The Tie That Binds and Heals
The Tie That Binds and Heals
Families’ Life Experiences with Mental with Mental IllnessIllness
Stressors, Coping, Adaptation, Stressors, Coping, Adaptation, RecoveryRecovery
____________________________________________________________________________________________________________________________________________________________________________________________________________________
Jody L Friesen Grande PhD LICSW BCD
Families’ Life Experiences with Mental with Mental IllnessIllness
Stressors, Coping, Adaptation, Stressors, Coping, Adaptation, RecoveryRecovery
____________________________________________________________________________________________________________________________________________________________________________________________________________________
Jody L Friesen Grande PhD LICSW BCD
Prevalence of Mental IllnessPrevalence of Mental Illness
22.1% of Americans ages 18 and older (one in five adults) receive a diagnosis of mental illness in a given year (NIMH)
Effects of mental illness touch many families (one in four)almost 50% of the United States population
66% of individuals diagnosed with mentalillness live with a family member withoutadequate support services
Even when individuals live separately, 60%of families continue to provide time,money, and social support on a daily or weekly basis
22.1% of Americans ages 18 and older (one in five adults) receive a diagnosis of mental illness in a given year (NIMH)
Effects of mental illness touch many families (one in four)almost 50% of the United States population
66% of individuals diagnosed with mentalillness live with a family member withoutadequate support services
Even when individuals live separately, 60%of families continue to provide time,money, and social support on a daily or weekly basis
Statement of the ProblemStatement of the Problem
Families are the vital link between home and community and is the most powerful factor affecting the outcome of the individual’s recovery
Families are frustrated with a mental health system that is failing to consider their needs
Families are not included in treatment planning or collaboration efforts
Families are disappointed in the perceivedinadequacy and fragmentation ofmental health services
Families are angered by their negative experiencesin working with mental health professionals whocontinue to blame them
Families are the vital link between home and community and is the most powerful factor affecting the outcome of the individual’s recovery
Families are frustrated with a mental health system that is failing to consider their needs
Families are not included in treatment planning or collaboration efforts
Families are disappointed in the perceivedinadequacy and fragmentation ofmental health services
Families are angered by their negative experiencesin working with mental health professionals whocontinue to blame them
Consequences to FamiliesConsequences to Families
Feelings of guilt and responsibility are intensified Feelings of alienation from mental health professionals Environmental climate of blame wears down effective
family relationships Experiences with mental illness weaken their ability to
support their family member
Poor person-environment fit between the complex and challenging needsof individuals diagnosed with mental illness, their families, and mental health professionals who are often ill equipped to provide appropriate mental health services--increasing objective burdens for families.
Feelings of guilt and responsibility are intensified Feelings of alienation from mental health professionals Environmental climate of blame wears down effective
family relationships Experiences with mental illness weaken their ability to
support their family member
Poor person-environment fit between the complex and challenging needsof individuals diagnosed with mental illness, their families, and mental health professionals who are often ill equipped to provide appropriate mental health services--increasing objective burdens for families.
Goals of the Research StudyGoals of the Research Study
Family member’s experiences and perspectives were explored, focusing on family stressors, coping skills, and adaptation of families experiencing mental illness
Mental health professionals’ experiences and perspectives were explored, focusing on the challenges and rewards of working with families experiencing mental illness, as well as the availability of mental health services for families
The concepts about causation and recovery were examined with both family members and mental health professionals
Family member’s experiences and perspectives were explored, focusing on family stressors, coping skills, and adaptation of families experiencing mental illness
Mental health professionals’ experiences and perspectives were explored, focusing on the challenges and rewards of working with families experiencing mental illness, as well as the availability of mental health services for families
The concepts about causation and recovery were examined with both family members and mental health professionals
Research QuestionsResearch Questions
What caregiving burdens do family members identify when managing a family member’s mental illness?
What types of self-care techniques do family members utilize when managing a family member’s mental illness?
What rewards and reciprocities (give and take)of human interaction have family membersexperienced with their family memberdiagnosed with mental illness?
From the families’ perspective what are theirexperiences with the mental health system and its services?
What caregiving burdens do family members identify when managing a family member’s mental illness?
What types of self-care techniques do family members utilize when managing a family member’s mental illness?
What rewards and reciprocities (give and take)of human interaction have family membersexperienced with their family memberdiagnosed with mental illness?
From the families’ perspective what are theirexperiences with the mental health system and its services?
