Aging with a severe mental illness: challenges and treatments

Severe mental illness (SMI) impacts many different facets of individuals' lives. As they age, those with SMI experience increased physical illnesses, functional impairment, cognitive deficits, and social disability. To promote more effective social work practice with this population, this article highlights the major biopsychosocial and family issues of aging with a psychiatric diagnosis. In addition, intervention approaches that have demonstrated efficacy are summarized along with ways to coordinate services across multiple service delivery sectors. Finally, future directions in practice and research are presented to develop additional methods of support for older adults with SMI and their families.     

‘Not a good person’: family stigma of mental illness from the perspectives of young siblings

The purpose of this paper is to critically examine family stigma as one form of the stigma of mental illness in child and youth mental health. Presented are the outcomes of a thematic content analysis of in‐depth, semi‐structured interviews conducted with seven (n = 7) young siblings, ages 13 to 21 years old, with a brother or sister identified as having a mental‐health issue. The focus of the interviews was on the ways the siblings experienced their other sibling's mental health and how those experiences shaped their sense of self and family. From the analysis, young siblings had predominately negative experiences, struggled with making sense of their brother or sister and the family as ‘flawed’ against the mental illness as ‘bad’ and experienced considerable family stress and overt family stigma. Current practice theories fail to consider the complexity of these factors and, in doing so, fail to adequately explain the nature and extent to which stigmatization occurs for immediate family members. The importance of peer support and understanding stigma in social work practice with children and their families is discussed.     

Aging With a Severe Mental Illness: Challenges and Treatments

Severe mental illness (SMI) impacts many different facets of individuals' lives. As they age, those with SMI experience increased physical illnesses, functional impairment, cognitive deficits, and social disability. To promote more effective social work practice with this population, this article highlights the major biopsychosocial and family issues of aging with a psychiatric diagnosis. In addition, intervention approaches that have demonstrated efficacy are summarized along with ways to coordinate services across multiple service delivery sectors. Finally, future directions in practice and research are presented to develop additional methods of support for older adults with SMI and their families.     

The Role of the Facilitator in Support Group Development

Support groups for family members of persons with mental illness have become common in the past fifteen years. Much has been written about appropriate formats and content for such groups, and research indicates that persons who participate in them frequently receive important benefits. However, less has been written about the process of effectively recruiting members for groups. Family members, for various reasons, are often reluctant to take the step of joining a support group. In this paper, the authors report their experience in organizing a support group for siblings and adult children of persons with mental illness. The role of the facilitator is highlighted, which was found to be essential in helping interested but ambivalent prospective members eventually join the group.     

Practice challenges at the intersection of child protection and mental health

This paper examines the complexity of collaboration between child protection and mental health services, where a parent has a mental illness and there are protection concerns for children. The paper reports on data from focused in‐depth interviews with 36 child protection workers, adult mental health workers and child and youth mental health workers. Data were analysed thematically, using NVivo to facilitate data management and analysis. Two dimensions were identified. The first, the process of collaboration, relates to four factors that assisted the collaborative process: communication, knowledge, role clarity and resources. The second dimension considers the challenges presented to collaborative work when a parent has a mental illness and a child is in need of protection, and identifies issues that are inherent in cases of this kind. Two types of challenge were identified. The first related to characteristics of mental illness, and included the episodic and/or unpredictable nature of mental illness, incorporating information from psychiatric and parenting capacity assessments, and the provision of ongoing support. The second type of challenge concerned the tension between the conflicting needs of parents and their children, and how this was viewed from both the adult mental health and the child protection perspective. Implications for policy and practice are identified in relation to the need for service models that provide ongoing, flexible support that can be intensified or held back as needed.     

