Care: giving, receiving and meaning in the context of mental illness

Relationship Quality Among Persons with Serious Mental Illness and Their Relatives: Rates and Correlates

Supportive family relationships for persons with serious mental illness (SMI) are correlated with positive functional, health and mental health outcomes and are essential to the recovery process. However, there has been a dearth of research on positive family dynamics. Using multivariate logistic regression with a U.S. community-recruited sample of persons with SMI (N = 523), we examined the extent to which demographics, clinical characteristics, and supportive and problematic relationship interactions were associated with relationship quality with reference relatives (RR). Secondarily, we tested whether the relationship between routine limit-setting practices by RR toward participants and relationship quality was significantly mediated by perceived emotional overinvolvement using Baron and Kenny's four step method. High levels of relationship quality were reported by two-thirds of the sample. Relationship quality was positively associated with frequency of contact between participants and RR, participants helping RR with activities of daily living, and caregiving provided by RR to participants. High relationship quality was negatively associated with RR being parents or other family members (compared to romantic partners), perceived emotional overinvolvement of RR, and psychological abuse by RR toward participants. Clinical and demographic characteristics were not associated with relationship quality. Perceived emotional overinvolvement was found to be a mediator between routine limit-setting practices and relationship quality. These results can help direct clinicians in targeting factors that will likely enhance the process of recovery.

Care-giving by people with psychotic disorders in the second Australian prevalence study of psychosis

Increasing numbers of people living with psychosis are providing care for others, although the associated benefits and impacts are poorly understood. This innovative quantitative study investigated this life role using a population-based framework aiming to compare the mental health and functioning of those providing care to and/or receiving care from others. Care-giving provided by people with psychosis was examined using data from the second Australian prevalence survey of psychosis. This epidemiologically based sample (n = 1,822) was divided into four subgroups based on providing and/or receiving care from others. Independent functioning, cognitive functioning, social functioning, social connection and mental health were compared between the four subgroups. One in seven participants were providing care to others. The majority of carers were female and half were living with the care recipients. Caregivers were more likely to experience better illness course and were more commonly diagnosed with bipolar disorder. Almost one-third of caregivers reported that caring adversely affected their lives a great deal. Functioning and social connection were better in caregivers compared to non-caregivers, although cognitive functioning did not differ. People with psychosis who were neither providing nor receiving care were more likely to be single and perceive less warmth in their relationships. As expected, those only in receipt of care were living with greater disability and poorer illness course. It is relatively common to encounter people with psychosis who provide care to others in clinical settings, and women in particular combine care-giving with multiple other roles. Despite most experiencing some negative emotional impact, care-giving is associated with enhanced social relationships which may provide meaning and purpose for recovery. Care-giving roles should be addressed in recovery and care planning so as to provide people with psychosis with adequate information and support to fulfil these potentially important life roles.

Mental Health Literacy of Youth That Have a Family Member With a Mental Illness: Outcomes From a New Program and Scale

A program evaluation examined mental health literacy levels and coping outcomes for youth (ages 10-16), before and at the end of their participation in a manualized, school-based mental health literacy program called Youth Education and Support (YES). Most of the youth reportedly had a parent or other family member with a mental health disorder such as depression, anxiety, and/or substance abuse. The mental health literacy levels of program participants from pre to post were evaluated with the developing Knowledge of Mental Illness and Recovery (K-MIR) scale. This scale was validated using item-response theory, demonstrating good psychometric properties. Youth answered two coping questions about their use of positive coping during the program and coping skills compared from pre to post intervention. Findings revealed that youth levels of mental health literacy increased significantly from pre to post program participation. Over 90% of the youth reported an improved use of positive coping strategies from pre to post intervention. The program appeared to deliver enhanced levels of literacy and coping for this sample of youth. The scale appeared to be appropriate to measure youth mental health literacy. Recommendations for practice, policy, and research are offered.

