, including Temporary Assistance for Needy Families (TANF), Children’s Health Insurance Program (CHIP), Medicaid, Supplementary Nutrition Assistance Program (SNAP), Women, Infants, and Children (WIC) benefits, child care support, and home visits, among others.

Ensure parents and caregivers have access to comprehensive and affordable high-quality mental health care. This includes strengthening public and private insurance coverage of mental health care, continuing and expanding enrollment promotion efforts, ensuring adequate payment for mental health services, enforcing parity laws, investing in innovative payment models that integrate mental health care and primary care, supporting telehealth options for delivery of care, and expanding the mental health workforce and community-based mental health care options (e.g. Certified Community Behavioral Health Clinics). Encourage flexible payment options that help parents and caregivers overcome financial barriers to mental health care.

Promote visitation initiatives and reentry programming to support currently and formerly incarcerated parents and caregivers, as well as their families. To help with reintegration into communities and families, reentry programming should focus on advancing cognitive and behavioral skills, addressing substance use disorders, protecting mental and physical health, and supporting formerly incarcerated individuals with housing, employment, and strengthening family bonds.^{127, 128}

What Employers Can Do

Expand policies and programs that support the well-being of parents and caregivers in the workplace. These can include offering paid parental, medical, and sick leave, flexible and fair work schedules, and access to child care (in the community or on-site).^{129, 130}

Implement training for managers on stress management and work-life harmony. Employers should include training, support, and resources for managers on how to recognize signs of stress and mental health challenges among parents and caregivers and how to support work-life harmony. Managers and leaders can also exemplify a family-friendly culture by actively including parents in leadership roles, which can put them in a position to support the overall well-being of other parents in the workplace and illustrate that career advancement and parenting roles can coexist.

Provide access to comprehensive and affordable high-quality mental health care. Research shows that mental health conditions among adults not only impact their productivity in the workplace but can also increase perceived barriers to accessing health care.^{131, 132} Employers should offer health insurance plans that include access to comprehensive and affordable mental health services and a robust network of high-quality mental health care providers. In addition, offering confidential counseling services through Employee Wellness Programs (EWPs) and/or Employee Assistance Programs (EAPs) can help expand access to mental health services and social support.¹³³

For additional information on how to strengthen mental health and well-being in the workplace, please see the Surgeon General’s Framework for Workplace Mental Health and Well-Being.

What Communities, Community Organizations, and Schools Can Do

Foster open dialogue about parental stress, mental health, and well-being in culturally appropriate ways. Community members and organizations can play a key role in reducing stigma and enabling conversations about mental health in culturally and linguistically relevant ways.^{134, 135} For example, community groups can partner with trusted messengers such as faith leaders, educators, and health care professionals to lead discussions about parental stress and mental health needs among groups or individuals with whom they have influence. Open dialogue can help reduce negative stereotypes and stigma surrounding mental health challenges and can also help parents address their mental health.

Equip parents and caregivers with resources to address parental stressors and connect to crucial support services. This should include conversation starters for parents to use with health care professionals, friends, significant others, and children; tools for parents to advocate for programs and resources to address critical stressors in the workplace, school, and community; guidance on how to manage stressors and mental health challenges; and information on how to seek professional help.

Create opportunities to cultivate supportive social connections among parents and caregivers. Social connection can decrease the negative effects of stress.^{48, 136, 137} Opportunities for fostering social connection include reimagining public spaces, including public libraries, faith-based organizations, schools, laundromats, barbershops and other places, as social infrastructure for parents and caregivers.⁴⁸ Programs should be tailored to accommodate the schedules and needs of parents and caregivers, ensuring they can actively participate and engage with one another, within and across generations (i.e., among parents with children in similar or different life stages).

Elevate the voices of parents and caregivers to shape community programs and investments. Utilize parent advisory groups and other models to involve parents and caregivers in all phases of programming, from ideation to implementation. Proactively include parents and caregivers disproportionately impacted by mental health conditions, such as racial and ethnic minorities, sexual and gender minorities, lower income parents, and those struggling with loneliness and isolation.

