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Running Head: Mental Illness and Family Functioning

 

 

Mental Illness and Family Functioning

Jessica M. Yoakum

Park University

 

 

Abstract

Mental Illness affects family function by providing obstacles and stress to the family system.  Mental illness also increases the family burden within the family social system.  Family functioning influences the sense of competence and the adaptation level of a mentally ill family member.  The roles of parents of children with a mental illness as well as adult children of parents with insight into role reversal within a family unit that mental illness causes.  Immigration to the United States has caused an increase in mental illness among minorities and therefore many psychiatric symptoms are being overlooked because of cultural differences.  Recent trends have shown that mental illness is on the rise and mental health disability is increasing faster than disability attributed to other chronic illnesses.  Many public health policies have been formed since the late 1800s in providing individuals with mental health services.  Newer policies are still developing to help accommodate those individuals who are in need of care and for individuals whose care has stalled.

 

Mental Illness and Family Functioning

          The effects that mental illness has on family functioning provide added obstacles and stress it is shown that cases of mental illness are on the rise.  These changes are predicted to keep rising due to those who are in much need of mental healthcare who also fall within the poverty level.  Assistance is needed to aid in the recovery of mental illness within individuals.  Other countries and cultures also deal with mental illness issues, so why isn’t their mental illness cases staying at the same rate or not growing as rapidly as the United State?  In Mexico, people believe mental illness is best-taken care of with the family unit or through spiritual guidance.  This shows the difference between the thought processes of Individualized countries such as the United States and Collectivist cultures such as Mexico.  Therefore families with mentally ill members do not function as easily as families who do not have a mental illness.to the family system.  A high percentage of people living within a low socioeconomic status, having a low education level and a high history of mental illness in one’s family is at a higher risk to develop a mental illness themselves.  Due to current economic situations between 2007-2009

 

Family with Members Having a Mental Illness 

          Mental illness and its burden affect the family unit as a whole.  Mental illness is usually first seen in the family and the family is usually the one who makes the decision on what type of treatment is needed. An increase in burden is placed upon family members when dealing with a mentally ill family member.  The term family burden is used colloquially to characterize the load, carrying capacity, and strain experienced by family members as individuals and as members of a social system (Gubman & Tessler, 1987).  Deinstitutionalization has increased the family’s role for the care and support for disabled family members, therefore, the family is seen as the ultimate form of rehabilitation for its mentally ill members.  Negative behavior from members who are mentally ill affects the family routine.  Arguments, withdrawal, lack of communication, bizarre behavior, and threats of harming one’s self or others is a cause for concern because family members are not specially trained in dealing with such behavior and are emotionally involved which causes a reaction that sometimes escalates the behavior.  Family members who deal with behavioral disturbances have a way of adapting to them and when asked about the mentally ill person’s progress.  One might deny the extent of the patient’s illness in a way to make it go away or over-exaggerate because of feelings of frustration.  It is very difficult to relate to the demands of caring for, living with, and/or relating to an emotionally disturbed family member and emotional responses typified by worry, anxiety, depression, and guilt

          Family functioning influences the sense of competence in getting the mentally ill family member to seek treatment.  In being that the family is the motivator many variables negative and positive have been seen due to their actions towards the ill family member.  High levels of negative expressed emotions correlate to the patient's relapse.  Too much stimulus such as arguments or the effects of the mental illness causes complex decision making.  Complex decision making needs a neutral environment where the mentally ill person can learn and initiate strategies in dealing with situations.  On the other hand, the family’s involvement and commitment have been seen as extremely important in getting the patient connected to mental health programs, encouraging medication compliance, and maintaining a supportive environment for the patient (Johnson, 1998)on the adaptation level of a mentally ill family member.  There is relatively little empirical evidence that identifies particular family strengths which can aid in coping with a chronic disability like mental illness (Johnson, 1998)  The family has been seen as a motivator

          The ill members level adaptation and the family functioning member who educate themselves about the overall definition of the ill member's disorder will be better prepared in aiding in the decision making process about treatment and provides motivation for the ill family member to increase their self-confidence in living with and treating their illness.  The use of both psych educational and psychotherapeutic approaches, in the individual family and multi-family settings, offer significant opportunities for increasing the family members’ sense of competence (Johnson, 1998) in managing the problem and burden of mental illness correlates with their self-competence.  

