Dreamtime Consulting

For clients diagnosed with a mental illness, having family involved can make matters much more stressful than the diagnosis itself. The process of educating a family system about mental illness is not a guarantee the family will act on that new found knowledge. Often, there is a much deeper issue at work and that is the issue of freedom of choice regarding how the client wishes to live their own life.

As the Recovery model of mental illness gains momentum, those involved in the mental health system, either as professionals or family, are having difficulties with some of the increased freedom given to clients to make their own decisions regarding treatment. For many, the issue of forced medication compliance is a heated one. In a recent workshop I attended in San Bernardino, CA this concept made many of those attending very uncomfortable to think the clients who they have been helping, will be given a more active role in treatment, including deciding not using medications. The client makes the decisions of what happens if they end up in the hospital and actually is told to write out their exact wishes. Case Managers, Therapists and other Mental Health professionals enter into an agreement with the client that these wishes will be followed by all involved in the treatment team, including the doctors.

For family, this issue becomes much more complicated because often the family can exert pressures in more areas and ways which impact the client emotionally. The natural course of action to help circumvent this is to educate the family on the dynamics of the mental illness. The foundation in doing this is once the family understands, they will be able to act in a manner which helps the client to recovery more quickly. Unfortunately, education can't assure family will act in a helpful manner. With many of the clients I work with, one of the things they find destructive to themselves, is when family automaticly assumes medication is the cure all to problems for the client. Everyday events which prior have been no problem, suddenly become tied into the diagnosis. The family sets up expectations and when those expectations are not met, then it is the fault of the client who is accused of not taking medication, or needing to get back on medication.

It may be the wish of the client to not take medication, but the client finds themselves pressured by the family into compliance. Not just in the realm of medication but of behavior. For example someone who is diagnosed with depression may get accused of isolating themselves when they wish to have some time alone. Developing hobbies and outside interests or activities are sometimes seen as detaching from the family, when in reality these hobbies or interests may be vital keys in the recovery process. Often times family preferences get communicated to the client as norms of behavior, and become a means of control. Family members will make statements like "Snap out of it" or "I wish you would start taking your medication". These statements and others like them are shame based, intended to control the decision making of the client. As the recovery process takes place, the client becomes more independent and more able to make wiser choices, which can be seen as a threat by family members due to the client being less willing to give up control of their life.

Many family members automaticly assume the client is no longer capable of making sound choices as they were in the past, and that the family knows best. They forget their knowledge of the diagnosis will always be less then that of the client, for the client is the one who knows the dynamics of the diagnosis and often times develops methods of compensating independent of family intervention. Understandably family wants to make their life easier, but it should not be at the cost of complicating the client's life more.

Family involvement is important, and most professionals I know want and encourage family to be involved in the treatment process. However, education about the diagnosis is not enough, there needs to be a education about the client's freedom to choose what they want and to work with that choice without pressure to take medications etc... The client and family need to be linked with advocacy and patient rights groups who can provide the extra piece, and support.