HD 301: Unit 4 Mental Illness. Slide #1. Mental Illness in Families. Unit 4 HD 301 Rodgers

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1 HD 301: Unit 4 Mental Illness Slide #1 Mental Illness in Families Unit 4 HD 301 Rodgers This lecture is mental health and illness in families. In this lecture you will be presented with several different, yet related models or approaches that are used to understand mental illness. One of those theories is Family Stress Theory. We ll also talk about family oriented studies that use biopsychosocial models, which can include stress and examine things such as genetic links, family environment, and genetic and family environment interactions. These different models help explain different aspects of a disorder. They can be used for different applications, for example, for family therapy, or for medical treatment. Slide #2 Mental Illness and Family Stress Theory C Family s Perceptions & definitions of members illness A X Family member s The degree of stress mental illness (low to high) B Available Resources (family strengths, community resources) As you can see on the screen here the Family Stress Theory is now being applied to mental illness in families. A is the family member s mental illness. The B factor, are the available resources that may contribute to understanding or dealing with this illness, for example the families strengths, or community resources. C refers again to the family s perception or definition of the member s illness. And then X refers to the degree of stress, either low to high degree of stress that the family members are experiencing around one member s mental illness. Again remember that Family Stress theory is a systemic theory, it s a systems theory and so there is the interaction of these factors with the family member s mental illness and that is represented by the lines that connect each of these components. Page 1 of 7

2 Let s talk about what moderating factors are that have been identified with mental illness. Now these moderating factors listed on your screen are really important to consider, but we also have to remember that they re generally things that we can t change. So they are considered social addressed variables. They re good to know for policy and where to target efforts, but they re not things we can easily change. So we are going to start here with these moderating factors and then look at some of the other. The first moderating factor is Gender. Women as opposed to men are more likely to experience affective disorders such as internalizing disorders: depression, anxiety; and women tend to utilize health care systems and outpatient services more than men. By comparison, men tend to have externalizing disorders, and these are things such as substance abuse, antisocial personality disorders. Disorders that we can actually see typically, and that s when we think about externalizing. That they re behaviors that are often observed, as opposed to internalizing which are more internal to one s psyche. Slide #3 Moderating Factors Gender Women more likely to experience affective disorders (internalizing) Tend to utilize health care system/outpatient services Men Tend to have externalizing disorders (substance abuse, antisocial personality disorders) More often seek inpatient care Age Highest rates of mental illness found in ages years 9% - 13% of children and adolescents have emotional disturbances Suicide is third leading cause of death for year olds Ethnicity Mental illness is overrepresented in high-need ethnic minority groups Access to and use of community services is lower compared with Caucasians Lack of insurance? Stigma? Lack of ethnic minority counselors? Men are more likely than women to seek inpatient care. Age is another moderating factor. The highest rates of mental illness are found in individuals between the ages years. 9-13% estimates suggest of children and adolescents have emotional disturbances. Suicide is the third leading cause of death for year olds. So as you can see, clearly there is a proportion of mental illness that occurs for children and adolescents, and it appears that the adolescent years into the early adult years are perhaps the highest risk years for mental illness. Ethnicity in a third moderating factor. Mental illness is overrepresented in high need ethnic Page 2 of 7

3 minority groups. Access to and use of community services is lower among ethnic minority groups than Caucasians. This might be because of a lack of insurance. Perhaps stigma might also be associated with this, the stigma of using counseling, using services. But a third factor that might contribute to this over representation is that there may be a lack of ethnic minority counselors. Counselors who can treat individuals with a culturally specific orientation. Now family oriented studies are studies of the etiology of mental illness that utilize a biopsychosocial model. In such models the family oriented studies perceive family relations as part of the mental illness. Slide #4 Family-oriented Studies Studies of the etiology of mental illness utilize a bio-psychosocial model Family relations are perceived as part of the mental illness Genetic predisposition Family history of disease is related to increased vulnerability of schizophrenia in early adulthood Twin/adoption studies suggest a genetic link for illnesses like mood disorder, autism, substance abuse, personality disorders Less blaming of family than in the 1980 s Genetic predisposition such as family history of a disease is related to increased vulnerability of schizophrenia in early adulthood. This is in an example of how the family genetics can actually be part of and included in understanding the illness. Some twin adoption studies suggest a genetic link for illness like mood disorder, autism, substance abuse, or personality disorders. Now fortunately because of family oriented studies or perhaps as a result of the understanding of mental illness, there has been less blame placed on the families than in the 1980s. In early years in the 80s it was likely that the understanding of mental illness was because parents didn t do something right. And we don t see that as much fortunately but rather understanding because coming from a biopsychosocial model, understanding that there are biological components, they re psychological components, and there s social components of interactions that all contribute to mental illness, or can contribute to mental illness. Slide #5 Family Environment Research Factors related to development of mental disorders Family stressors Conflict, support, relationship quality Maternal physical and mental health Divorce Parental death Daily stressors/hassles Page 3 of 7