Strengthen and establish school-based support programs. Most parents and caregivers are connected to local education institutions via their children or via their own education. Early childhood education programs, primary and secondary schools, and institutions of higher education can use existing gathering spaces to increase social connection and support opportunities among parents and caregivers. For example, local Early Head Start and Head Start programs offer group-based, evidence-informed classes for parents and caregivers of young children, such as those available from the National Center on Parent, Family, and Community Engagement. Schools and child care providers can also consider partnering with community groups and health organizations to connect parents to existing resources that help address underlying economic, social, and health challenges that may drive parental stress.^{138, 139, 140, 141} Institutions of higher education can support student-parents by training campus mental health professionals on how to address the stressors unique to this group, creating spaces and activities for the children of student-parents at schoolwide events, and offering on-campus child care.¹⁴²

What Health and Social Service Systems and Professionals Can Do

Prioritize preventive care. Health and social service systems and professionals can provide prevention education about stress management, mental health, and implement trauma-informed care (TIC) principles and other prevention strategies to improve care for parents and caregivers.^{143, 144} For example, health professionals can utilize existing touch points with parents and caregivers (e.g., wellness visits, pediatric visits) to check in about their well-being, including stress, sleep, and mental health, and equip parents with information around what to expect across various stages of parenting and childhood development.

Screen parents and caregivers for mental health conditions. Universal screenings can be done in primary care settings, at prenatal and postpartum visits, and in urgent care settings and emergency departments. For example, primary care providers can conduct screenings (e.g., using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale-7 (GAD-7)) during annual preventive visits. Pediatricians, in particular, have a unique opportunity to screen parents and caregivers. The American Academy of Pediatrics and Bright Futures recommend screening for maternal postpartum depression during each child well-visit (from 1-month through 6-months) and can include caregiver emotional and mental health screening from birth to age 21 as well.¹⁴⁵ Providers should also ensure that screening services are systematically linked to care.

Foster partnerships with community organizations that provide support and resources for parents and caregivers. Health and social service professionals can refer parents and caregivers to resources to help address economic and/or social needs. For example, they can prioritize developing, expanding, or linking to comprehensive support systems for parents and caregivers experiencing intimate partner violence ensuring families have access to essential resources and culturally responsive services.¹⁴⁶ Additionally, health professionals can use social prescribing to combat loneliness and isolation by connecting individuals to community supports like group volunteer activities, hobby groups, or local social clubs.^{147, 148}

Recognize parents and caregivers who are at a higher risk for mental health conditions. This includes parents and caregivers who have been marginalized due to their race, ethnicity, immigration status, socioeconomic status, health status, disability status, sexual orientation and gender identity, and other factors. In addition, the health care system should provide additional support for parents and caregivers who have children with special health care needs¹⁴⁹ or complex medical needs themselves.

Support interdisciplinary partnerships between primary care and mental health professionals. Primary care clinics and systems can offer opportunities to implement collaborative care models by working in partnership with mental health providers, peer support specialists, and social workers.¹⁵⁰ These partnerships can also involve implementing family therapy and family system approaches. In addition, acute care settings (including emergency departments and urgent care centers) have opportunities to further advance behavioral health integration and linkage to care.¹⁵¹

What Researchers Can Do

Conduct studies to better understand, prevent, and improve mental health conditions in parents and caregivers, including prevalence, trends, risk and protective factors, the role of parental stressors, the impact on child and family outcomes, and effective prevention and intervention strategies. This requires rigorous methodologies, samples of diverse populations, and a systemic approach.^{152, 153} Researchers should also prioritize the involvement of parents, caregivers, and families with different lived experiences in all stages of research. Additionally, this research should include:

• Qualitative analyses, mixed methods research, and community-based participatory research to understand the experiences of parents and caregivers and their mental health challenges. Qualitative research methods (e.g., interviews, focus groups, observations, and content analysis) can be used to explore and understand the impact of nuanced behaviors like parenting on mental health.
• Development and evaluation of effective prevention strategies, assessment tools, and interventions that improve mental health outcomes of parents and caregivers. Researchers should seek opportunities to actively partner with clinicians, parents and caregivers, and communities to build a shared research agenda and to help inform prevention strategies, assessment tools, and interventions within real-world settings. Research findings are most useful when they are generalizable and can be implemented in everyday environments. Those who design, implement, and evaluate strategies to prevent or improve the mental health of parents and caregivers should also ensure that their work is widely available and replicable.
• Development and evaluation of service delivery strategies for improving access to appropriate mental health interventions and services for parents and caregivers. This includes research aimed at addressing financial, transportation, geographic, technological, and other barriers to seeking and accessing care as well as strategies that can be used to address system-level barriers.