Caregiving for Parents and In-Laws: Commonalities and Differences

This study examined support, stress, and well-being between adults who provide care for an aging and disabled parent and those who care for an aging and disabled parent-in-law. The study utilized a sample of individuals caring for a parent (n?=?77), individuals caring for an in-law (n?=?26) and a comparison group of noncaregivers (n?=?1,939) from the Midlife Development in the United States study. In-law caregivers provided more financial assistance but adult child caregivers provided more emotional support and unpaid work. Adult child caregivers reported poorer mental health and family strain; in-law caregivers reported more spouse support and less family strain.     

A Natural Locally-Based Networking Approach for Singleton Disabled Elderly: Implementation and Case Illustration

Correspondence to Dr. Yip Kam-shing, Associate Professor, Department of Applied Social Studies, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong. E-mail: SSKSYIP{at}POLYU.EDU.HK Summary Hong Kong is a high industralized and commercialized city-sizedregion. Within such a business-orientated and competitive lifestyle,the elderly usually are the ones who have poor social supportand social networks. Many singleton elderly lead lonely liveswithin the community. The Good Neighbour Centre of the UnitedChristian Nethersole Community Health Service in Hong Kong hasimplemented a natural locality-based supportive networking approachfor disabled singleton elderly in a public estate (1991-2000).As part of this approach, various psycho-social interventionswere developed over nine years to strengthen mutual supportamong neighbours, able-bodied elderly, outpatients sufferingfrom mental illness and volunteers who were matched and integratedwith the disabled singleton elderly person to form a locality-basednaturally supporting community. Different stages of developinga natural, supportive community by networking were identifiedin this project: network assessment, network matching, networkformation and network strengthening. The concepts of stableand constant mutual support, mutual development and mutual concernwere stressed. Feedback from stakeholders was encouraging andthe demonstrated improvement in the functional and psycho-socialwell-being of disabled singleton elderly and mental health outpatientswas impressive and clear. Also, according to the principlesof the strengths perspective, the approach was strength oriented,that is it cultivated the potential strengths within a locally-basedcommunity: challenging the care and concern of members withinthe community through the loneliness of singleton elderly; developingthe mutual support and nurturing new supportive resources withina locally-based community. Further research may help to consolidatethe effectiveness of this approach through new strategies.     

‘His mam,my dad,my girlfriend,loads of people used to bring him up’: the value of social support for (ex) offender fathers

This research analyses key findings from qualitative research conducted with (ex) offender fathers and their probation officers. This paper focuses on the critical role of family and social support for (ex) offender fathers who seek to build and maintain relationships with their children. The research reported in this paper shows that the men receive social support, both formal and informal from a wide ranging and complex network of family, friends and practitioners, which facilitates and enables their commitment to fathering. Drawing on social support theory, I argue that identification of support networks recognizes the productive possibilities of vulnerable families which constitute a source of strength and connection to be nurtured in contexts of adversity. This strengths‐based paradigm advocates the need to identify and facilitate family, friendship and professional networks in the context of social work with offenders and their families.     

The Diversification of Children’s Support for Their Parents in the Context of an Aging Society: Concepts and Behavior*

China’s aging society and the family-based model of basic aged care determine that children’s support for their parents directly affects the standard of living of the majority of the aging population. Existing theories indicate that in this era of social transition, the implications of filial piety have shifted from the traditional emphasis on the parent-child generational relationship and children’s duty to obey their parents to a dual mode in which family love coexists with the authority of the elders. Using data from the Chinese General Social Survey of 2006, we explore the ways in which the two basic dimensions of authoritarian filial piety and reciprocal filial piety connect with various types of filial behavior. The results of our multivariate linear model show that on average, authoritarian filial piety, which emphasizes authority relationships and children’s duty, increases children’s financial support for their parents, while reciprocal filial piety, stressing family love and generational equality, significantly increases children’s emotional support for their parents. A comparison of the basic dimensions of filial piety shows that neither significantly increases children’s physical support for their parents. Further analysis of the interaction effect indicates that the link between authoritarian filial piety and financial support is more significant among younger groups. In addition, for males, a marginally significant positive relation exists between authoritarian filial piety and physical support for their parents.     

