Canadian families caring for members with mental illness: a vicious cycle

Exploration of recovery of people living with severe mental illness (SMI) in low/middle-income countries (LMICs): a scoping review

OBJECTIVE

To examine the literature on how recovery of people with severe mental illness (SMI) is conceptualised in low/middle-income countries (LMICs), and in particular what factors are thought to facilitate recovery.

DESIGN

Scoping review.

DATA SOURCES AND ELIGIBILITY

We searched 14 electronic databases, hand searched citations and consulted with experts during the period May-December 2019. Eligible studies were independently screened for inclusion and exclusion by two reviewers. Unresolved discrepancies were referred to a third reviewer.

DATA EXTRACTION AND SYNTHESIS

All bibliographical data and study characteristics were extracted using a data charting form. Selected studies were analysed through a thematic analysis emerging from extracted data.

RESULTS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram offers a summary of the results: 4201 titles, 1530 abstracts and 109 full-text articles were screened. Ten articles were selected for inclusion: two from Turkey, two from India, and one each from China, Swaziland, Indonesia, Egypt, South Africa and Vietnam. Although most studies used qualitative methods, data collection and sampling methods were heterogeneous. One study reported on service provider perspectives while the rest provided perspectives from a combination of service users and caregivers. Three themes emerged from the data analysis. First, studies frame recovery as a personal journey occurring along a continuum. Second, there was an emphasis on social relationships as a facilitator of recovery. Third, spirituality emerged as both a facilitator and an indicator of recovery. These themes were not mutually exclusive and some overlap exists.

CONCLUSION

Although there were commonalities with how high-income countries describe recovery, we also found differences in conceptualisation. These differences in how recovery was understood reflect the importance of framing the personal recovery concept in relation to local needs and contextual issues found in LMICs. This review highlighted the current sparse evidence base and the need to better understand recovery from SMI in LMICs.

[To recuperate and preserve the relative: Family caregivers strategies to manage mental health crisis]

Objetivo

Conocer y comprender las estrategias que llevan a cabo los familiares de personas con problemas mentales en las crisis de sus familiares enfermos.

Diseño

Estudio cualitativo.

Emplazamiento

Servicio de Salud Mental (SESCAM) y centros sociosanitarios de Castilla-La Mancha.

Participantes

Veinticuatro familiares adultos que conviven y cuidan de un familiar que sufre crisis de salud mental; contactados a través de la dirección de salud del área y de una fundación socio sanitaria. Se seleccionaron con propósito y en bola de nieve.

Método

Veintidós entrevistas semiestructuradas y analizadas según los procedimientos de teoría fundamentada constructivista desarrolladas entre enero del 2014 y febrero del 2016. El muestreo teórico guio la obtención de los datos que finalizó con la saturación de las categorías emergentes.

Resultados

La persona con un problema mental durante las crisis se convierte en un ser extraño e inaccesible para los familiares. En esta situación los esfuerzos se dirigen a recuperar al familiar, a sacarlo de la sinrazón y a conservarlo en una normalidad cotidiana y construida para ellos. Gracias a esto el familiar enfermo está integrado en la vida familiar.

Conclusiones

Los familiares cuidadores de personas con problemas mentales luchan por no perderles en las crisis y por conservar los vínculos familiares. Los profesionales de Atención Primaria deben dar importancia a estos vínculos pues determinan sus estrategias de cuidado durante una crisis y las estrategias para conservar al familiar.

Comparing Strategies for Providing Child and Youth Mental Health Care Services in Canada, the United States, and The Netherlands

This paper reviews how child and youth mental health care services in Canada, the United States, and the Netherlands are organized and financed in order to identify systems and individual-level factors that may inhibit or discourage access to treatment for youth with mental health problems, such as public or private health insurance coverage, out-of-pocket expenses, and referral requirements for specialized mental health care services. Pathways to care for treatment of mental health problems among children and youth are conceptualized and discussed in reference to health insurance coverage and access to specialty services. We outline reforms to the organization of health care that have been introduced in recent years, and the basket of services covered by public and private insurance schemes. We conclude with a discussion of country-level opportunities to enhance access to child and youth mental health services using existing health policy levers in Canada, the United States and the Netherlands.

Navigating in an unpredictable daily life: a metasynthesis on children's experiences living with a parent with severe mental illness

A large group of individuals suffering from mental illness are parents living with their children. These children are invisible in the health care even though at risk for illhealth. The aim of this metasynthesis was to advance knowledge of how children of parents with mental illness experience their lives, thus contributing to the evidence of this phenomenon. The metasynthesis is following Sandelowski and Barroso's guidelines. Literature searches covering the years 2000 to 2013 resulted in 22 reports which were synthesised into the theme 'navigating in an unpredictable everyday life' and the metaphor compass. Children of parents with mental illness irrespective of age are responsible, loving and worrying children who want to do everything to help and support. Children feel shame when the parent behaves differently, and they conceal their family life being afraid of stigmatisation and bullying. When their parent becomes ill, they distance to protect themselves. The children cope through information, knowledge, frankness and trustful relationships. These children need support from healthcare services because they subjugate own needs in favour of the parental needs, they should be encouraged to talk about their family situation, and especially, young children should to be child-like, playing and seeing friends.

