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Relatives Of People Who Have A Mental Illness Social Work Essay

2.1 Introduction

Tanner (2000) stated that professionally delivered services are only a small part of the lives of people who have relatives with a mental illness. He said that it is necessary to recognise the full extent of what is happening within the family itself.

The circumstances of family members of people with mental illness were first mentioned in the 1950’s. At that time, studies found that caring for a relative with mental illness interferes with the daily lives of the families, with their social activities, work attendance, creates a financial burden and affects the relative’s capacity to devote time and emotional resources to the patient’s siblings and other healthy family members (Doron, Raba, Kurs, Bleich & Melamed, 2009). The literature shows that many years later studies have validated this early research.

2.2 Definitions

2.2.1 Burden

Burden amongst relatives is a complicated and multidimensional concept that looks at the perceived impact on caregivers. It is divided into two types – objective and subjective burden. Objective burden is the disruption of tangible aspects of the carers life, whilst subjective burden refers to the extent that a relative or caregiver perceives their situation to be overly demanding and stressful (Liu, Lambert and Lambert, 2007).

2.2.2 Stigma

Rose please – would definitions go here or in methodology ?

2.2.3 Effects on relatives of people who have a mental illness

Generally, caring for a family member can place considerable burden on the carer and family (Maurin & Boyd, 1990). This is especially the case for mental health carers given that carers of those with a mental illness have been shown to report higher levels of burden than carers of a person with physical disability (Magliano, et al, 2005). Eakes (1995) stated that the uncertainty that is associated with persistent mental illness often leads to unresolved grief and chronic sorrow. Aside from emotional, psychological, and financial difficulties, families of mentally ill patients often experience guilt, shame and embarrassment that becomes a heavy burden (Doron, et al 2009). Other negative outcomes associated with mental health care giving include restriction of daily and social activities (Rose, Mallinson, & Gerson, 2006), feelings of grief, loss and worry (Schulze & Rossler, 2004), as well physical ill health (Holmes & Deb, 2003).

2.2.4 Relatives of hospitalized patients

There are few studies that have examined the difficulties and suffering experienced by family members who have a relative being cared for in a psychiatric institution (Pejlert, 2001). Most studies in this area have tended to focus on the experiences of families who care for their relative at home (ibid). Rose (1996) suggested that this may be because professionals devote their caring efforts mainly towards the patient or because there is an assumption that once a person is hospitalised the family are then free from caring responsibilities. This assumption is proved to be incorrect in research such as a study carried out by Stephens et al (1991) which showed that relatives of elderly patients admitted into institutional care, may feel some relief but yet still experience high levels of anxiety and another study by Aimberg et al (1997) which found that there was no difference in burnout experiences between care givers who has a relative with dementia living at home and those whose relative was institutionalised.

Pejlert (2001) conducted a small scale study to describe the experiences of parents who had an adult son or daughter with a severe mental illness living in a care setting. She found that there was often a cultural conflict between the family system and the care system, and that the respondents reported ongoing grief and sorrow, experiences of stigma from the public and mental health professionals but also there were reports of receiving comfort and having confidence in the care that was given.

2.5 Stigma

Many families assume major roles in the lives of their relative’s mental illness. The family’s role is frequently undermined by stigma through their association with the person with mental illness (Larson and Corrigan, 2008). Goffman (1990) said stigma can be spread from the stigmatised individual to those close to him. Goffman called the stigma experienced by parents, siblings, spouses, and children ‘courtesy stigma’. In local research Gafa (2006) when looking at the impact of media stigmatization on patients’ perceptions of their mental illness and stated that relatives of the mentally ill usually have a role which is demanding and distressing. He cited a study conducted by Struening, Perlick, Link, Hellman, Herman and Sirey in 2001, where the authors concluded that the greater part of the general public devalues the families of mental health consumers. Such devaluation results in stigma, social isolation and rejection.

2.2.6 Support

Access to support, both formally and informally, has been shown to reduce burden and distress in mental health carers (Magliano, Marasco, Fiorillo, Malangone, Guarneri and Mei, 2002; Schulze & Rossler, 2004). However, many mental health carers report that they have limited access to any type of support and that they are not confident that they will receive professional or informal support in times of need or crisis (Magliano et al, 2002). Social isolation, and the lack of much needed services, further serves to increase the burden and distress experienced by mental health carers (Hoskins, Coleman & McNeely, 2005).

Age of carers

Family members who provide care to people with changes in health and daily functioning are more likely to be middle-aged and older women, many of whom also care for other children and / or their parents or grandchildren (Roberto and Jarrot, 2008). Jeon, Brodaty, O’Neill and Chesterson (2006) in a study concerned with older carers of mentally ill people stated that more than six percent of people between 18 and 64 years of age experience a severe mental illness such as schizophrenia, major depression and bipolar affective disorders. They state that since severe mental illness occurs more frequently in younger adults, their main carers are more likely to be older parents, most mothers (ibid).

2.7 Relationship with professionals

In recognising the substantial contribution that informal carers (most commonly a relative), make to the well-being of people with mental health problems, various studies have looked at interventions that can minimise adverse effects on the family / carers themselves (Crombie et al, 2007). A Scottish study conducted in 2007 identified key areas in which professionals can intervene. These include providing greater information and education for carers (e.g. concerning services, aetiology, crisis management, income, education and housing, financial support, care plans); providing practical support through respite care, financial support, transport assistance and increased employment opportunities; psychological support (counselling, coping skills training, stress management for carers, family based therapy); provision of supporting agencies such as peer support groups, non-governmental organisations and so on; and greater carer participation in service delivery and planning (Crombie et al, 2007).


Coping may be defined as how the family attempt to reduce or manage demands on the family system and to acquire or manage resources to handle their situation (Han, 2003). Murray-Swank et al (2006) conducted a study that looked at how spirituality can be effective as a means of support for carers of people with serious mental illness. They found that religiosity may contribute to enhanced well being amongst care givers.

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