4 Now if we think about family environment research there are a couple factors related to the development of mental disorders. I am going to go through those right now. The first is family stressors. One example is that research indicates that adolescent depressive symptomology has been associated with two or more stressors six years later. So looking at family stressor at one time, and when there were two or more of those, that predicted six years later that an adolescent would experience this symptomology. Conflict support and relationship quality in the family is another factor that s associated with mental disorders. In families that have low family support in which conflict is high, in which relationship quality is low, there is a greater risk for mental disorder. Maternal physical and mental health is associated with mental disorders. Divorce, parental death, and daily stressors or hassles are also factors that have been associated with higher risk for a mental disorder to occur. This is not to say that one who experiences these factors, or has these factors in their lives, will definitely have a mental disorder; but it certainly increases the risk. Slide #6 Expressed Emotion EE is relevant to family members perception ( C ) of the mental illness The level of emotional over-involvement among family members The degree to which family members display critical attitudes toward and/or make hostile comments about person with mental illness In research with families that has looked at processes that are going on in families, one of the things that has been noted is what is called expressed emotion or EE. EE is relevant to the family member s perception of a mental illness. The level of emotional over involvement among family members is part of EE, and the degree to which family members display critical attitudes towards the person who has the mental illness, or makes hostile or critical comments about the person with the mental illness, are ways that EE is measured or identified. Slide #7 Research on Schizophrenic Child Relation with family communication patterns EE = Expressed emotion High EE parents attributed abnormal behavior to the mentally ill person s character, see it as something they can control and change Low EE parents See abnormal behavior as not in the person s control; as a result of the illness itself. EE may be bidirectional CD = communication deviance Fragmented erratic, disruptive, awkward Page 4 of 7

5 Amorphous vague, confused, intrusive Is higher in families with schizophrenic child Researchers who have looked at schizophrenia in childhood have used the idea of EE or expressed emotions to begin to understand how family processes or this perception about the child verses the illness, may contribute to that child s illness and recovery. The relation of family communication patterns then is examined looking at EE. High EE parents are those that attribute the abnormal behavior to the mentally ill person s character in other words parents in studies on schizophrenic children who saw the behavior of the schizophrenia as something that the child could control were identified as high EE parents. They were more likely to target the child and be angry about the child not being able to control their behaviors. So they made negative and critical comments. Low EE parents were more likely to see the abnormal behaviors of their child associated with the schizophrenia as not in the person s control, but rather as a result of the illness itself. So these parents were less critical or less hostile towards the child or critical about the illness itself. So low EE parents were able to separate the child from the illness, and in this way this was a more positive kind of way that they were able to express their emotion around. They could separate out being frustrated maybe about the illness but not frustrated at the child themselves. CD refers to communication deviance. In families with a child who has schizophrenia researcher have found that the communication deviance is either fragmented or amorphous. Fragmented conversations were those that were eradicate, disruptive, or awkward. So if you were observing this family you wouldn t really see them having a flowing conversation where somebody says something and then it s responded to, but rather they re stifled and it s sort of static. Amorphous communication was another form of communication deviance in that the communication was vague or maybe confused. You couldn t quite track what was going on. Or intrusive, that there again was a lack of flow, and researchers have observed that either one of these kinds of communication deviances are higher in families with a schizophrenic child. Slide #8 Vulnerability-Stress Model Examines link between heredity and environment Assesses Family Strengths (resiliency factors) Family support Family bonding Insight and caring competence Empowerment through advocacy (of health care system) Identifies subjective and objective burdens associated with mental illness Subjective perceptions of illness Objective measurable, concrete burdens associated with illness Page 5 of 7