Research Questions (Continued)Research Questions (Continued)
From the perspective of mental health professionals, what are their experiences in working with families experiencing mental illness?
From the perspective of families and mental health professionals, how do they define and explain the following concepts and to what extent are these definitions/explanations congruent? Causation of mental illness Recovery for individuals diagnosed with mental illness and
their family members
From the perspective of mental health professionals, what are their experiences in working with families experiencing mental illness?
From the perspective of families and mental health professionals, how do they define and explain the following concepts and to what extent are these definitions/explanations congruent? Causation of mental illness Recovery for individuals diagnosed with mental illness and
their family members
Significance of Research StudySignificance of Research Study
Acknowledge families’ life experiences Acknowledge affects mental illness has on all family
membersparents, siblings, spouses, and offspring
Provide a “voice” to family members
Mental health professionals receive a renewed understanding offamilies’ life experiences with mental illness
Enable mental health professionals to provide quality and effective mental health programs for families experiencing mental illness
Develop educational programs for families Develop training programs for mental health professionals
Acknowledge families’ life experiences Acknowledge affects mental illness has on all family
membersparents, siblings, spouses, and offspring
Provide a “voice” to family members
Mental health professionals receive a renewed understanding offamilies’ life experiences with mental illness
Enable mental health professionals to provide quality and effective mental health programs for families experiencing mental illness
Develop educational programs for families Develop training programs for mental health professionals
Historical PerspectiveHistorical Perspective
Colonial times … it was the family’s responsibility to care for their family member experiencing symptoms of mental illness and bizarre behaviors
1700s … opening of the first asylum provides aglimpse of care removed from the family
1950s … deinstitutionalization with manyindividuals landing on their family’s doorstep
Today … families have been requiredto assume an increasingly heavy burdenof responsibility for the care of theirfamily member diagnosed with mental illness
Colonial times … it was the family’s responsibility to care for their family member experiencing symptoms of mental illness and bizarre behaviors
1700s … opening of the first asylum provides aglimpse of care removed from the family
1950s … deinstitutionalization with manyindividuals landing on their family’s doorstep
Today … families have been requiredto assume an increasingly heavy burdenof responsibility for the care of theirfamily member diagnosed with mental illness
Primary Roles of FamiliesPrimary Roles of Families
The philosophical, economic, and political mood, which has encouraged the development of community care, has frequently come to simply mean care by the family
Caregiver … families assist and supervisetheir family member in obtaining theirbasic needs (e.g., shelter, food, finances)and teaching them activities of daily living(e.g., self-care, household chores
Case Manager … families can assume 30% or more of their waking hours in caring for their family member diagnosed with mental illness; helping them to connect to the mental health system, obtain services, medical and treatment options, and wade through the befuddling system of entitlement on a day-to-day basis
The philosophical, economic, and political mood, which has encouraged the development of community care, has frequently come to simply mean care by the family
Caregiver … families assist and supervisetheir family member in obtaining theirbasic needs (e.g., shelter, food, finances)and teaching them activities of daily living(e.g., self-care, household chores
Case Manager … families can assume 30% or more of their waking hours in caring for their family member diagnosed with mental illness; helping them to connect to the mental health system, obtain services, medical and treatment options, and wade through the befuddling system of entitlement on a day-to-day basis
MethodologyMethodology
Qualitative and phenomenological research design A “warm” analysis, wherein empathy is integral to this
study in an attempt to make sense of, and interpret the meanings of and perceptions of how mental illness affects the lives of family
Hennepin County the largest populated county(23% of population) of Minnesota
Maximum variation sampling was used to identify participants who were likely to be “information-rich”
Qualitative and phenomenological research design A “warm” analysis, wherein empathy is integral to this
study in an attempt to make sense of, and interpret the meanings of and perceptions of how mental illness affects the lives of family
Hennepin County the largest populated county(23% of population) of Minnesota
Maximum variation sampling was used to identify participants who were likely to be “information-rich”
Phase I - FamiliesPhase I - Families
40 participants; 10 family members from each family subgroup: parents, siblings, spouses, and offspring
Semi-structured in-person interview exploring the family member’s life experiences Coping, adapting, and managing a family member’s
mental illness Caregiving burdens and self-care techniques Experiences with mental health services Perceptions of the causation of mental illness Necessary components needed for recovery
Phenomenological approach provided an opportunity forfamily members to voice their experiences so that acomprehensive reflective analysis could portray the essencesof their life experiences with mental illness (Moustakas)
