Families And Mental Illness: Understanding Caregiving Complexities And Coping Strategies

7 Principles Relating to Carer

Discuss about the Families and Mental Illness.

Mental health problem has become a huge problem in the modern day context. However, the next big issue is giving care to the mentally ill family member by carers that can be a paid carer or a family member. Even after establishing rules for creating good care relationship, due to the complexity in the genre, it becomes difficult for carers to provide care mentally ill patients. This assignment, therefore, focuses on identifying the complexities that are present in providing care to mentally ill patients by a family member.  Further, it also focuses on analysing the rules that are there for promoting the rights of the caregivers in order to develop a good care relationship.  Further, the assignment also analyses the four-phase method by David Karp that illustrates the ways by which families can cope with mental illness of a family member.

According to Knapp, McDaid and Mossialos (2006), the term caregiver is sometimes misinterpreted as it is natural that a family member is supposed to care for a mentally ill family member. However, as per the feminist point of view, women that care for the family members are unpaid and non-recognised as it is a natural fact to care for the family members. However, the Carers Recognition Act, 2012 has identified the importance and role of caregivers and recognises their needs and requirements. It specifies a set of 7 principles that shows the importance of care relationship. The first principle asks for respect and recognises for the caregivers. Beutler and Levant (2006) remarked that care relationship between service users and caregivers is so complex that sometimes, it becomes difficult to recognise the carers. Mayberry and Heflinger (2013) remarked that as carers are paid for their service, recognising them is not required. Further, as per the concept of family roles, family members are bound to care for their family members.  Therefore, special recognition is meaningless. However, according to the point of view of Lester and Glasby (2010), respect and recognition are the two main elements that create good relationship between service users and caregivers whether they are family members or paid care givers. 

The second principle is that of being supported as an individual during the change of care relationship whereas the third principle asks for being recognised for the efforts that a caregiver provides.  Beutler and Levant (2006) identified that a caregiver should be supported both as a carer and an individual. The main reason is that a caregiver with utmost dedication for the service users and therefore, they deserve the support and being recognised. Family members who work as care giver also deserve the support when they are ill.  However, in most of the cases, they are not recognised or supported, which shows the difficulties and complexities that are present in care giving. The fourth principle shows that the views and cultural identity of the caregivers need to be taken into account as per the best interest of the service users. It means that there should not be any discrimination for the carers even though they are from others ethnic identify or cultures.  However, discrimination is a common fact in Australia. Every out of 10 people, 4 are discriminated. The principles included social wellbeing and consideration in the decision-making. Knapp, McDaid and Mossialos (2006) pointed out that both the caregivers and the service need to be responsible enough to focus on their social and health wellbeing.  However, even after this recognition in the job role, carers whether family members or paid carers have to deal with highly difficult situations. The next section illustrates the difficulties. 

Key Themes in Literature on Carers and Caregiving

Drake et al. (2001) remarked that while dealing with mental health patients, caregivers have to deal with unpredictable and uncontrollable situations.  It creates job strain among the carers. Giovannetti et al. (2013) defined role strain as the situation when someone is unable to carry out the given tasks properly. Due to the unpredictable behaviours that caregivers needs to deal with, family members who intend to care for the mentally ill persons suffer from this role strain.  Mayberry and Heflinger (2013) found out that carers sometimes need to take new roles while treating mentally ill patients.  According to Perry and Pescosolido (2015) when carers are given with new, but conflicting roles at the same time, they are exposed to emotionally conflicting situations which create role distress among them. It thus creates situations where the carer funds himself or herself in mental disorder. Thus, it has a huge impact on both the carer and all the family members of the mentally ill person. Fine and Glendinning (2005) is the view that the complexities in caregiving and care relationship is huge.  It not only impacts on the mental health of a family member or a carer giving care to a mental health person but also impacts on the physical health.  Painful and conflicted emotions are established during that time and therefore, there are requirements for taking new measures for dealing with mental health illness. The following section analyses the four phases by which families can cope with mental health illness of a family member and can provide accurate care.

As per Kohn et al. (2004), the first phase in the career of the family caregivers is emotional anomie. This emotional anomie is a phase where the family caregivers are confused and lack a reference point. This lack of reference point and confusion leads to delayed understanding on the perspective and the problems of the ill people. In this context, Norcross, Beutler and Levant (2006) added that the family caregivers tend to have the lower understanding on the initial stage which mainly involves their connection with the family members. The situation, however, is different in the case of the children of a parent who is suffering from mental illness. Karp (2001) agreed to this and further added that the in such situation the family caregivers refers to the fact that they have normalised in such situation as they are not known to another world. In the first phase, the family caregivers tend to become emotional that affects their rational thinking which in turn leads to confusion. Lack of reference in the first phase mainly deals with the fact that the family caregivers are too emotionally attached which deviates them from the assessment of the situation while leading to further deterioration of the health. In this context, Young et al. (2004) added that the emotional anomie generally leads to delayed understanding on the patient's behaviour which not only affects the patients but also the family members. Richardson et al. (2013) added that the main reason behind this is that the family caregivers and especially children off parents with mental illness persuaded by feeling and emotional attachments.  Thus, it can be said that by controlling the emotional anomie, it might be possible for the family carers to understand the actual behaviour of the mentally ill patients and thereby can be possible to give the patient with utmost care. Further, it can be said that non-control of the emotional anomie can lead to confusion regarding the behaviour of the patient as well.