A Journey of Discovery: Experiences of Carers of People with Mental Illness Seeking Diagnosis and Treatment for Their Relative

This study explores the experiences of informal carers of people with mental illness in an Australian mental health service. A qualitative descriptive approach was used with data collected via focus group interviews with a purposive sample of 19 carers. Data analysis revealed two major themes: (a) "Something is not right" and (b) "Now we have a diagnosis." The carers noticed that there was something wrong with their relative before they received a diagnosis but were often hesitant to engage Mental Health services. Carers have trouble understanding if the problems they are witnessing are part of normal development, contemporary culture, or are symptoms of mental illness. Fear of stigma remains a barrier to accessing services and early diagnosis. Findings suggest a need to target support for informal carers in the period prior to and leading to the establishment of a mental health diagnosis.

A qualitative analysis of relatives', health professionals' and service users' views on the involvement in care of relatives in Bipolar Disorder

BACKGROUND

Relatives of people with bipolar disorder report that services do not meet their own needs, despite clinical recommendations for the development of care plans for relatives, provision of information regarding their statutory entitlements, and formal involvement in decision making meetings. Further, there is now conclusive evidence highlighting the benefits of relatives' involvement in improving outcomes for service users, relatives, and the health system as a whole. This qualitative study explored the views of relatives of people with bipolar disorder, service users and healthcare professionals regarding the barriers and the facilitators to relatives' involvement in care.

METHODS

Thirty five people were interviewed (12 relatives, 11 service users and 12 healthcare professionals). Audio recordings were transcribed verbatim and common themes in participants' narratives emerged using framework analysis.

RESULTS

Participants' accounts confirmed the existence of opportunities for relatives to be involved. These, however, were limited and not always accessible. There were three factors identified that influenced accessibility namely: pre-existing worldviews, the quality of relationships and of communication between those involved, and specific structural impediments.

DISCUSSION

These themes are understood as intertwined and dependent on one another. People's thoughts, beliefs, attitudes, cultural identifications and worldviews often underlie the ways by which they communicate and the quality of their relationship. These, however, need to be conceptualised within operational frameworks and policy agendas in health settings that often limit bipolar relatives' accessibility to opportunities for being more formally involved.

CONCLUSIONS

Involving relatives leads to clear benefits for relatives, service users, healthcare professionals, and the health system as a whole. Successful involvement of relatives, however, depends on a complex network of processes and interactions among all those involved and requires strategic planning from policy makers, operational plans and allocation of resources.

Great expectations: a systematic review of the literature on the role of family carers in severe mental illness, and their relationships and engagement with professionals

As community care has become embedded in the U.K. as in much of the western world more responsibility for psychosocial care has been placed on family carers. A systematic review of the literature about the role of family carers supporting a relative with severe mental illness and their relationships and engagement with professionals was carried out. The review aimed to find out what professionals expected of family carers and what family carers expected of themselves. Themes were identified: the distinct and personal nature of family caring, potentially effective family caring, barriers to effective caring and ways to overcome barriers. There were expectations that family carers were obligated to help support effective care, but that the rights to enable carers to fulfil these obligations were not consistently upheld. Barriers to upholding rights include: types of service provision, professional attitudes to communication and engagement with carers, and carer ability to cope. Recommendations for practice included: service provision aimed at including carers, more empathic communication by professionals, and a covenant between mental health services and people who depend on them. The idea of a covenant requires more discussion and research is needed into what is expected of family carers.

Primary caregivers' satisfaction with clinicians' response to them as informal carers of young people with first-episode psychosis: a qualitative study

AIM

To explore first-time primary caregivers' experience of the way mental health nurses and other mental health clinicians respond to them as carers of young people with first-episode psychosis.

BACKGROUND

Caregivers have a key role in supporting family members/relatives with mental illness, but their contribution is undervalued frequently by mental health nurses and other mental health clinicians. Design.  Qualitative interpretative phenomenological analysis.

METHOD

A qualitative interpretative design was undertaken, using semi-structured, audio-recorded interviews. Twenty primary caregivers were recruited through Orygen Youth Health, a first-episode psychosis centre in Melbourne. Interpretative phenomenological analysis was used to identify themes in the data.

RESULTS

Two competing themes were identified in the data, highlighting caregivers' contrasting experience with mental health nurses and other mental health clinicians. First, most clinical staff were approachable and supportive. Second, several carers felt their contribution was undervalued by some clinical staff. This was as a consequence of being excluded from clinical deliberations because of clinical staffs' concerns and young people's requests about maintaining confidentiality regarding treatment, as well as carers feeling their role was not taken seriously by clinical staff.