40 participants; 10 family members from each family subgroup: parents, siblings, spouses, and offspring
Semi-structured in-person interview exploring the family member’s life experiences Coping, adapting, and managing a family member’s
mental illness Caregiving burdens and self-care techniques Experiences with mental health services Perceptions of the causation of mental illness Necessary components needed for recovery
Phenomenological approach provided an opportunity forfamily members to voice their experiences so that acomprehensive reflective analysis could portray the essencesof their life experiences with mental illness (Moustakas)
Phase II - Mental Health Professionals
Phase II - Mental Health Professionals
10 program directors from Minnesota Rule 29 Community Mental Health Clinics
Telephone interview or completing questionnaire via mail Explored their views about the challenges and rewards of
working with families experiencing mental illness Availability of services for families Training Stigma Causation of mental illness Needed components for recovery
Snapshot view of the connection of the person-in-environment perspective
10 program directors from Minnesota Rule 29 Community Mental Health Clinics
Telephone interview or completing questionnaire via mail Explored their views about the challenges and rewards of
working with families experiencing mental illness Availability of services for families Training Stigma Causation of mental illness Needed components for recovery
Snapshot view of the connection of the person-in-environment perspective
Parents as ParticipantsParents as Participants
Coping with mental illness for an average of 13 years Majority of participants female (mother) All over the age of 50 Majority married All had some college experience; 80% had a college
degree Half retired; with over half reported incomes of over
$75,000 annually Majority indicated their religious affiliation as none All were Caucasian
Coping with mental illness for an average of 13 years Majority of participants female (mother) All over the age of 50 Majority married All had some college experience; 80% had a college
degree Half retired; with over half reported incomes of over
$75,000 annually Majority indicated their religious affiliation as none All were Caucasian
Siblings as ParticipantsSiblings as Participants
Coping with mental illness for an average of 10 years Majority of participants female (sisters) Age 18 to 59, with half older than their brother/sister Majority of participants were either divorced or single
and never married Majority had some college experience; 50% had a college
degree Half employed; reported earning $35,000 to $49,999
annually Religious affiliations ranged from none to Catholic, Non-
denominational, Jewish, Lutheran, and Presbyterian All were Caucasian
Coping with mental illness for an average of 10 years Majority of participants female (sisters) Age 18 to 59, with half older than their brother/sister Majority of participants were either divorced or single
and never married Majority had some college experience; 50% had a college
degree Half employed; reported earning $35,000 to $49,999
annually Religious affiliations ranged from none to Catholic, Non-
denominational, Jewish, Lutheran, and Presbyterian All were Caucasian
Spouses as ParticipantsSpouses as Participants
Majority knew about their spouses mental illness prior to their marriage; two whose mental illness appeared after their marriage are now divorced
Participants were half male (husbands) and half female (wives) Age 18 to 59 Majority of participants were married All had some college experiences; 60% had a college degree All were employed; half reported earning over $75,000
annually Religious affiliations ranged from none to Christian, Lutheran,
and Hindu Majority were Caucasian; with one identifying himself as
East Indian (Asian/Pacific Islander)
Majority knew about their spouses mental illness prior to their marriage; two whose mental illness appeared after their marriage are now divorced
Participants were half male (husbands) and half female (wives) Age 18 to 59 Majority of participants were married All had some college experiences; 60% had a college degree All were employed; half reported earning over $75,000
annually Religious affiliations ranged from none to Christian, Lutheran,
and Hindu Majority were Caucasian; with one identifying himself as
East Indian (Asian/Pacific Islander)
Offspring as ParticipantsOffspring as Participants
Majority of participants where female (daughters) Age 28 to 49 Majority of participants were either divorced or
separated Majority had some college experience; over half had a
college degree Half employed; reported earning $35,000 to $49,999
annually Religious affiliations ranged from none to Christian,
Catholic, Lutheran, Mormon, and “Spiritual” Majority were Caucasian; with one identifying herself
as Hispanic/Latin
Majority of participants where female (daughters) Age 28 to 49 Majority of participants were either divorced or
separated Majority had some college experience; over half had a
college degree Half employed; reported earning $35,000 to $49,999
annually Religious affiliations ranged from none to Christian,
Catholic, Lutheran, Mormon, and “Spiritual” Majority were Caucasian; with one identifying herself
as Hispanic/Latin
Most Devastating to FamiliesMost Devastating to Families
Ambiguous Loss defined as the lack of clarity which causes confusion and stress, and is often tormenting (Boss, 1999)
Disenfranchised Grief defined as the experience of grieving that cannot be openly acknowledged, publicly mourned, or socially supported, due to the stigma that often accompanies mental illness (Doka, 1989)
Parents loss of their own dreams andexpectations for their child
Siblings experience a loss of whotheir brother/sister had been
Spouses dreams and expectations of their marriage is shattered
