Caregiving for Relatives with Psychiatric Disorders vs. Co-Occurring Psychiatric and Substance Use Disorders

Substance Use in Relation to Mental Illness: A Study of Mexican-Origin Latinos with Schizophrenia and Their Family Members

Little is known about family context and substance use behaviors among Latinos with schizophrenia. Learning about patient and family caregiver perceptions of use is critical to our understanding of how best to support these vulnerable patients and family caregivers. This study explored perceptions of substance use in relation to mental illness among Latinos primarily of Mexican origin with schizophrenia and their family caregivers. Semistructured interviews were conducted with 34 participants (20 family caregivers; 14 patients) with direct and indirect substance use experience, in their preferred language. Data were analyzed using thematic analysis, which consisted of comparing codes across and within patient and family caregiver transcripts. Findings revealed that substance use affected well-being, particularly patient recovery and caregiver burden. Strategies to address well-being included limiting substance use, being vigilant about patient use, and communicating the negative impact of use. The environmental impact and stigma of substance use were major contextual challenges. Patients addressed these by limiting their socialization. Family social context was important to how substance use was perceived and managed by patients and caregivers. As such, treatment models should consider a holistic perspective that incorporates family context when addressing substance use among Latinos with schizophrenia.

Family Conflict and Violence by Persons with Serious Mental Illness: How Clinicians Can Intervene During the COVID-19 Pandemic and Beyond

Although most persons living with serious mental illness (SMI) do not act violently, this population is at a modestly increased risk of engaging in violence, with family members being the most common victims. Consequently, evidence suggests that a sizable minority of family members-many of whom are caregivers-have experienced violence by their relative with SMI. The risk of conflict and violence in families of persons with SMI is likely currently heightened due to a range of challenges resulting from the COVID-19 pandemic (e.g., interruption in treatment services and the occurrence of arguments while sheltering in place together). As such, during the pandemic, it is particularly important that clinicians intervene with these populations to prevent conflict and violence and strengthen their relationships with each other. Based on available evidence, we recommend that clinical interventions aiming to do so address the following topics with family members and/or persons with SMI: mutual understanding; positive communication; effective problem-solving; symptoms and psychiatric crises; triggers to, and early warning signs of, anger and conflict; and strategies for de-escalating conflict and managing violent behavior. We offer suggestions for how clinicians can address these topics and recommend established clinical resources providing more guidance in this area.

Perceived Isolation among Family Caregivers of People with Mental Illness

Family members (who are overwhelmingly women) providing caregiving for individuals with mental illness (MI) are known to experience significant burden. Little research, however, has addressed how such burden can affect caregivers' personal time and perceived isolation. Using data from a survey of 1,505 family caregivers of adults with MI, authors examined the extent to which factors related to caregivers, care recipients, caregiving, and treatment are associated with caregivers' perceived isolation and the mediating role of caregivers' inadequate personal time. A series of multivariate logistic regression models and Sobel testing were performed. Half of caregivers perceived being isolated. Perceived isolation was positively associated with care recipients having a serious mental health problem, coresiding, effects of stigma, and caregivers having inadequate time for themselves. Perceived isolation was negatively associated with the ability to rely on others for help, caregivers being satisfied with the amount of community mental health services, and caregivers having received education on caregiving. Caregivers having inadequate time for themselves was most strongly related to perceived isolation. Female caregivers were more likely to experience isolation; however, this relationship was mediated through caregivers having less time for themselves than preferred. The article concludes with a discussion of the implications for social work practice.