Families and the Life Transition of First-Time Mental Illness: Swept Along on the Waves : Families and the Life Transition of First-Time Mental Illness: Swept Along on the Waves


Slide2: Funded by Sigma Theta Tau, International


Objectives: Objectives Following this presentation, participants will be equipped to: 1. List at least 3 sources of family uncertainty at the initial hospitalization of a family member on a psychiatric unit, 2. Cite examples of at least 3 management strategies used by families in this study, and


Objectives: Objectives 3. Discuss at least two interventions for mental health professionals when assisting families who have a hospitalized family member with a psychiatric illness.


Starting Research: Starting Research Background Why


Family: Family


The Question: The Question How does the family manage the uncertainty of a first time hospitalization of mental illness in a family member?


Who: Who Patients (over age 18) hospitalized for their first acute mental illness Patient diagnoses included those with psychotic features, such as Brief Reactive Psychosis (usually several diagnoses) Families present at the hospital English speaking


Family Definition : Family Definition Those immediate members who designate themselves as having close emotional bonds and meeting basic needs of the designated patient (Gilliss, Highley, Roberts, andamp; Martinson, 1989) Present in the hospital with the patient Family included parents, in-laws, spouses, and siblings.


How: How Depth interview Done at the hospital 1st - all family members present at the hospital Next – each individual family member available Tape recorded, transcribed


Qualitative Methodology: Qualitative Methodology Depth interview Blumer’s symbolic interactionism Emphasizes importance of meaning and interpretation Occurs during the interactions Coding is by patterns


Demographics: Demographics 16 families 30 individual members 11 spouses 11 parents 3 siblings 4 children 1 friend


Demographics: Demographics Most families lived within 50 miles of the medical center 11/16 lived in a small town


Demographics: Demographics About the patient- mean age=36.6 (range 20-55) Most common diagnoses Depression with psychosis (8) Delusional disorder (5) Manic-depression (4) Acute psychosis (4)


Life Transition: Life Transition Life transition= hospital event intruding into every aspect of the family's world and a sense of the family being altered from what it was previously (Selder, 1989)


Becoming Aware : Becoming Aware Awareness over time Knowing something was wrong Not knowing what to do Symptoms became severe Turning point leading to hospitalization


Seeking Help: Seeking Help 'So then he, I went out to the park and he couldn't talk. Everything was brain waves and psychics and he couldn't go into ____ [their home] because psychics were giving him too much power and he couldn't..... Well, then I knew it's, something had to be done. I could see tears in his eyes, like, 'Oh, please help,' you know. So I said, 'Well, the only thing I can do is take him to the emergency room.'


The Hospitalization: The Hospitalization Reaction – unreal: 'You know, how are you supposed to take this. Is this for real or what?' or, '...Is this really happening?'


Sources of Uncertaintyfor Families: Sources of Uncertainty for Families 'We were scared and, God, he shouldn't be here, you know, I want him home, but yet I didn't, I know he's not, he can't come home....'


Sources of Uncertaintyfor Families: Sources of Uncertainty for Families How to deal with patient symptoms What to say? How to react? How much to visit?


Sources of Uncertaintyfor Families: Sources of Uncertainty for Families Naiveté about mental illness Compared with physical illnesses No past experiences


Sources of Uncertaintyfor Families: Sources of Uncertainty for Families 'And then, too, I mean mental illness, it's always been made fun of, I mean, from where I've been around, you know, 'He's flipping out' or those kinds of comments and stuff. And then, it's kind of embarrassing. I mean, people ask you, 'well, what happened to him? He flip out?'... I don't know how to answer that.'


Sources of Uncertaintyfor Families: Sources of Uncertainty for Families 'You can't control it [mental illness]... . And there's no guarantees. You want a guarantee, you want an iron-clad thing saying, 'Okay, she takes this, this, and this, and then she's fine' you know, and you won't ever have to worry about this. We don't have that.'


Slide24: Sorting it out Establishing Boundaries Normalizing Creating Options THE FAMILY


Management Strategies: Management Strategies Sorting it out A process to decrease uncertainty when families had no control over patient’s illness


Sorting it Out: Sorting it Out Comparative testing Measuring self against identified model Biographical Compared this hospitalization with previous life experiences 'Well, I had a heart attack and they could open that up and fix it. With him [the patient] it's mind baffling to me.'


Sorting it Out: Sorting it Out Seeking information Finding sources about M.I. 'You know, the more information you get, the better it seems to be.... But when things are explained, it really alleviates a lot of fear.'