Offsprings loss of a relationship with their parent diagnosed with mental illness
Ambiguous Loss defined as the lack of clarity which causes confusion and stress, and is often tormenting (Boss, 1999)
Disenfranchised Grief defined as the experience of grieving that cannot be openly acknowledged, publicly mourned, or socially supported, due to the stigma that often accompanies mental illness (Doka, 1989)
Parents loss of their own dreams andexpectations for their child
Siblings experience a loss of whotheir brother/sister had been
Spouses dreams and expectations of their marriage is shattered
Offsprings loss of a relationship with their parent diagnosed with mental illness
Subjective Burdens -- Emotional Distress
Subjective Burdens -- Emotional Distress
Sadness__grief, loss, depression, helplessness and hopelessness Parents primary response
Anger__frustration; not knowing what to do, where to go, or how to help Siblings, Spouses, and Offspring primary response
Sadness__grief, loss, depression, helplessness and hopelessness Parents primary response
Anger__frustration; not knowing what to do, where to go, or how to help Siblings, Spouses, and Offspring primary response
Subjective Burdens (Continued)Subjective Burdens (Continued)
Parents found themselves overwhelmed with caring for an adult son/daughter Question their own parenting skills Greatest fear is what will happen to their child if they are no longer
available Siblings reported feeling trapped, bitter, and resented the loss of
parents time Presumed the role of caregiving for their parents Greatest fear were concerns of their own mental health
Spouses identified their anger as “excruciating” (BM) Emotional abuse was suggested by several spouses Greatest fear relates to the loss of their relationship
Offspring identified their anger as unmanageable and chaotic, which appears to reflect the environment in which they grew up Self-focus to get their needs met Greatest fear were concerns of their own mental health
Parents found themselves overwhelmed with caring for an adult son/daughter Question their own parenting skills Greatest fear is what will happen to their child if they are no longer
available Siblings reported feeling trapped, bitter, and resented the loss of
parents time Presumed the role of caregiving for their parents Greatest fear were concerns of their own mental health
Spouses identified their anger as “excruciating” (BM) Emotional abuse was suggested by several spouses Greatest fear relates to the loss of their relationship
Offspring identified their anger as unmanageable and chaotic, which appears to reflect the environment in which they grew up Self-focus to get their needs met Greatest fear were concerns of their own mental health
Objective Burdens -- Daily Challenges
Objective Burdens -- Daily Challenges
Symptoms of mental illness Loss of family
Parents … changes in their physical environment Spouses … loss of their relationship Siblings and Offspring … changes in family dynamics
Symptoms of mental illness Loss of family
Parents … changes in their physical environment Spouses … loss of their relationship Siblings and Offspring … changes in family dynamics
Objective Burdens (Continued)Objective Burdens (Continued)
Parents take on the caregiving role for their adult children out of responsibility or guilt Actively involved in their child’s treatment Loss of personal time, career and retirement plans
Siblings struggle with communication and how to motivate their brother/sister Future caregiving responsibility Own mental health concerns
Spouses are frustrated with being their husband/wife’s caregiver Emotional abuse Communication concerns
Offspring found themselves having to “grow up” sooner than normal due to caregiving responsibilities Issues of feeling safe and secure Continued caregiving responsibilities as their parent ages
Parents take on the caregiving role for their adult children out of responsibility or guilt Actively involved in their child’s treatment Loss of personal time, career and retirement plans
Siblings struggle with communication and how to motivate their brother/sister Future caregiving responsibility Own mental health concerns
Spouses are frustrated with being their husband/wife’s caregiver Emotional abuse Communication concerns
Offspring found themselves having to “grow up” sooner than normal due to caregiving responsibilities Issues of feeling safe and secure Continued caregiving responsibilities as their parent ages
Coping -- A Process of AdaptationCoping -- A Process of Adaptation
Humbling experience for parents Lesson of compassion, empathy, and acceptance for
siblings, spouses, and offspring
Parents -- values and belief system, education, connection to others
Siblings -- connection with others, values and belief system, family
Spouses -- values and belief system, family, education Offspring -- self care, family, connecting with others
Humbling experience for parents Lesson of compassion, empathy, and acceptance for
siblings, spouses, and offspring
Parents -- values and belief system, education, connection to others
Siblings -- connection with others, values and belief system, family
Spouses -- values and belief system, family, education Offspring -- self care, family, connecting with others
Mental Health System -- Family Perception
Mental Health System -- Family Perception
Communication Limitations Policy of “family inclusion” which includes acceptance,
validation, acknowledgement, and respect Education Limitations
Advice in how to maximize their family member’s potential Coping skills in answering the following questions, What do I
say? How do I deal with him/her? Am I helping or hurting? Boundary setting (self-care vs. caregiving), problem-solving
skills, time management, anger management, stress management, and emotional regulation
Need to learn self-care skills and be ableto answer the question, Who am I?