Complex home care: challenges arising from the blurring of boundaries between family and professional care

Over the last 50 years, increasingly complex care (such as tracheostomy management, dialysis or enteral feeding) has shifted from hospital to home, with a concomitant rise in patient self-management and care given by family members. Recognition of the importance of the contribution of family care to the health system is also growing. This article reports the findings of a New Zealand study which explored the experiences of family carers who manage technical health procedures at home. It then draws attention to some broader issues raised by shifting complex care from professional management in hospital settings to family care at home, namely the ways in which complex home care blurs the boundaries between professional and family care (creating the ambiguous position of the expert carer) and questions of safety and responsibility in family care. We also discuss the implications for policy around family caregiving in New Zealand. Given the potential physical and mental health impacts of caring, it is time for renewed consideration of what family carers should be expected or allowed to manage and how the health system can support them in their important role.     

Mothering after child removal: Living under the rule of Greek gods

Many women who experience mental illness are mothers. Evidence suggests that the role of mother is of great importance and value to these women, yet they are more likely than other women to have their children removed from their care. Little is known about the experiences of these mothers after their children are removed. This paper presents a phenomenological analysis of in‐depth interviews with 8 women to answer the following question: How do mothers living with severe mental illness experience mothering after removal of their children by child protection services? The analysis showed that mothering continued to be a major life role for these women, but the way they enacted this role was transformed. Their mothering was now constrained and prescribed by external agents, likened to Greek gods, which imposed both boundaries to what they could do and an obligation to prove themselves worthy. Like Greek gods, these external agents were seen as all powerful, unpredictable, and flawed. The study highlights the need for child protection services and support services to recognize and support noncustodial mothering activities.     

Families on the move in China: challenges,strategies, and implications

We studied 12 migrant families who lived on the outskirts of Beijing, conducting participant observations and in-depth interviews between July 2008 and December 2009. Adopting the family strengths perspective, we identified the strategies employed by the migrant population to manage family life, the reliance on family networks for help and support, and their means of coping with the lack of equal access to state-provided benefits and services. We argue that migrants and their families should not be the target of policy or practice interventions – despite the unequal treatment, they cope with various difficulties, survive the migration process and succeed in adjustment and adaptation to the migrant life – rather, the divisive hukou system and the associated unequal distribution of benefits and services require fundamental reform.     

优势视角:残疾人工作的新视角

在残疾人工作方面,存在着两种不同的工作视角,一种是问题视角也称之为缺陷视角,它是以问题为核心,强调将关注点聚焦在残疾人所面临的问题和困难上;另一种则是关注于挖掘残疾人优势的优势视角。优势视角及其工作模式,是当前推进残疾人工作的更为合理的视角和模式。     

Impact of a multicomponent support services program on informal caregivers of adults aging with disabilities

A multicomponent support services program was implemented for veterans aging with disabilities and their informal caregivers (n = 42 dyads). Caregiver outcomes (satisfaction, physical and mental health status, burden, and benefits) were evaluated before and after program use. Caregivers reported significant improvements in mental health post-program. Caregivers who provided care to individuals with impaired physical health experienced meaningful improvements in burden after the support services were rendered. Supporting caregiver health status through such programs is vital to preserve noninstitutional long-term care for persons aging with disabilities, particularly when care is provided over many years to an individual with physical impairments.     

A family support service for homeless children and parents: user and staff perspectives

Children and their parents who become homeless constitute a group of families with a complex range of social care and health needs, including mental health difficulties. In response to this, a local authority housing department established a family support team (FST) that provides assessment and detection of a range of problems, support to parents and children, parenting interventions for child behavioural problems, liaison with other agencies, and referral to specialist services when appropriate. The aim of this study was to establish the perceptions of parents and staff on their experience of the service, and ways of improving it in the future. The study adopted a developmental evaluation approach and used multiple methods, including in‐depth interviews with families; diaries; reflective activities; participatory learning and action; and observation of the FST. The study mapped the innovative service and captured the range of skills in the team and the complexity of agencies the team interacted with. It also identified areas for further development in terms of the mental health needs of children and parents who have become homeless.     

