When Ms. A. visited with her son’s psychiatrist, she broke into tears: "I don’t know what to do! My son hates us! He calls us ‘messengers of the devil!’ His sister is getting teased at school. Her classmates won’t talk to her, and they say her family is "really messed up." No one understands our problems, and I feel so alone. I am too ashamed to confide in any of our family friends. Our friends’ kids all seem to be doing so well. What should I do?"
Dr. Michael Ascher
Fortunately, the psychiatrist was aware of the NAMI Family-to-Family Education Program, which provided her with a free, 12-week course for family caregivers of individuals with severe mental illnesses. Family members who had been trained to run the program taught the course. It afforded Ms. A. the opportunity to learn current information about the biology of schizophrenia, medication, and strategies for medication adherence. She also got a chance to meet others who had experienced the maelstrom that mental illness can have on families. From another mother in the group, Ms. A. learned strategies aimed at managing her son when he became angry.
More importantly, however, she learned not to blame herself and to take time to look after her own health and well-being. She got advice about how to help her daughter manage the teasing at school. In addition, she took educational material into the school and gave it to her daughter’s homeroom teacher.
Families of individuals who suffer from mental illness experience a myriad of emotions: anger, frustration, hopelessness, sadness, fear, anxiety, shame, and loss. Psychiatrists must maintain a nonjudgmental and empathic stance with patients and their families.
In addition, we must be mindful of the profound influence mental illness has on the family system. Relatives might become psychologically distressed from the burden of caretaking and the social stigma of mental illness (J. Fam. Psychol. 2001;15:225-40). Recognizing that caregivers and families are often under stress and might have depression or anxiety must be a paramount goal of the clinician (J. Affect. Disord. 2010;121:10-21). Caregiver burden itself impairs the support that the caregiver can provide (Expressed Emotion in Families: Its Significance for Mental Illness, New York: The Guilford Press, 1985).
Psychiatrists are in the position to identify resources in the community that can help families build a knowledge base, which can be a tool for families to assist their loved ones and themselves. Support groups empower families to advocate for their loved ones, can alleviate the burdens of caregiving, and give family members a sense of community (Family Relations 1999;48:405-10).
The websites below contain helpful information, including support groups for families dealing with the mental illness of a loved one. We encourage clinicians to recommend these sites to families.
Many institutions provide patients and family education, so local or state resources can be of additional help. Please let us know about any websites that are not on our list that you would recommend to family members.
The following websites might help patients cope with family members who have mental illness:
P National Family Caregivers Association
P American Foundation for Suicide Prevention
P Families for Depression Awareness
P Depression and Bipolar Support Alliance
P The Children’s Society’s Include Project
P The National Alliance on Mental Illness Family-to-Family Education Program
P Support and Education Program for Families
P Children and Adults with Attention Deficit/Hyperactivity Disorder
P Substance Abuse and Mental Health Services Administration Resources for Military Families
P Compeer
P National PLAN (Planned Lifetime Assistance Network) Alliance
Dr. Heru is an associate professor of psychiatry at the University of Colorado at Denver, Aurora. She has been a member of the Association of Family Psychiatrists since 2002 and currently serves as the organization’s treasurer. In addition, she is the coauthor of two books on working with families and is the author of numerous articles on this topic. Dr. Ascher is a resident in psychiatry, department of psychiatry and behavioral sciences at Beth Israel Medical Center, New York. He is the Dear Abby Fellow, Group for the Advancement of Psychiatry (GAP) Family Committee. This commentary appears in Clinical Psychiatry News, a publication of Elsevier.