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This article provides an overview of what we know about families where a parent has a mental illness, in order to situate the following papers for the special edition. An extensive search during November, 2014 in the Ovid MEDLINE and PsycINFO databases identified relevant papers that were then synthesized and presented in terms of (a) prevalence of parents and children living with parental mental illness, (b) mechanisms of risk for children, (c) needs of children, (d) needs of parents, and (e) intervention types and outcomes. A significant paradigm shift across all levels of policy and service development is required to adequately meet the needs of parents and children living with parental mental illness.