Toward Empowerment: ReVisioning Family Support Groups

ABSTRACT

Family support groups (FSG) have been recognized as an important and viable means for responding to the needs of family caregivers. How these groups work, however, is not well understood. The purpose of this qualitative exploratory study was to explore the impact of attending a family support group on the caregiving experience from the perspective of the family member. Personal, semi-structured interviews took place with eleven family members who had participated in at least one FSG. Data was analyzed for themes, using a constant comparative categorizing strategy. This analysis suggests that attending a FSG impacts the caregiving experience in four important ways: helping the family member to construct a self-identity as a ‘caregiver’; promoting a sense of personal competence; fostering the use of formal support groups; and creating a community context within which to experience the caregiving role. Cumulatively, these have the potential to contribute to a sense of empowerment for the family member by helping him or her to reposition the caregiving experience as more than a personal issue and promoting the emergence of a more collective voice.     

Expanding the scope of research with transition‐age foster youth: applications of the social network perspective

The support and resources embedded in social networks may be especially important for youth aging out of child welfare custody, such that foster youth support network characteristics influence the degree to which individual risk factors translate to poor outcomes during the transition from care. To examine the extent of this network influence on youth outcomes, social network analysis can be used to measure the interconnected relationships in the service network of caseworkers, foster parents and other providers, and in the personal network of biological family and community supports. By assessing these patterns of relationships, researchers can identify social network characteristics associated with particular subpopulations of foster youth who experience relatively successful or unsuccessful transition outcomes. This paper applies social network concepts and related methodology to frame foster youth transition support from a network perspective and to promote the generation of network‐informed hypotheses that could expand the scope of research with this important population.     

Discharge procedures for mentally ill people: The perspective of former psychiatric patients on their primary social network, quality of life and future life expectations

This article on literature about social networks and social support in order to integrate a number of key concepts and findings that must be considered in research about the social conditions of mentally ill people. Interviews with 53 former psychiatric patients were carried out to get their perspective on their social network, quality of life and future life expectations. The duration of and stigma attached to mental illness, being without work and gender seemed to have the most influence on the primary network. The same issues, except for gender, together with place of residence, financial difficulties and inability to exert influence over one's own situation influenced the respondents' quality of life and their expectations of the future. These findings are analysed and discussed from a social psychological perspective.     

Families and Serious Mental Illness: Working with Loss and Ambivalence

Correspondence to Dr David W. Jones, School of Social Science, University of East London, Barking Campus, Longbridge Road, Dagenham RM8 2AS, UK. E-mail: D.Jones{at}uel.ac.uk Summary This paper examines, in terms of a complex loss, the experiencesof people who have a family member who suffers from seriousmental illness. Whilst partnership between professionals andfamily carers is clearly being encouraged and is doubtless laudablein the whole area of health and social care, there seem to beserious obstacles to successful collaboration between familiesand professionals involved in serious mental illness. Part ofthe reason for this is that the emotional experiences of relativesare not well understood. This paper uses interview materialfrom a larger qualitative study of an ethnically diverse sampleto argue that the families of people with serious mental healthproblems need to be understood as having experienced a complexloss. The loss is complicated by (i) the continuing presenceof the person who is felt to have been lost; (ii) feelings ofanger (and subsequent guilt); and (iii) feelings of shame. Professionalswho work with families need to be aware of the uncomfortablefeelings that they are often struggling with. Professionalsare in a good position to provide support in allowing thosefeelings to be acknowledged and to take their place in the dialoguethat families need to have if they are to move on from the frustrationsof the chronic grief that others have observed (MacGregor, 1994;Wasow, 1995).