Knowledge and information about mental illness Groups, specific to parents, siblings, spouses,
offspring; possible mentor or sponsors as you wouldfind in AA or Alanon groups
Resources available
Communication Limitations Policy of “family inclusion” which includes acceptance,
validation, acknowledgement, and respect Education Limitations
Advice in how to maximize their family member’s potential Coping skills in answering the following questions, What do I
say? How do I deal with him/her? Am I helping or hurting? Boundary setting (self-care vs. caregiving), problem-solving
skills, time management, anger management, stress management, and emotional regulation
Need to learn self-care skills and be ableto answer the question, Who am I?
Knowledge and information about mental illness Groups, specific to parents, siblings, spouses,
offspring; possible mentor or sponsors as you wouldfind in AA or Alanon groups
Resources available
Strength of Mental Health SystemStrength of Mental Health System Parents focused on the mental health system as a whole
“We could not live without it” (RL) Sibling’s focused on the mental health services their
brother/sister was receiving Group home, in-home services, medications
Spouses focused on their husband/wife’s willingness and motivation in obtaining appropriate services “For somebody who is willing and motivated to use; tow
work to get better, that has a good therapist, a good doctor, that is willing; who is on mediation and is willing to work with the medications, than the tools are there for them to get better … but, if the person is not willing to get better, there are not checks and balances” (RL)
Offspring’s focused on mental health professionals Resourceful, knowledgeable, supportive
Parents focused on the mental health system as a whole “We could not live without it” (RL)
Sibling’s focused on the mental health services their brother/sister was receiving Group home, in-home services, medications
Spouses focused on their husband/wife’s willingness and motivation in obtaining appropriate services “For somebody who is willing and motivated to use; tow
work to get better, that has a good therapist, a good doctor, that is willing; who is on mediation and is willing to work with the medications, than the tools are there for them to get better … but, if the person is not willing to get better, there are not checks and balances” (RL)
Offspring’s focused on mental health professionals Resourceful, knowledgeable, supportive
Recovery ProcessRecovery Process Acceptance; accountability/responsibility and the “do”
attitude/desire to recover Support Network including friendships/companionship of
peers Family Support Medication Management Individual and group therapy Aftercare services for mental health monitoring and follow-
through
Medication, access to good therapy, good family and friend network,support network outside of therapy … your
environment needs to be supporting meaning you knowwhere you are, doing something that you feelis worthwhile--a positive environment (CW)
Acceptance; accountability/responsibility and the “do” attitude/desire to recover
Support Network including friendships/companionship of peers
Family Support Medication Management Individual and group therapy Aftercare services for mental health monitoring and follow-
through
Medication, access to good therapy, good family and friend network,support network outside of therapy … your
environment needs to be supporting meaning you knowwhere you are, doing something that you feelis worthwhile--a positive environment (CW)
Challenges/Rewards of Working with Families
Challenges/Rewards of Working with Families
Resistance by the client to include families Family member not available … deceased, living far
away, burned out, or just not wanting involvement Projective nature of relationship -- you are the problem
and we are not
Being able to education family members, validating, and seeing client develop a quality of life with the help and support of family
Resistance by the client to include families Family member not available … deceased, living far
away, burned out, or just not wanting involvement Projective nature of relationship -- you are the problem
and we are not
Being able to education family members, validating, and seeing client develop a quality of life with the help and support of family
Recommendations for FamiliesRecommendations for Families
Involvement in the first (intake) session Provide a history of symptoms Be willing to help, listen and have a willingness to
adapt to changes Support, encouragement, and validation to their family
member
Involvement in the first (intake) session Provide a history of symptoms Be willing to help, listen and have a willingness to
adapt to changes Support, encouragement, and validation to their family
member
Implications for Practice & PolicyImplications for Practice & Policy
Individuals Diagnosed with Mental Illness
Development of a Recovery Program, including the following components: Renewing hope and commitment Redefining self Incorporating illness Being involved in meaningful activities Overcoming stigma Assuming control Empowered and exercising citizenship Managing symptoms Being supported by others
Individuals Diagnosed with Mental Illness