 

Family Relationships

          When a couple plans to have a baby they think about the child will up and become.  Parents guide their children throughout their transitions between stages in life and this time is used to initiate and strengthen the bond between parent and child.  When these stages are not accomplished on time that is socially expected because of mental illness it changes the parents’ life course.  Repeated hospitalizations, and dealing with symptoms such as paranoia, depression, and hallucinations, make it difficult for the ill individual to finish college, live independently, and have intimate relationships with others: the illness hinders successful completion of expected life tasks mastered by same-age peers (Pickett, Greenley & Greenberg, 1995).  Personal feelings of worry about the mentally ill child’s well-being as well as the stigma they live with providing the parent with a sense of loss whom they will take after, what name they will give the child and who

           In the article, Off- of loss, fear, and stigma were measured.  It was found that off-tiredness was significantly related to loss, fear, and stigma.  Parents who provided more care for their children showed higher levels of loss, fear, and stigma.  Older parents showed lower levels and in contrast younger parents showed higher levels.  Parents with higher education levels were more likely to view their child as being off-time as well as less stigmatized due to having a better understanding of the illness.  As life-span studies have shown, parents remain physically and emotionally connected to their children and are concerned with their offspring’s’ successful navigation of the life course (Pickett, Greenley & Greenberg, 1995)  Mental illness affects the timeliness of certain life goals putting higher amounts of stress on the family, therefore, affecting its functioning.   Timeliness as a contributor to subjective burdens for parents of offspring with severe mental illness (Pickett, Greenley & Greenberg, 1995), family members who were considered to have the most/closest to the mentally ill child were asked on a 4-point scale about the functioning of the child and achievement so far.  57% of the children were sons and 43% were daughters.  The off-timedness

         Role reversal has been seen between parents and children within caregiving of the person with mental illness.  Instead of children filling the mentally ill role the other side of children of parents with a serious mental illness has shown to create a cycle of mental illness.  In adulthood, up to two-thirds of these children experience psychosocial and/or mental disorders, although approximately one-third appear to develop into confident and competent adults who may be considered resilient (Foster, 2010).   As small children, these adult children experienced a chaotic family life which often turned into abuse or neglect from the parent during certain times of distress or episodes.  Episodes are defined as periods of neurotic behavior which at times can turn into psychotic behavior.  As adults, these adult children experience high levels of taking care of their ill parent.  The worry about the future as well as the burden of caregiving for the parent’s illness puts stress on the family in part because the adult child may have a family of their own. 

          Feelings of being certain, struggling to connect, being responsible, and seeking balance are repeated routinely around the mental state of the ill parent.  As a young child with each new day come feelings of not knowing what is to expect from the mental state of their ill parent.  Not knowing the parent has a mental illness leads the child to believe the parent’s behavior is just a part of their personality but also leaves them with a feeling of knowing something is not right.  Throughout adolescence, there is usually difficulty connecting with parents emotionally mainly because the ill parents’ emotional state was in a constant state of change.  Many children grow up too fast because of the added responsibility of taking on some of the parent’s role during illness.  Many children assume protective and/or caring roles for siblings and sometimes take on a parental role (Foster, 2010).  Caretaking responsibilities often continue into adulthood and often become demanding of the adult child’s time and emotional energy.  Strategies of seeking a balance in adulthood are needed for these adult children to cope with the burden of a mentally ill parent as well as the adult child’s mental well-being.  These adult children are at a higher risk for substance abuse problems and mental illness themselves.  Whether or not to have children is a sometimes difficult decision because the thought of passing the vulnerability of having a mental illness genetically to one’s child could cause the cycle to be reborn.  Throughout all difficult choices, these adult children make their main concern is being different from their ill parent (Foster, 2010).

