We are influenced tremendously by our family of origin. From the time we are born, we begin to form early attachments to our primary caregivers. This need for connection and attachment to others continues throughout our lifespan. Our families shape us, they influence our development, and we model their behaviors and habits. We look to our families for shelter, support and provision of resources. We instinctively expect our families to be available for us in our time of need.
For patients with mental illness, the family unit plays an even more crucial role. Mental health problems have been associated with an assortment of social and psychological processes in one’s family of origin.
With the deinstitutionalization of mental health services over the past few decades, families are now expected to be the primary caregivers of patients with mental illness. As a result, families have often felt blamed for mental health problems and laden with the responsibility of providing support.
This movement towards engaging families and caregivers of people with mental illness has demonstrated both short and long-term benefits. Family engagement in patients with mental illness could lead to better patient outcomes, such as fewer relapses, longer duration between relapses, reduced hospital admissions, shorter inpatient stay, and improved compliance to medication and treatment plans. For patients with schizophrenia, family engagement has also been shown to lessen residual psychotic and deficit symptoms, as well as helping with earlier detection of warning signs of relapse. For patients with depression, early intervention involving the family when symptoms first emerge may help to reduce the severity of the episodes. Family engagement is associated with better self-reported quality of life by patients and reduced general social impairment. There is evidence that these benefits endure over time if family engagement is actively maintained. Families could also help patients gain access to mental health services during times of crisis. Family engagement does not merely benefit the patients but extends to the family and caregivers as well. Studies have shown that family engagement helps to ease family burden and caregiver stress, as well as reducing expressed emotions in family members and caregivers.
Despite the well-documented potential benefits of family engagement in the care of patients with mental illness, there have been many reports of difficulties with the implementation of family engagement in routine psychiatric care. However, there is hope in Bridging the Gaps with these helpful tips for families:
“Let’s Bridge the Gap”
- Feeling irrationally guilty not only hurts the family, but it also reduces its ability to see things clearly and provide the optimal combination of support and limits for the loved one.
- How well the family copes with the person’s psychiatric problem usually influences how well the loved one will cope with it. And how well the loved one copes with their problem will reciprocally influence how well the family copes with their loved one and with it.
- Family coping not only depends on the strength and resilience of its individual members, but also how well and consistently they work together and are able to support each other. Family therapy may help improve family coping.
- Don’t feel you have to hide the family’s psychiatric problem. Societal stigma is rapidly diminishing and increasingly everyone is coming to understand that there is no shame in having a mentally ill loved one.
- Seeking help earlier rather than later will greatly reduce the severity of symptoms, problematic behaviors, impairment in functioning, risks, burdens, and complications.
- Be a very well informed consumer. Learn all you can about the diagnosis; treatment alternatives; insurance coverage; housing; disability; navigating the mental health and medical systems; and how to access social services. Never be shy about asking questions and expect providers to have clear, convincing, common sense answers. The internet is a great source of information, but don’t believe everything you read.
- Be unembarrassedly honest; open to learning new ways of understanding and relating to your loved one; and to developing new family coping skills.
- Our society over-treats the worried well and mildly ill, while cruelty neglecting those with severe mental disorders. Be wary of getting too much treatment (especially medication) for problems that would get better on their own; and too little for those that will get much worse in the absence of immediate and thorough attention.
- Psychiatric medications are not a good first good choice if your family member has only mild, transient, and/or expectable symptoms of sadness, grief, anxiety, or stress. There is not a pill for every problem and most problems resolve on their own. Kids, in particular, are being over-medicated after quick and careless evaluations. Be skeptical, be informed, and always ask lots of questions before accepting a psychiatric med.
- Be aware that there are lots of different forms of psychiatric treatment and that no one size fits all.
- Many treatments have a strong base of supporting evidence, some do not. Whenever possible, evidence-based treatments are preferred.
- Psychiatric treatments are about as effective (but also as ineffective) as most treatments in the rest of medicine. It makes sense to be optimistic they will help, but don’t expect miracles. Too-good-to-be-true claims for magical results turn out never to be true.
- Things often go better if your family member allows you to contribute to discussions regarding choice of optimal treatment. Selecting a specific treatment plan among the plausible alternatives depends on the person; the nature of the problem; its severity; preferences; provider training; availability; and the results of previous serial systematic trials aimed at learning what works best.
- Stopping/erratically taking needed medication is the biggest cause of relapse and should be the first thought if symptoms start returning. The risks of stopping needed medications are great if there is a full-blown relapse off medications, restarting them later may no longer be as effective or even work at all.
- People tend to stop the medications they need because of any combination of side effects; feeling better; use of alcohol or drugs; forgetfulness; resentfulness; and/or denial of illness. Identifying the reason(s) may shape effective responses that help the patient stay on an effective dose for the necessary duration.
Family engagement is an important aspect of the holistic management of patients with mental illness. Despite its challenges, family engagement for patients with mental illness has demonstrated benefits in several patient outcomes. Stay tuned for more tips to BRIDGE THE GAP. NEVER GIVE UP HOPE!