Development of a Recovery Program, including the following components: Renewing hope and commitment Redefining self Incorporating illness Being involved in meaningful activities Overcoming stigma Assuming control Empowered and exercising citizenship Managing symptoms Being supported by others
Implications for Practice & Policy (Continued)
Implications for Practice & Policy (Continued)
Family Needs
Information about mental illness; hands-on-training about mental illness
Development of skills for coping with and managing mental illness Development of self-care skills Development of caregiving skills; families are looking for
information in helping their family member diagnosed with mental illness to maximize their potential and develop an authentic quality of life
Psychoeducational groups for families specificallyaddressing the needs of all family members -- parents, siblings, spouses, and offspring;providing informational and emotional supportin a holistic family-centered atmosphere
Family Needs
Information about mental illness; hands-on-training about mental illness
Development of skills for coping with and managing mental illness Development of self-care skills Development of caregiving skills; families are looking for
information in helping their family member diagnosed with mental illness to maximize their potential and develop an authentic quality of life
Psychoeducational groups for families specificallyaddressing the needs of all family members -- parents, siblings, spouses, and offspring;providing informational and emotional supportin a holistic family-centered atmosphere
Implications for Practice & Policy (Continued)
Implications for Practice & Policy (Continued)
Mental Health Professionals
Development of educational programs addressing the following issues: Collaboration with family Basic information on mental illness Stress management skills for families Utilization of the mental health system Helping family members meet their own needs Behavioral issues Manage professional and ethical issues,
including issues of confidentiality
Mental Health Professionals
Development of educational programs addressing the following issues: Collaboration with family Basic information on mental illness Stress management skills for families Utilization of the mental health system Helping family members meet their own needs Behavioral issues Manage professional and ethical issues,
including issues of confidentiality
Implications for Practice & Policy (Continued)
Implications for Practice & Policy (Continued)
Mental Health System Families are not using the mental health system as
intended as a result of their negative experiences (e.g., excluded, ignored, disrespected)
Mental health services may be available but due toa complicated system that is fragmented anddisconnected the delivery of services is ineffective
Family members and mental health professionalsare all seeking ways of better communicationand yet this need continues to be unmet …development of a communication policy is neededwhich includes acceptance, validation, acknowledgement,and respect for all parties involved
Mental Health System Families are not using the mental health system as
intended as a result of their negative experiences (e.g., excluded, ignored, disrespected)
Mental health services may be available but due toa complicated system that is fragmented anddisconnected the delivery of services is ineffective
Family members and mental health professionalsare all seeking ways of better communicationand yet this need continues to be unmet …development of a communication policy is neededwhich includes acceptance, validation, acknowledgement,and respect for all parties involved
LimitationsLimitations
Small sample of families in Minnesota solicited from mental health organizations that typically advocate for individuals and families experiencing mental illness and may have more knowledge and information than families not yet connected to mental health services
Participants were primarily Caucasian from middle class backgrounds and urban population and the research study focused on adults diagnosed with mental illness and did not address the issues of families with children (under the age of 18) experiencing mental illness and their unique challenges
Program directors were difficult to engage in theresearch study due to limited time availability
Small sample of families in Minnesota solicited from mental health organizations that typically advocate for individuals and families experiencing mental illness and may have more knowledge and information than families not yet connected to mental health services
Participants were primarily Caucasian from middle class backgrounds and urban population and the research study focused on adults diagnosed with mental illness and did not address the issues of families with children (under the age of 18) experiencing mental illness and their unique challenges
Program directors were difficult to engage in theresearch study due to limited time availability
To My Family and FriendsTo My Family and Friends
We can only be said to be alive in those momentswhen our hearts are conscious of our treasures
(Thornton Wilder)
We can only be said to be alive in those momentswhen our hearts are conscious of our treasures
(Thornton Wilder)