 

Minorities and Mental Illness

          The United States formed as a series of mass immigration and with this came a mix of several different racial backgrounds and religions.  The development of systems of caste and class-stratified by racial and ethnic statuses has been a central theme of its history, shaped over many generations by the European conquest of indigenous peoples by the massive waves of both coerced and non-coerced immigration from all over the world (Vega & Rumbaut, 1991).  The mental health status of these immigrants has not been emphasized as much due to the fact of not being able to completely understand their lifestyle before then after immigration.  Many cultures see mental illness as part of life and have not put such great emphasis as the United States.

          Latin migration to the United States has been and still is on the rise.  During the 1980s a total of six million immigrants and refugees were legally admitted into the United States, nearly half from Asian countries and the bulk of the rest from Latin America (Vega & Rumbaut, 1991).  In 2006 the largest minority group was the Hispanic population with approximately 28 million people with seven million of the Mexican population resides in Texas.  These statistics do not measure illegal immigrants coming from Mexico which would probably add to the Latin population.    

          The reason for illegal immigration into the United States as well as their current living situations may place individuals at a higher risk to experience a mental illness.  The term “mental health” was originally intended to reflect psychological well-being and resilience (Vega & Rumbaut, 1991).  Minority mental health has not been studied into great detail and minorities are often not represented in studies, therefore, populations are being grouped together and cultural factors such as perception, recognition, and overall psychiatric symptoms are being overlooked. Also, many Mexican immigrants are from low socioeconomic backgrounds and suffer much psychological distress due to living conditions. 

          Depression is one of the most diagnosed mental illnesses that is most often a side effect of a much more serious mental illness.  The Mexican American population differs in many dimensions including birthplace, acculturation, genetics and race, healthcare access and usage, and language fluency which may influence treatment preferences (Martinez, 2008).  The Mexican culture doesn’t tend to stick to the use of antipsychotics and antidepressants and Mexican’s with mental illness tend to self-medicate rather than seek help for their symptoms.  The reason for not seeking medical help is due to the complexity of social and cultural factors.  Some of these include language barriers, lack of mental health service access, the utilization of general physicians rather than mental health specialists, and the self-esteem reduction experienced when interacting with professionals (Martinez, 2008). 

          The social reason for not seeking medical help is because seeking help would be the individual openly admitting they are suffering from a mental illness which then they would be considered weak or stigmatized as crazy.  This is due to the fact that private matters stay private and seeking help from outside one’s self or the family is a sign of disrespect.  Depression is also seen as something that one can control in the presence of others and before it gets too serious not thinking that there could be a more serious form of mental illness forming.  The notion of face-saving is widely apparent in collectivist cultures such as Mexico, in which the well-being of the group over the individual is of utmost importance (Martinez, 2008). 

           Spiritual guidance is the main resource that is used in the treatment of depression by the Mexican culture when the illness becomes serious.  Since dealing with one’s problems within one’s self this is the most respected form of treatment because it is based on the faith to get well.  The belief is being able to build a relationship with God and keeping a positive mindset will help your mind to gain strength and help you overcome difficult times.  Many Mexicans who have sought medical treatment independently but did not see results have also turned to faith as their ultimate resource.  Most cases of Mexican Americans seeking medical care is sought after or during emergency room visits when the mentally ill family member has attempted suicide.  Most members who do seek help are usually accompanied by other family members.