CONCLUSION

First-time primary carers have positive and negative experiences with first-episode psychosis mental health nurses and other clinicians, and these competing events are interrelated. Experiences are affected directly by the manner they are treated by clinical staff and this may, in turn, affect carers' commitment to caring, the way they engage with clinical staff on subsequent occasions and towards the first-episode psychosis service generally.

RELEVANCE TO CLINICAL PRACTICE

Greater appreciation is needed of the contribution, experience and difficulties caregivers encounter in their role and in engaging with mental health nurses and other clinicians. Additional training is required for clinical staff in family interventions and to familiarise them with legislation and mental health policies relating to carers.

First-time primary caregivers' experience accessing first-episode psychosis services

AIM

Easy access to first-episode psychosis (FEP) services is critical in reducing the duration of untreated illness. However, primary caregivers can encounter difficulties accessing services on behalf of young people with FEP. This qualitative study describes the lived experience of first time primary caregivers of young adults with FEP, with a focus on examining how they access specialist FEP services.

METHODS

A qualitative study was undertaken using semi-structured, in-depth interviews with 20 caregivers in Melbourne.

RESULTS

Most carers were women (85%, n = 17) and parents (85%, n = 17). Nearly all lived in the same households as the young people with FEP (90%, n = 18). The mean duration of their involvement with the FEP service was 14.5 months (standard deviation = 8.9). Three competing themes were identified in the data, reflecting caregivers' polarized experiences accessing FEP services. First, general practitioners were regarded as either a resourceful or an unresourceful means of access to FEP services. Second, caregivers often encountered service-focused and carer-focused barriers when initially accessing services. Third, a combination of acquired knowledge, experience with services and caregiver assertiveness enhanced access on subsequent occasions.

CONCLUSION

This study highlights the important contribution and experience of first-time primary caregivers and the difficulties they face accessing services. The findings suggest access should be influenced more by clinical need and less by caregivers'perseverance. The findings also underline the importance of providing clinical training that acknowledges the needs and contributions of caregivers, as well as interventions that meet the unique challenges faced by first-time caregivers accessing services after the onset of FEP.

Choosing "the best of the hells": mothers face housing dilemmas for their adult children with mental illness and a history of violence

Family members in the United States--especially mothers--are frequently caregivers, and provide housing for their adult relatives and children with mental illness. They often do so with little support from the mental health system. The purpose of this analysis was to explore mothers' experiences related to housing options available to their adult children with a mental illness and a history of violence (MIHV) toward the mothers. The results of this study reveal a complex mixing of desires, feelings, internal factors, and external forces experienced by mothers of adult children with MIHV when considering whether or not these children can live in their homes. The findings from this study illuminate needs for greater familial involvement in mental health treatment decisions, respite for caregiving families, and housing as a crucial element of a comprehensive mental health treatment plan.

Beliefs, suffering, and healing: a clinical practice model for families experiencing mental illness

PURPOSE

Mental illness often changes families' lives and relationships forever. A Family Systems Nursing framework is proposed for working collaboratively with families.

CONCLUSIONS

The Illness Beliefs Model (Wright & Bell, 2009) offers clinicians ways to target illness beliefs that may perpetuate or, alternatively, soften suffering.

PRACTICE IMPLICATIONS

We have learned from families that it is often not the family member with the illness who is suffering most, but rather, other family members. The complexity of "relational suffering" challenges mental health nurses to acquire knowledge and skills to work with families to soften physical, emotional, relational, and spiritual suffering.

Excellence in nursing: a model for implementing Family Systems Nursing in nursing practice at an institutional level in Iceland

An innovative opportunity is being created by nursing leaders from practice and education in Iceland to implement Family Systems Nursing at an institutional level on all units and divisions with the Landspitali University Hospital. This article describes the phases of the implementation model for knowledge translation that will be operationalized over four years. The goals of implementing Family Systems Nursing at the Landspitali University Hospital are to (a) educate all practicing nurses in Family Systems Nursing and, in particular, the Calgary family assessment and intervention models; (b) strengthen practicing nurses' clinical skills for intervening with families by offering specific clinical training courses to all nurses using family skills labs; and (c) explore and assess the difference that the theoretical and clinical programs make for the nurses, the patients and their families, and the nurses' practice (the family-nurse relationship).

Patients' report of help provided by relatives and services to meet their needs

This article analyzes help provided by relatives and/or services to the needs of individuals with severe mental illness who have, versus do not have, regular contact with family. Factors that influence help are also examined. Data collection is based on a random sample of 186 Quebec outpatients. Patients' needs were assessed using the Camberwell Assessment of Need. Relatives provided adequate help for social and functioning needs, adequately complementing services in other needs categories. Six sociodemographic variables influence help from relatives, only one affects help from services. The role of relatives is identified as important in meeting patients' needs, either solely or jointly with services.