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Is concern justified? Problems of definition and prevalence 31a mental illness were more likely than those without to have no formal educationalqualifications and to come from social class V (unskilled, manual occupations) andbe economically inactive. Adults with mental health problems have the highestunemployment rates for any of the main groups of disabled people; only 21% areemployed (Office for National Statistics 2006b). The impact of class and poverty areexacerbated when adults are parents caring for children. ‘... among those with childrenat home, working-class women were four times more likely to suffer from a definitepsychiatric disorder’ than comparable middle-class women (Brown and Harris 1978,p.278).Vulnerability to mental disorders may be the result of adverse life events such aspoverty, poor environment, sexism or racism and other forms of social disadvantage(Centre for Disease Control and Prevention 2004; Ghate and Hazel 2002; Propperet al. 2004). For example, research based in 15 electoral wards in London found theincidence of schizophrenia in non-white minorities was related to the proportionof the ethnic minority living in the area; the smaller the minority group the greaterthe incidence of schizophrenia (Boydell et al. 2001). Of significance are individualexperiences, particularly those involving long-term threat (Brown and Harris 1978;Sheppard 1993).The picture is further clouded because mental illness is perceived differentlyby different cultural groups (NSPCC 1997a; Anglin et al 2006). For example,the literature seems to suggest that in some south Asian cultures mental illness isexpressed in terms of physiological ailments. As a result, symptoms may be reportedas problems requiring medical rather than psychiatric services. Likewise, in somecultures outside the Western world schizophrenia is interpreted as a possession ofthe sufferer by malevolent spirits, and the services of priests rather than doctors aresought (Littlewood and Lipsedge 1997).This cumulative body of evidence, although illustrating some of the difficultiesin assessing prevalence, suggests that a considerable number of children are living infamilies where at least one parent is suffering from a mental illness.Prevalence of parental mental illness:child protection studiesThe majority of parents who experience mental illness do not neglect or harm theirchildren simply as a consequence of the disorder (Tunnard 2004). Children becomemore vulnerable to abuse and neglect when parental mental illness coexists withother problems such as substance misuse, domestic violence or childhood abuse(Cleaver et al. 2007).Studies in the field of child protection suggest that the prevalence of identifiedmental illness, which in many cases exists alongside other parental difficulties,increases with the level of enquiry. At the referral stage prevalence is low. Cleaver and