The Four Phases through which Families Cope with Mental Illness

The second phase in the career of the family caregivers is diagnosis wherein, the both the family caregivers, as well as the person in the family with illness, tends to embrace the medical version for whatever is going wrong. In this context, Harden (2005) added that the people in the family tend to accept the medical version of the illness just to bring themselves relief. Knapp, McDaid and Mossialos (2006) agreed to this and further added that this medical version of the illness not only calms the family caregivers but also the personal with the illness. This acceptance, on the other hand, brings relief both in terms of mental peace and health. The reason behind this is that the treatment based on medical version helps better assessment of the illness while on the other hand, removes the confusion created in the previous or initial phase. As in the words of Lester and Glasby (2010), the acceptance of the medical version does bring peace in the minds of the family caregivers but also have a certain adverse impact as well. The reason behind this is that the medical versions sometimes bring the harder truth about the illness, which in turn directly influences the person with the illness and the family caregivers. However, the main purpose of embracing the medical version is to bring peace in the mind of the family caregivers while providing adequate treatment of the ill person and removing the confusion created in the earlier phase.

In the third phase, the family caregivers tend to recognise that the illness of the family member shall continue over a long duration and therefore, make adjustment accordingly. In this context, Fine and Glendinning (2005) stated that the third phase in the career of the family caregivers tends to be the toughest of all the first three phases. The reason behind this is that it leads to an intensification of the sorrow while on the other hand, also leads to the framing of emotional management. On the contrary, Giovannetti et al. (2013) stated that the perceiving of the permanence of illness also leads to resentment and anger in the minds of the family caregivers. The reason behind this is that the family caregivers tend to blame themselves for such events. In this context, Mayberry and Heflinger (2013) opined that such deliberate emotion management is generally driven by the attachment between the ill member of the family and the caregiver. This emotion management in accompanied by narrative reconstruction; which enable the family caregivers to make embrace the feelings and continue in life. In addition to this, the chronic sorrow, ambiguous grief as well as disenfranchised grief are some of the possible outcomes, which also involve the distinction between the illness and the person.

The final phase in the career of the family caregivers is the acceptance phase; in this phase, the caregivers tend to draw a line, which separates the ill person from the caregivers. The reason behind this is that the family caregivers tend to realise that this might have an adverse impact on their personal life as well as the other people of the family. Therefore, draws a line between the personal with illness and self. As in the words of Karp (2001) in the final phase, the family caregivers acceptance tends to become emotionally wrenching while on the other hand, also influencing the personal suffering from illness. In this context, Calvocoressi (2001) added that the separation by the family caregivers is mainly influenced by the strong sense of the importance of their lives for both themselves as well as for other members of the family. The final stage also enables the family caregivers to reduce the feeling of hatred while on the other hand, also enable the person suffering from the illness to accept the fate. However, Drake et al. (2001) stated that the family caregivers can bring mental peace through acceptance of the fact that their efforts could not solve the health of the person while on the other hand, maintain a strong sense of personal identity and wellbeing.

Conclusion:

Thus, from the above analysis, it becomes clear that providing care to mental health patients is not an easy task as it tends to create role distress, role strain and also questions on family roles in providing care to a family member suffering from mental illness. The analysis also makes it clear that while giving care to a mentally ill family member, family members are neither given recognition nor they are given with physical or mental health wellbeing. Eventually, they become the victim of role strain and role stress. However, as everything has a solution, the four phase’s method by David Karp shows the ways by which it is possible to deal with mentally ill patients.

References:

Calvocoressi, L., 2001. The Burden of Sympathy: How Families Cope with Mental Illness. The Journal of Nervous and Mental Disease, 189(11), pp.800-801.

Drake, R.E., Goldman, H.H., Leff, H.S., Lehman, A.F., Dixon, L., Mueser, K.T. and Torrey, W.C., 2001. Implementing evidence-based practices in routine mental health service settings. Psychiatric services.

Fine, M and Glendinning, C 2005, ‘Dependence, independence or interdependence? Revisiting concepts of "care" and "dependency"', Ageing and Society, vol. 25, no. 4, pp. 601-621.

Giovannetti, A.M., Leonardi, M., Pagani, M., Sattin, D. and Raggi, A., 2013. Burden of caregivers of patients in vegetative state and minimally conscious state. Acta Neurologica Scandinavica, 127(1), pp.10-18.

Harden, J 2005, ‘Parenting a person with mental health problems: temporal disruption and reconstruction’, Sociology of Health & Illness, vol. 27, no. 3, pp. 351-371.

Karp, D 2001, The burden of sympathy: how families cope with mental illness, Oxford University Press, Oxford & New York.

Knapp, M., McDaid, D. and Mossialos, E., 2006. Mental health policy and practice across Europe. McGraw-Hill Education (UK).

Kohn, R., Saxena, S., Levav, I. and Saraceno, B., 2004. The treatment gap in mental health care. Bulletin of the World health Organization, 82(11), pp.858-866.

Lester, H and Glasby, J 2010, Mental health policy and practice, Palgrave Macmillan, Basingstoke, Hampshire.

Mayberry, L.S. and Heflinger, C.A., 2013. How caregivers make meaning of child mental health problems: Toward understanding caregiver strain and help seeking. Families in Society: The Journal of Contemporary Social Services,94(2), pp.105-113.

Norcross, J.C., Beutler, L.E. and Levant, R.F., 2006. Evidence-based practices in mental health: Debate and dialogue on the fundamental questions. American Psychological Association.

Perry, B.L. and Pescosolido, B.A., 2015. Social network activation: the role of health discussion partners in recovery from mental illness. Social Science & Medicine, 125, pp.116-128.

Richardson, M, Cobham, V, McDermott, B and Murray, J 2013, ‘Youth mental illness and the family: parents’ loss and grief’, Journal of Child and Family Studies, vol. 22, no. 5, pp. 719-736.

Young, J, Bailey, G, and Rycroft, P 2004, Family grief and mental health: a systemic, contextual and compassionate analysis, Australian and New Zealand Journal of Family Therapy, vol. 25, no. 4, pp. 188-197.