Mental health inpatient experiences of adults with intellectual disability

This paper presents findings from a study exploring the mental health inpatient care of people with a dual disability of intellectual disability and mental health issues from the perspective of those people with the dual disability. A mixture of semi-structured interviews and focus group interviews were carried out with nine participants who had been admitted to an inpatient unit for mental health care exploring their experience of care. Interviews were transcribed and analyzed using open coding and Leximancer (an online data mining tool) analysis to identify dominant themes in the discourse. Analysis revealed themes around 'Therapeutic and Meaningful Activity', 'Emotion Focussed Care', and 'Feeling Safe?' Participants were able to identify the aspects of inpatient care that worked for them in terms of coping with time in hospital. This research suggests that there are several factors that should be considered in providing effective mental health inpatient care for people with dual disability. A number of strategies and recommendations for responding to their needs are identified and discussed.

Information needs, care difficulties, and coping strategies in families of people with mental illness

Objective:

To determine information needs, care difficulties, and coping mechanisms of family members of people with mental illness.

Methods:

In this descriptive cross-sectional study, the study sample consisted of the families of 134 patients who were treated in the Psychiatric Unit of Cumhuriyet University Training and Research Hospital in Sivas, Turkey between January and May 2011. Data was collected by a questionnaire and analysed descriptively, and by chi-square testing.

Results:

It was determined that 79.1% of family members were knowledgeable of the patients’ illness. It was found that they experienced difficulties in communicating with the patient, and in ensuring drug compliance and anger management and that they used psychological and social coping strategies.

Conclusion:

Our results indicate that access to medical information on its own is not sufficient for carers of people with mental illness, and the necessity of developing positive attitudes when dealing with the illness and its symptoms. We recommend that nurses and other health professionals offer long term support and consultation programs to family members.

Factors affecting disruption in families of adults with mental illness

PURPOSE

This study examined relationships between vulnerability/risk and protective factors, and family functioning in women family members of adults with serious mental illness.

DESIGN AND METHODS

Using a descriptive, correlational design, this secondary analysis examined characteristics of the family member with mental illness (e.g., diagnosis, level of care) and measures of caregiver stigma and strain, client dependence, family disruption, sense of coherence, and resourcefulness.

FINDINGS

Family disruption was greatest in women who provided direct care and whose family member had major depression, followed by bipolar disorder, schizophrenia, and panic disorder. Sense of coherence and resourcefulness were associated with lower family disruption, but did not mediate the effects of caregiver strain.

PRACTICE IMPLICATIONS

Interventions restricted to one family member may be insufficient for improving the family functioning.

The seriously mentally ill older adult: perceptions of the patient-provider relationship

PURPOSE

The purpose of this study was to give voice to the lived experiences of older adults with serious mental illness and their perceptions of the healthcare provider relationship.

DESIGN AND METHODS

A qualitative phenomenological research design was used. In-depth interviews were conducted with eight members of a mental health clubhouse.

FINDINGS

Study themes revealed not only elements of goodwill toward providers but also elements of concern about the reliability and quality of healthcare provider relationships. Findings provided theoretical support for using Peplauian approaches in clinical practice.

PRACTICE IMPLICATIONS

Partnering with patients, utilizing peer support networks, and placing a broader emphasis on the recovery model should be explored.

The role of personal loss in the caregiving experiences of well siblings of adults with serious mental illness

OBJECTIVE

The present study examined the role of personal loss due to mental illness and meaning-related coping strategies on reports of caregiving among well siblings of adults with serious mental illness.

METHOD

A sample of 103 well siblings of adults with serious mental illness completed an online survey. Participants were recruited through websites related to mental illness and through contact with leaders of family support groups.

RESULTS

Personal loss, not meaning-related coping, was the strongest predictor of current caregiving among well siblings. Well siblings' age, support group affiliation, and perceived level of sibling dependence also contributed to variation in reports of current caregiving.

CONCLUSION

Personal loss has powerful implications for research and interventions focused on sibling involvement in caregiving for adults with mental illness.

Professional competencies for promoting recovery in mental illness

This study explored professional caregiving from the perspective of people diagnosed with schizophrenia to develop proposed professional competencies for promoting recovery. We conducted semi-structured qualitative interviews with 40 people diagnosed with schizophrenia to explore their experiences of caregiving. Interview segments related to professional caregiving were analyzed to derive categories and themes that described aspects of caregiving that clients believed contributed to their recovery. The proposed competencies derived from the interviews overlap with hypothesized competencies identified in the literature, but also suggest other areas of skill and attitude that relate to promoting recovery, including use of time, talk, and teamwork. The significance participants attach to time and talk suggests that services play an important role in recovery by creating the space for service users and service providers to engage in recovery-promoting practices.

