Practical Suggestions for Providers and Families

Mental health disorders are complex and often difficult to treat. Mental health research receives a great deal of funding from the U.S. federal government in order to determine the most cost-effective, culturally appropriate, and applicable ways to treat and prevent men­tal illnesses.

Box 9.5 It Happens in Real Life: What Is Life Like Now?

The accused killer is currently being held in a state hospital, until the day he is deemed fit to stand trial. He is "incompetent," meaning he is unable to stand trial, unable to understand the proceedings, and unable to assist in his defense. A trial will only happen if his competency improves. His case, and competency, will be reviewed every 2 years. If his level of competency changes, as deemed so by the court or the hospital staff, he will stand trial. It is most likely, however, that he will be locked in the state hospital for the rest of his life. Although he wasn't able to stand trial, his attorneys and the judge agreed that the prosecution provided overwhelming evidence identifying him as the person who com­mitted the crimes. For this reason, in August 2007, just 2 years after the shooting spree, a judge sen­tenced the killer to 179 years: Five counts of First Degree Murder, 30 years for each of the five individuals who lost their lives (150 years); one count of Child Abuse, 18 years; one count of Armed Robbery, 9 years; Firearm Enhancements on the Child Abuse and Armed Robbery charges, 2 years. He remains in a "medically fragile" state. He is on a minimum of six psychotropic medications a day, and years later is unable to return to a stable state. He wanted help. He asked for help. His family wanted help.

instrumental role in the recovery. The latest indication for recovery in depression, anxiety, substance abuse, and schizophrenia is family­based treatment. Family members are being retrained in communication skills, problem solving, and parenting. They are also being educated in new ways in regard to mental health disorders. They are being given more information about the disorders and are being given concrete guidance on behaviors that support well-being. Practitioners and families alike can take advantage of free resources on the Internet (see Appendix 9.1) and participate in funded clinical trials. Oftentimes, when par­ticipating in clinical trials, families can receive free treatment and providers can receive free, in-depth training.

Future Directions

Several future directions in research will help unite existing literature with areas yet to be thoroughly explored. One area for further understanding is assessing culture within the context of family conflict and mental health outcomes. There is evidence presented in this chapter about the consequences of family conflict on mental health outcomes. However, what is lacking is a better understanding of what family conflict looks like among cultures and how that conflict affects mental health outcomes. For example, Lopez et al. (2004) found that family warmth is a protective fac­tor for relapse to schizophrenia in Mexican American families, while criticism is a risk fac­tor for relapse to schizophrenia in White fami­lies.

A second, and quite complex, area of study that warrants a close look is teasing out the pathways of poor mental health and substance abuse/dependence outcomes and family conflict. Through mostly retrospec­tive evidence, researchers have demonstrated that family conflict negatively affects mental health. What is missing in the literature, how­ever, is an understanding of the impact that mental health has on family conflict; and an understanding of what comes first (is it the mental health that leads to family conflict or the family conflict that leads to mental health). For example, Awad and Voruganti (2008) examined the “burden of care” for caregivers of people with schizophrenia. The burden of care includes economic, physical, social, and emotional consequences, including factors such as shame, guilt, self-blame, and embar­rassment. This “burden of care” likely creates conflict within families and between caregiver and patients. In support of this point, Kung (2003) found a positive association between burden of care and family conflicts in Chinese American caregivers. A longitudinal study assessing these factors will allow newfound clarity on the subject and will benefit the development of prevention measures and also provide knowledge of how to manage conflict during the treatment process.

A final area of research (and perhaps for practical prevention programs), is a better understanding of, and an offering of sup­port to, families who have a family member with a mental disorder. Stories like Martin’s (Box 9.3) are tragic and, sadly, not uncom­mon. Identifying ways to include family mem­bers in a network of support services prior to—or exclusive of—the individual receiving treatment would go a long way in gaining an understanding of the family’s needs as a whole and also would provide a unique opportunity to support the individual as well (via his or her family).

Conclusion

In conclusion, this chapter examines the rela­tionship of mental health and conflict on families. Specifically, this chapter provides definitions and descriptions of four mental health disorders—depression, anxiety, sub­stance abuse and dependence, and schizophre­nia; explores the role of race and ethnicity on mental health; explores the relationship between mental health disorders and family conflict; and, finally, offers practical sugges­tions for providers and families.

While evaluating the relationship between mental health disorders and family conflict, several constructs emerged: (a) marital discord and family conflict, (b) parenting, (c) family violence, and (d) attachment. The literature provides overwhelming evidence that exces­sive marital discord and family conflict, poor parenting styles—either authoritarian or too permissive—family violence, and developing poor styles of attachment all lead to poor mental health outcomes for children and spouses. Additionally, the literature also pro­vides evidence that parents who have mental health disorders (such as the ones addressed in this chapter; anxiety, depression, substance abuse/dependence, and schizophrenia) are more likely to have children who also suffer from mental health disorders than are parents who do not have these mental health disor­ders. Finally, the chapter discusses the impor­tant role that families have in the initiation, maintenance, and also treatment and recovery of mental health disorders. These disorders occur within the individual, although come about in the context of the family. Therefore, family members have the ability to play a criti­cal role in the treatment process.

Through effective family-based prevention and treatment interventions, we have the capacity to prevent another massive shooting spree, another death by suicide, by people suf­fering from mental illness.

and implement effective, culturally relevant, family-based interventions. Theory, research, and practice in isolation will not be sufficient to address the complex family dynamics and mental health outcomes in our society.

Appendix 9.1 Useful Website Resources for Family Members and Practitioners

NOTE: PTSD = post-traumatic stress disorder; NIH = National Institutes of Health.

a. Items listed under the “Useful Tools” section are not exhaustive. Each website has an abundant amount of information that is not listed here.