Putting the Family in the Picture

A best practice

Jane Duval and Nichola Malim Hall

Reprinted from "Families" issue of Visions Journal, 2013, 8 (3), pp. 5-6

As family members ourselves, we know first-hand the challenges that are faced when someone we love struggles with mental illness and/or substance abuse. And we know the strengths that we can bring to help and support those family members.

Families are often instrumental in helping someone with mental health and/or substance use issues to access treatment. Family members are usually the ones contacting counsellors and physicians, encouraging their relative to seek professional help, taking them to the hospital or clinic, sometimes dealing with the police, and advocating for appropriate levels of care and safety. At the same time, families desperately need help in finding those resources in the first place.

"Collateral information”—information from family members and friends about a person’s behaviour and symptoms—is crucial for the best possible assessment and diagnosis.1

Family members who watch the individual’s illness develop see how their behaviour changes, and they know what the person was like before they were affected by their mental illness or addiction. Family members usually also have substantial knowledge of treatment history, such as which medications were used in the past, and what doses and treatments worked or didn’t work. When there is a concurrent disorder—as is often the case—the family can provide information about previous symptoms or self-medication with unprescribed drugs.1

So families can be an important diagnostic resource, especially when critical information is not available from previous treating professionals. And while professionals come and go, families are generally there for a lifetime.

Family as a therapeutic partner

Treatment for both people with mental illness and those with addictions (and especially for those with a concurrent disorder) varies enormously from individual to individual. In the case of substance abuse, treatment (either day or residential) may have to be repeated several times. In the case of mental illness, pharmaceutical prescriptions may take years to adjust to an effective dosage.

During treatment and in the subsequent period of stabilization and rehabilitation, however, families can also play a major role in continuity of care. They monitor and encourage the person to follow their treatment plan. They can play a key role in alerting professionals to early warning signs of relapse, calling for emergency outreach if things deteriorate, and helping get the person back on track or into hospital.

Families often arrange regular social contact, organize shared activities, and provide support of all kinds—physical, emotional, financial—for the person struggling with mental health or substance use issues. These are all major elements of rehabilitation. This regular interaction with family complements the work of mental health and addiction teams, whose heavy caseloads often allow only periodic contact.

If someone relapses, it’s family members who most often are there to pick up the pieces and advocate to help the ill person regain their physical and mental health.

There is significant evidence that family involvement leads to lowered relapse rates and improved functioning.2 Unfortunately, the delivery of mental health and addiction services by professionals often bypasses the family.2

It is sometimes true that family dysfunction can be a contributing factor to the individual’s problem. If this is indeed the case, clinicians must use their professional judgment as to whether or not the family should be involved. Given the importance of family support—when families are involved, prognosis is greatly improved—every effort should be made to determine whether the family can offer valuable natural support.

The client’s right to privacy is also of paramount concern for professionals—and families understand the need for privacy. However, privacy issues do not mean that the family’s knowledge and expertise cannot be tapped.3 In our experience, a separate interview with the family can fill in many gaps left (either intentionally or unintentionally) by the individual, and can provide a wider context and perspective.

Regardless of the age of the individual with mental health or addiction issues, family involvement should be part of a specific treatment plan when it is possible. Family members should be actively approached and engaged as early as possible.

Supporting families

How families are treated and the way they are supported can contribute to the client’s recovery. Involving families in the therapeutic process improves not only client outcomes, but also family well-being.2

Families need support, however—both for themselves and to assist their ill family member. When a loved one has a mental illness or an addiction, there are enormous stresses on the family. The chronic stress family members experience as primary caregivers often undermines their own health, financial resources and ability to cope.

We feel that there is great value in providing families with resources such as professional counselling, psychoeducation, stress management and coping skills. Peer support groups can be immensely helpful for family members. Many people receive support from their faith groups.

Through family support organizations and interaction with professionals, families can learn how best to respond when their relative is not doing well. Family members become empowered by learning how their local mental health and addiction system works and how to be effective advocates on behalf of their loved ones.

‘Hopefulness’

“Professionals . . . must help the ill person set realistic goals. I would entreat them not to be devastated by our illness and transmit this hopeless attitude to us. I urge them never to lose hope; for we will not strive if we believe the effort is futile.”4
–Esso Leete, who has had schizophrenia for 20 years

While it is important not to have false hopes or unrealistic expectations, research shows that maintaining a sense of “hopefulness” is also important for family members in coping with the impact of mental illness and addiction.5

Skilled professionals who engage families as therapeutic partners are keenly aware of their capacity to either sustain or diminish hope. Above all, they understand and respect the expertise of the family, as well as the important role of hope and time in the process of grief and acceptance.

When the real value of a therapeutic partnership is recognized between the client, treating professionals and the family, there is true hope for recovery. As mothers and members of that network called “family,” we ourselves subscribe wholeheartedly to that hope.

 
About the authors

Jane is Executive Director of the BC Schizophrenia Society. She has 18 years experience in mental health policy research, education and advocacy for families affected by serious and persistent mental illness. She has been involved with the creation and promotion of two education programs used by the national Schizophrenia Society: Reaching Out (early psychosis intervention) and Strengthening Families Together. Jane has an adult son with schizophrenia

Nichola is a founding member of From Grief to Action (FGTA). She has two sons who are in recovery from addiction to unprescribed drugs and are currently on the methadone program. Her work in raising awareness of addiction as a disease that knows no socio-economic or family boundaries won Nichola a YWCA Woman of Distinction Award in 2003. She represents FGTA on both the BC Alliance on Mental Health and Addictions and the Community Action Initiative

Footnotes:
  1. British Columbia Ministry of Health and Ministry Responsible for Seniors. (2002). BC’s mental health reform: Best practices: Family support and involvement. www.health.gov.bc.ca/mhd/best.html.
  2. Ehmann, T. & Hanson, L. (2002). Early psychosis: A care guide. Vancouver, BC: University of British Columbia.
  3. See Freedom of Information and Protection of Privacy Fact Sheet, “Releasing Personal Health Information to Third Parties.” Guide to the Mental Health Act, Appendix 13. http://www.health.gov.bc.ca/library/publications/year/2005/MentalHealthGuide.pdf.
  4. BC Schizophrenia Society. (2008). Basic facts about schizophrenia. Richmond, BC: BCSS. (p. 24).
  5. Darlington, Y. & Bland, R. (1999). Strategies for encouraging and maintaining hope among people living with serious mental illness. Australian Social Work, 52(3), 17-23.
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