Sorting it Out: Sorting it Out Story telling Construction of narrative to review recent events leading to hospitalization Helped to make sense out of the situation


Sorting it Out: Sorting it Out Seeking the key Finding causes for the M.I 'I was a detective. I thought, 'Hey, I got the key. I'm going to get him out of here''


Management Strategies: Management Strategies Establishing boundaries Demarcating, making distinctions among competing demands 'And I get frustrated, because, it's like, well, I have to worry about her [young daughter] and I have to worry about him [the patient], and then I have a cat running around that wants my attention....' Consisted of Rumor Control andamp; Time


Management Strategies: Management Strategies Boundary - Rumor Control Limit how information given and to whom 'The people I wanted to know, I told....'


Management Strategies: Management Strategies Boundary – Time Boundaries Limit focus to present, not future 'I know that counselor [the patient's] gave me a handout as to some support groups, but I don't know if I really, I don't think I want to get into that quite yet. Maybe that's something later down the road...'


Management Strategies: Management Strategies Boundary – Time Boundaries 'I'm more concerned about now. And, uh, dealing with now, and, ah, maybe the future will take care of itself in the process, hopefully. But, you know, those, this conversation that ____ [the other parent] and I have had, and, what if, you know, what if, what if. But obviously our emphasis is on now.'


Management Strategies: Management Strategies Normalizing Engaging in behaviors that mirror established standards by your own group Consisted of 3 types: Coordinating others Establishing a family routine Normalizing patient’s symptoms


Management Strategies: Management Strategies Coordinating others Making arrangements to bring order to the family Who would visit the patient, when Calling others to care for children, animals at home when gone Work coordination


Management Strategies: Management Strategies Establishing a family routine Regulating family schedules Attempts to minimize family disruptions 'I'm trying to keep... the kids as normal as possible.' '...because this [hospitalization] was going on and with the …kids, you always have at least three balls up in the air.... So we made it to her [daughter's] basketball game late.'


Management Strategies: Management Strategies Attempts to normalize the patient’s symptoms Ways to view pt. symptoms as standard behavior mirrored by psychiatric community


Management Strategies: Management Strategies Attempts to normalize the patient’s symptoms 'So I just stopped her nurse in the hall and talked, ... and just talking to her helped, I mean, it kinda, she was explaining how this was... people have done this [behavior] before, and, yeah, we see this, and it was no big deal to her, anyway, because it's, quote, unquote, typical, if there's such as thing.'


Management Strategies: Management Strategies 3 strategies used to create new options to manage uncertainty: Test options Relinquish care Work options


Management Strategies: Management Strategies 'I basically mothered him…I still have to say to him, 'no, you can’t do that’ or ‘it’s time to get up now’'


Management Strategies: Management Strategies 'I can’t do anything while he’s in here, really. So, sometimes I feel like I’m more of a hindrance when I’m here than a help' 'I was so worried about him [pt.], and I thought….'heavens, he’s here, he’s in good hands’'


Management Options: Management Options Creating options Work options Tried methods to alter workload Unable to concentrate at work Relied on work colleagues Changed schedules


Implications for Health Care Providers: Implications for Health Care Providers UNDERSTAND families Events leading up to the hospitalization (lack of sleep, vigilance, etc) Lack of mental illness information or experience The family is disrupted with this illness of one member Uncertainty about many things


Implications: Implications Help families with information Who to include in teaching May not want all ed materials now


Implications: Implications Assist families with boundaries Don’t need to visit all the time Realize their home demands Assist with rumor control Follow confidentiality policies


Implications: Implications May need 1 family 'communicator' to others in the family Encourage them to tell their story about events leading to the hospitalization and about the patient


Implications: Implications Role model how to talk to the patient Assist families with what to say, when, how 'So from 1 to 5:30 we had no idea if we were doing the right thing. We were just talking. He was emptying himself out....it was terrible....You know, how are you supposed to take this?' Doctor’s advise: 'just save it for the doctor and let's go and think about something else to talk about, or the kids or....'


Implications: Implications Consider the family’s developmental stage Family with young children Family with adolescents Launching children andamp; moving on Carter andamp; McGoldrick (1980). The family life cycle: A framework for family therapy


2 Stages of Families: 2 Stages of Families


Implications: Implications Note any ways to help families decrease their uncertainty They feel a loss of control, as they are being………. Swept along on the waves


Slide51: