Family and social treatments

Episodes of mental illness are often precipitated or prolonged by family and social problems. To make matters worse, family life and social function is often adversely affected by mental illness. Dealing with these issues can be as effective as drug and psychological treatments and should be considered in the management of anyone with a mental disorder.

Family treatments

Family therapy

All forms of family therapy are based on the principle that it is helpful to involve families when treating mental illness, regardless of whether the problem is considered to lie within an individual family member or be a consequence of disturbed family dynamics. In family therapy for schizophrenia, education is provided about the condition, with the aim of encouraging family members to be realistic in their expectations and to help them reduce the levels of expressed emotion within the family. Family therapy is commonly used in the treatment of childhood psychiatric disorders. Therapists will see families together and look for patterns of interaction that may be maintaining the presenting problems, rather than looking at the behaviour of individual family members.

Couples therapy

Many patients describe a poor relationship with their partner. In some cases this is secondary to their mental illness, which may place a strain upon the relationship or alter their perception of it. In such cases, treatment of the mental illness may be enough, along with carers’ support, as described below. In some cases though, relationship problems will be a cause of mental illness and couples therapy may be needed.

Couples therapy is often provided by organisations outside the health service, such as ‘Relate’. Although a variety of therapeutic techniques are used, most treatment is based on the fact that relationships usually deteriorate because couples start to communicate poorly and problems build up as a result. Addressing their differences with the help of a third person helps couples improve their communication and regain a sense of togetherness. Making the time to do enjoyable things together reinforces this process.

Families with young children

Caring for young children can be very demanding, especially for parents with a mental illness. Additional support from health visitors may be required, and parenting resource centres, which give support and guidance for parents, are a useful source of help where available. Support with child care costs can provide respite for parents. Parental mental disorder can be a cause or effect of emotional and conduct problems in children, and it will sometimes be necessary for adult and child psychiatry services to work jointly.

Working with carers

The term ‘carer’ is used to describe those who provide care for relatives or friends who are unwell. Usually they are the patient’s spouse, parent or child. They are often the primary caregiver, especially if they live with the patient. They face the distress of seeing someone close to them becoming mentally ill and the burden of looking after them. As a result, they may stop providing care and may become mentally ill themselves. Most carers want to provide care however and are able to do so effectively if given adequate levels of support, as summarised in Figure 1.

Fig. 1 Working with carers.

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