People with mental illnesses and their families face community stigma, family stigma and self-stigma. In general, these conditions are poorly understood and poorly supported in natural communities. The experience of mental illness can be overwhelming and isolating for the person. It can also be that way for people who love them. Very often the experience of serious mental illnesses creates a strain in personal and professional relationships. It can make it difficult to perform at school, work, or in other social roles (such as child-rearing or being a good neighbor). A portion of people with serious mental illnesses will experience prolonged isolation. This may be due to incarceration, homelessness or similar life circumstances. These can further deplete the person’s social network and disrupt their access to social roles they once valued.
Many practitioners do not actively see these aspects of recovery as something to focus on. They focus on symptoms rather than inclusion. However, sitting alone in an apartment with less active symptoms but nothing to do and no friends or family is rarely how people describe recovery for themselves. People are interested in engaging in life again after a setback. This can include having purpose; having friends; reconnecting to family or reclaiming roles in the family. It may include working, volunteering, or having a sexual and/or domestic partners. These relationships are not one-sided. They include mutuality and shared value.
Families often experience stigma and lack of support in their own natural networks like faith communities or extended family. They are rarely taught about these conditions and what they can do. This means families may disengage or do poorly at helping the person reintegrate into the family structure after a crisis. Families that are educated and supported in recovery typically do better with this. Family members also find they become isolated from their social networks. They report being rejected or ignored by groups they highly value. These are groups such as their faith community, work relationships, or extended family. Some lose their jobs, use up their sick and vacation time, or cut back on hours to provide direct support to a child or adult relative with mental illnesses. However, even then, their needs and views are not reliably included in ongoing planning or seen as valuable or important.
Sometimes family situations increase stress or even create trauma for individuals with mental illnesses. However, many traits of family “dysfunction” are really a reflection of families hurting under the strain of an unresponsive, stigmatizing system. Families are often the people who try to do the most for the person. They are typically the least supported. Individual family involvement must be carefully and clearly sorted out with each individual. Even “challenging” family members can be a resource to the person in some way (spiritual, emotional, economic, or instrumental). Professionals must learn the art of family supports that respect the autonomy of individuals supported. Professionals can help the person balance personal desires in the context of family. Keep in mind also that family is individually and culturally defined.People do not always rely on their biological or legal family for support. People may consider other people who are significantly important to them as “family.” The term “natural supports” refers to people who are there voluntarily there for each other in life and may include family or others.
Culture and diversity will strongly affect what roles and relationships a person thinks are valuable and acceptable. Some find satisfaction in attending spiritual practice or support group. For others it means being a good parent, sibling or neighbor. Some people find that volunteering is a valued social role for them. Work is often a valued social role but not always. Culture will also affect how people feel about sharing their condition or talking about their condition. It will affect how comfortable their families are. Their communities will set some of the tone of these conversations.
It’s important to work with the person in their own cultural context. Some people are comfortable getting support outside of the family. Others will not find that comfortable. People may come from communities that are less supported or have more stresses. This might be experiences such as being a person of color, having served in the military, or being non-binary or gay. It’s important to be really open and accepting to people’s perspectives and experiences. They need to connect to communities and roles that make sense to them. This includes learning how to navigate situations that can be challenging such as not misusing substance when around family that still uses. People alone should decide how they want to handle their social needs. Professionals can help them build skills and explore options regarding how to do that successfully.
Respect of the confidentiality and privacy of the individuals is essential to people feeling safe with professionals. It’s also supported by laws and regulations such as the Health Insurance Portability and Accountability Act(HIPAA) and professional ethical codes. At the same time there is evidence that mental health professional apply these rules in more stringent ways than other types of professionals. Sometimes, the approaches create additional issues of isolation for the person supported. For example, professionals in mental health services may not consider doing something as simple as asking the person if there someone they want involved in their care. Or they may consider the person’s opinion of family during an acute episode to be permanent. However they may feel very differently when they are not symptomatic. On the other hand, a person may no longer want someone involved in their treatment that previously was. That should be checked on and respected as well. It’s just important to keep in mind recovery often is achieved through practical and social support of people who care about us. It’s important