Unit 3: families and mental illness

Mental illness

Clinically significant disturbances in thinking, emotion or behaviour that impair daily functioning.

Mental health continuum

Good mental health can coexist with mental illness, and poor mental health can occur without a diagnosis.

Mental illness and the family system

Disrupts family balance, altering routines, communication, roles, boundaries and relationships.

Common family stressors in mental illness

Unpredictability, stigma, social isolation, financial stress, caregiving demands and role changes.

Unique stressors of caring for someone with mental illness

Unpredictable symptoms, stigma, safety concerns, lack of insight, ambiguous loss, limited supports.

Ambiguous loss

The person is physically present but psychologically changed.

Role effects of a mental illness diagnosis on well members

Increased caregiving demands leading to role strain, role conflict or role overload.

Chronic sorrow (Olshansky)

Ongoing grief from repeated losses with no clear endpoint, as in chronic mental illness.

What families grieve in mental illness

The person they once knew or the future they imagined.

Impact on siblings

Feeling overlooked, resentful, pressured into caregiving, grief, and lower self-worth.

Adult roles siblings may take on

Mediator, therapist and/or social worker for the family.

Supports for siblings

Education about the illness, open communication, acknowledging their needs, recognizing caregiving gains.

Impact on children of a parent with mental illness

Higher risk of emotional/behavioural problems, anxiety, neglect and accidents; often overlooked by providers.

Children may internalize...

Guilt or the belief that they caused the parent's illness.

Inappropriate caregiving roles

Children or siblings taking on responsibilities beyond their developmental capacity.

Recovery (mental health)

Living a meaningful life despite mental illness; recovery does not mean cure.

Core elements of recovery

Hope, positive identity, responsibility for one's life, and meaning beyond illness.

Recovery-oriented care values

Hope, identity, meaning, autonomy and strengths.

Recovery for families

Supporting autonomy while remaining emotionally connected, not organizing life around the illness.

Protective factors for families

Social connection, spirituality, humour, professional support, inner strength, medication management, positive outlook.

Family resilience (Unit 3)

Capacity to withstand adversity and emerge strengthened.

Family-focused nursing strategies (mental illness)

Education, building on strengths, enhancing communication, connecting to resources, recovery support.

Evidence-based principles for working with families

Involve family in treatment, explore losses, teach problem solving, expand social support, encourage boundaries.

Compassion fatigue

Emotional depletion and reduced empathy from ongoing exposure to another's suffering; the "cost of caring."

Compassion fatigue is also called...

Secondary traumatic stress.

Compassion fatigue vs burnout

Compassion fatigue = prolonged emotional exposure to suffering; burnout = workload and chronic stress.

When compassion fatigue develops in caregivers

Persistent or relapsing illness, helplessness, limited improvement, ongoing crises or hospitalizations.

Compassion fatigue symptoms

Emotional numbness, detachment, frustration toward the ill member, guilt about negative feelings, less patience.

RPN role for compassion fatigue

Recognize signs, validate feelings, set realistic expectations, encourage self-care, support groups, respite.

Mental Health Act (involuntary admission)

Used when a person poses risk to self/others and refuses care; often involves police bringing them for assessment.

Section 28 apprehension

Police apprehension for assessment; does not guarantee certification or admission.

Involuntary certification timeline

First certificate allows 48 hours; a second doctor's certificate is valid for one month.

FIPPA

BC privacy law allowing limited information sharing with family when needed for continuity of care or safety.

Information sharing rule

Seek client consent first; release must be in the client's best health interests.