6 Now the Vulnerability-Stress Model examines the link between heredity and the environment. And this assesses family strengths, or resiliency factors. Such as family support, family bonding, the insight of the family members about the illness itself, and their competence in being able to care for the person who is mentally ill. And also assesses empowerment through advocacy of the health care system. The Vulnerability-Stress Model identifies both subjective and objective burdens that are associated with mental illness. For example subjective burdens are those that refer to the perceptions about the illness itself. So subjective are those perceptions of the illness. And objective burdens are those that are very measurable, the concrete burdens that are associated with the illness. For example if you have a member of a family who (he or she) is a primary bread winner, if they become mentally ill and they can no longer work, they re incapacitated; then an objective burden then would be that lack of income that is associated with their mental illness. It s very measurable, it s very concrete. If you think about again some those objective burdens such as the cost of mental health care, that s very measurable, it s very concrete, and it certainly can be very burdensome for families. So these are factors that contribute to the stress of the family who has a mentally ill individual. Let me talk a little bit more about some of the subjective burdens as well. Perhaps the most severe subjective burden is the social stigma that comes with mental illness. Being embarrassed about a family member s illness for example because of the social stigma is a subjective burden. The social stigma is really created by misperceptions and stereotypes about mental illness, and unfortunately they re often promoted by media. Healthcare professionals might also hold misperceptions or biases that contribute to social stigma. Clearly these are some forms of subjective burden. Psychological burdens that are associated with that social stigma include a decreased self esteem, decreased social contact, or even family relational problems that result from that. So one may feel a lower sense of self because they have this mental illness. Or also because maybe they re in a family that has high EE, that message may be sent to them through family members. Slide #9 Resources (B) Psycho-education: Focus is on Education about illness Learning coping skills Social support Non-blaming approach Encourages active learning by family members Goal is prevention of relapse as well as reducing pain and suffering of family Internet resources Page 6 of 7

7 Now if we go back to our Family Stress Theory and think about resources, we can begin to think about the B factor (Available Resources). Past therapy has focused on changing the family and using a blame perspective as I mentioned earlier. And this generally was not useful from a family resiliency perspective. More common now is what is called the psycho-education approach. This psycho-education focus or approach is really focused on educating family members, both the person who has the mental illness, as well as those who are in the family context and support them about the illness. The idea is educating these family members about the illness will help them separate the illness from the individual and ultimately have lower EE. Another part of psycho-education is its focus on learning specific coping skills. So learning what are the triggers or stresses that can make that mental illness worse/work. And then putting into action those skills that reduce those triggers. Finally the third part of psycho-education is the social support aspect. Psycho-education focuses and takes a non blaming approach, and it encourages the family to be active members in their handling of the mental illness in their family, because clearly it takes a very systemic approach. That the illness is not just one person but the whole family is affected. So there is a strong emphasis to encourage family members to learn as much as they can about an illness so that they can feel empowered. They can be in control of their actions and know what they can control and what they can t control. So if we think about this, when individuals know what they can be in control of and what they can t be in control of, then they re going to be less stressed. One of the goals of psycho-education then is the prevention of relapse as well as reducing the pain and suffering of families. The idea here is that if one can prevent relapse of mental illness then families won t have recovering pain and suffering and anxiety or anxiousness, or even ambiguous loss around that mental illness. Research finds that the success of psycho-education is pretty positive with the treatment of schizophrenia, depression, bipolar disorders, and mood disorders. Now internet resources are fairly new but they can provide a lot of support for individuals who are caretakers of a family member with a mental illness. One of those resources that I encourage you to look at is The National Institutes of Health, and it has numerous pages and links with information about disorders and support groups and ways that individuals can find support and help if they have a family member with a mental illness. Page 7 of 7