 

Trends and Mental Health Policy

     Mental illness has increased therefore affecting more families and the way they function.  One study found no change in the prevalence of the common mental disorders in the United States between the early whereas another study found an increase in the prevalence of depression during this time (Mojtabai, 2011).  Currently, US Supplemental Security Income and Social Security Disability insurance have shown a significant increase of 2 million adults receiving disability due to mental illness between the years 2007-2009.  The economic downturn has been a contributor to these statistics as well as persons who are already on disability due to other chronic health problems.  Young and middle-aged women have had a significant increase in depression.  Within this group, a subgroup of Hispanic women studied showed they do not respond as well to treatment as do other subgroups.  This indicates their levels of mental illness are higher than other subgroups and are still on the rise. 1990’s and the early 2000’s

          In the study, National Trends in Mental Disability, 1997-2009 (Mojtabai, 2011), adults between the ages of 18-64 were surveyed on a 4-point scale to assess their difficulty and ability to perform to afford insurance was also assessed.  The assessment lasted 12 months with participants who were receiving treatment at the beginning of the study.  It was found that within this 12 month period many were not able to afford treatment when needed.  Also, it was found after not receiving treatment for their illness after a 12 month period their illness had progressed.  It was also found that most of the participants surveyed were also suffering from another form of illness which also qualified them for disability.  Disability attributed to other chronic conditions did not change appreciably from 1997-1999 (19.7%) to 2007-2009 (19.8%).  However, based on population estimates for US adults aged 18-24, there has been an increase of approximately 2 million adults with mental health disability in this time period from approximately 3.2 million to 5.2 million (Mojtabai, 2011).  Socioeconomic changes and greater rates of recognition has most likely attributed to these increases in mental health disability an everyday task.  Demographics and ability

          As the rate of mental illness has increased so has the need for services for the aid of prevention and treatment.  There has been an increase in the pressure of resources that needs policies to allocate them.  Serious mental illness is a term used in federal regulations that defines some 5.4 percent of the U.S. adult population with a mental disorder that interferes with at least one area of social functioning (Goldman & Grob, 2006). 

          The first form of health policy that was created by the government was the State Care Act which transferred the responsibility for the care of people with mental disorders to the state (Goldman & Grob, 2006).  The State Care Act aided in the building of asylums and care was also paid for by the government.  Due to the influence of these programs the definition of mental illness could be redefined to help in the cost of such programs.  It wasn’t until The Joint Commission on Mental Illness and Health was created did commissioners start to focus on mental health problems and prevention.  Then in 1977 when Jimmy Carter was elected president he created a President's Commission on Mental Health which included recommendations in the treatment of individuals with severe mental illness.  It also created programs for children and minorities to help aid in the treatment and prevention of mental disorders.  The latest development in mental health treatment was the Federal Mental Health Systems Parity Act created in 1998 and still effective today.  It focused on insurance protection, in that it mandated parity with respect to annual and lifetime limits only (Goldman & Grob, 2006).  Newer mental health policies are under investigation to help with changing status due to the outside and new findings in biological data which has increased the chances for one to develop a mental illness.  In the future these and newer policies will be able to help those most in need and recovery for individuals who care has stalled. 

           Mental Illness increases the family burden within the family social system.  65% of psychiatric patients discharged from public and private hospitals returning to live in family residences (Gubman & Tessler, 1987).  The way a family functions correlates with the individual’s self-competence.  Role reversal has been seen between parents and children within caregiving of the person with mental illness.  These role reversals cause children to grow up and become dependent on themselves for everyday survival at an early age.  Ethnic minorities such as immigrants show lower rates of mental illness such as depression as compared to the second generation of immigrants born within the United States.  Treatment of mental illness has been a controversial subject since the late 1800’s when the first State Care Acts transferred responsibility for the care of people with severe mental disorders to the state.  With state involvement, arose programs that helped the mentally ill in gaining the care needed to overcome and better acclimate to life situations.  There has been an increase of 2 million adults who have become disabled due to mental disorders from 2007-2009.  Mental illness has increased therefore affecting more families and the way they function. 

           

 

 

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