Develop and establish parent-specific standardized measures of mental health and well-being that are regularly evaluated and can be used across basic research, clinical assessment, population surveillance, intervention evaluation, and other contexts.

Improve mental health data collection and integration to better understand parental behavioral health needs, trends, services, and interventions. The integration of behavioral health data across health care systems can allow for the exchange of data across the care continuum to better identify effective strategies and understand gaps in service adoption, implementation, and improvement.

Prioritize research among diverse parent and caregiver populations and family structures, such as racial, ethnic, sexual and gender minority parents and caregivers, those across different socioeconomic status groups, and those with disabilities or caring for children with disabilities. Researchers and research sponsors should ensure that these and other traditionally underrepresented populations are involved in basic, translational, effectiveness, and services research studies. This will help improve understanding of mental health access needs, disparities in risk, and responsiveness to interventions across diverse populations.

What Family and Friends Can Do

Offer practical support. Increasing support can help reduce the impact of stress. Opportunities include lending assistance with household chores, child care responsibilities, or running errands. Look for ways to support parents and caregivers so they can take breaks, attend needed appointments, and engage in self-care activities. Family, friends, and members of the community can be essential peer supporters and can also help parents and caregivers navigate the health care system and/or the universe of resources, including parenting classes, support groups, recreational activities, and other community events, that can support their well-being.¹⁵⁴

Connect with parents and caregivers in your life on a regular basis. For example, find opportunities to include parents and caregivers in your routine by scheduling a weekly walk or making a plan for a regular call to check-in. Recognize that each parent or caregiver may experience parenthood differently and face their own set of challenges especially during times of transition (e.g., a newborn child, divorce/separation, death of a significant other or a loved one, new job, etc.). Listen with empathy and without judgment and be a steady, supportive presence.

Learn about mental health challenges parents and caregivers may face. Recognize mental health challenges and possible warning signs of distress in parents and caregivers, which may include anxiousness, fatigue, anger, loneliness and isolation, reduced productivity at work, and changes in sleeping and eating patterns. If you notice potential signs of distress in a parent or caregiver, offer your support and/or assist them in seeking help from a health care professional.

What Parents and Caregivers Can Do

Remember, caring for yourself is a key part of how you care for your family. Some activities that can help reduce stress include exercise, sleep, a balanced diet, mindfulness, meditation, and recreational activities that bring joy.¹⁵⁵ It can be difficult to prioritize yourself amid the demands of parenting, but even small investments of time in stress-reducing activities can make a meaningful difference. Setting healthy boundaries that allow one to take such time should not bring guilt or shame but rather be seen as vital actions that can ultimately benefit parents and caregivers as well as their children. Finally, it is impossible to get parenting right all the time, so being compassionate and forgiving with oneself is essential.

Nurture connections with other parents and caregivers. Parenting is best done with the support of other parents, family members, and friends. Seek out or create relationships with parents of children across age groups. Such community can provide opportunities to share your feelings, concerns, and challenges while also learning from the experiences of other parents. Fostering a supportive environment can help reduce the stresses of parenthood. Mental Health America offers opportunities to connect with fellow parents and caregivers in your local community or virtually.

Explore opportunities to secure comprehensive insurance coverage for yourself and your family. Health insurance has a positive impact on overall health and mental health-related outcomes. Having reliable coverage for physical and mental health needs can reduce stress and provide security when health needs arise. To learn more about enrolling in Medicaid, CHIP, or a Marketplace plan, go to HealthCare.gov.

Empower yourself with information about mental health care. Educate yourself with credible resources about mental health.^{156, 157} For information on accessing health care or support, including treatment options, how to pay for treatment, ways to cope, and how to assist others with finding treatment, visit FindSupport.gov.

Recognize how mental health challenges manifest and seek help when needed.¹⁵⁶ Mental health is just as important as physical health. If you feel bad and are not getting better, you need and deserve additional care. Don’t be afraid to ask for support from a peer, family member, mental health provider, or any medical professional.

• If you are pregnant, a new mom, or a loved one of an expecting or new mom facing a mental health challenge, call or text the free Maternal Mental Health Hotline at 1-833-TLC-MAMA (852-6262) for 24/7 confidential support in English or Spanish. If you’re experiencing a mental health crisis, call or text the free, multilingual, and confidential 988 Suicide & Crisis Lifeline.