Family network support and mental health recovery

Family members often provide critical support to persons living with a serious mental illness. The focus of this study was to determine which dimensions of the family support network were most important to the recovery process from the perspective of the recovering person. Consumers of a community mental health program completed in-depth structured interviews that included separate measures of social network support and recovery. Consumers named an average of 2.6 family members on the social network, interacted with family on a weekly basis, and were quite satisfied with their contact. This study revealed that support and reciprocity with family members are important dimensions of a personal support network that relates to the recovery process.

Attitudes and perceived barriers to working with families of persons with severe mental illness: mental health professionals' perspectives

A state-wide survey of 453 clinicians serving people with severe mental illness in community mental health centers evaluated the degree to which they provide services to families and their perceptions of barriers to developing such services. Most clinicians did not provide many services to families and reported barriers related to the family or client (e.g., family's lack of interest) and their own work environment (e.g., heavy workload). Clinicians who had received prior training on working with families provided more services, had more positive attitudes toward family, and felt more competent about their knowledge, confirming the importance of staff training.

The coping experiences of carers who live with someone who has schizophrenia

AIMS AND OBJECTIVES

The purpose of this study was to understand the coping experiences of carers living with a schizophrenic family member. Our research may be a valuable reference for mental health professionals seeking to improve the quality of care for people with schizophrenia and their carers.

DESIGN

We employed a qualitative descriptive phenomenological research methodology to understand the coping experiences of carers living with a schizophrenic family member.

METHODS

Purposive sampling and in-depth, face-to-face interviews were used to collect data. When data saturation was reached, the sample size comprised 10 carers (five men and five women). The interview focused on the carer's coping experience. During the process of data collection and data analyis we established epoches (bracketing) and returned to the reality of the carers' experience to keep the data objective. Narratives were analysed according to Colaizzi's seven steps method.

RESULTS

The two most commonly used coping mechanisms that emerged from this study were psychological coping strategies (cognitive, behavioural and emotional) and social coping strategies (religious, social and professional support). Furthermore, three factors were found in the study, including low social status, traditional help-seeking behaviours and feelings of shame.

CONCLUSION

Findings from this study demonstrate the importance of understanding the coping experiences of carers who have a family member with schizophrenia. Further research is needed to identify more important detailed factors that affect the coping strategies of carers. Relevance to clinical practice. Community mental health care professionals need to improve the quality of care for helping carers living with a family member who has schizophrenia. It is important to develop effective coping intervention strategies that help carers cope with the stress and strain of caring for a family member with schizophrenia.

Psychotic-spectrum illness and family-based treatments: a case-based illustration of the underuse of family interventions

Psychotic-spectrum illnesses (PSIs) are a significant cause of relational dysfunction and vocational disability, and result in substantial economic costs to society. The impact of family process, particularly "expressed emotion," on influencing the relapse rate of PSIs is now well documented. Over the last two decades, evidence has emerged supporting family-based treatments that decrease family stress (e.g., psychoeducation, training in problem solving, and improved communication), reduce the relapse rate, and improve medication adherence and social functioning among patients with PSIs. Family interventions are now included in the Expert Consensus Guidelines and the Agency for Health Care Policy and Research/National Institute of Mental Health (AHCPR/NIMH) Schizophrenia Patient Outcomes Research Team (PORT) recommendations for the treatment of schizophrenia. Nevertheless, family-based treatments are underused in the care of PSI patients. Building upon a case example, this article explores the barriers to implementing family interventions in the acute and outpatient treatment of these patients. The case discussion highlights the convergence of problems in the mental health care system with clinicians' typical capacities and practices, difficulties intrinsic to the nature of PSI itself, and the burden and stigmatization of families of the severely mentally ill. Taken together, these factors undercut the implementation of evidence-based family interventions.