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27th May 2016

Family, Recovery and Individuals with Serious Mental Illness: A Welsh Perspective

Last week I wrote about the recovery challenge posed by schizophrenia. This week I am exploring some of the real life challenges faced by individuals recovering from mental illness, in particular, schizophrenia and their families. So what exactly do we mean by recovery?

I guess it’s the holy grail following mental illness? The Social Services and Well-being (Wales) Act, 2014 lists determinants of well-being in an attempt to outline a holistic scheme which takes account of the full range of experience which gives life meaning. I shall refer to one of the specific determinants as the article unfolds.

Recovery is not the same as an absence of symptoms but implies getting back to a decent level of functioning, an even keel, some kind of normality, achieving a new equilibrium and being able to withstand whatever else life decides to throw at an individual. But the nature of mental illness is that it doesn't just disappear, it leaves a stain of taboo and some very real deficits in respect of cognitive functioning to say nothing of the collateral damage on relationships, career, self esteem and well-being. Above all, recovery must keep hope alive and the prospect a fulfilling life.

"For any one individual the biggest step to recovery may be finding a place to live, getting a job, establishing a good relationship with their family… usually there are a set of different things which are important to an individual’s recovery." Hafal, 2016.

Let us consider one of the 'steps' mentioned by Hafal (family relationships) with reference to one of the specific determinants outlined in the act as it might apply to an individual recovering from schizophrenia. Determinant d) in the Act refers to "domestic, family and personal relationships"

While I was nursing I remember working with a very skilled nurse who had training in family support for families with a family member who had schizophrenia. She taught me how the family has a very important bearing on the overall recovery. The dynamics of family life can be testing on the most able and well individual, but for the individual with schizophrenia, stress and tension can be enough to trigger relapse and new episodes of acute symptoms. In particular households with high levels of 'expressed emotion' may be difficult for the recovering individual. These households often express frustration or anger towards the recovering individual borne out of a lack of understanding of the reduced level of functioning which they may perceive as lazy or feckless behaviour. Oftentimes the family is left without any real understanding of the illness or how they may be able to play a constructive role in promoting recovery.

In many instances the individual recovering may be a parent themselves which can leave children with increased duties, responsibilities and difficulties such as:

  • Domestic chores;
  • Emotional caregiving;
  • Keeping up with school work;
  • Maintaining social and leisure activities.

The knock on effect of the illness can be that it not only affects the well-being of family members often causing anxiety and depression, but that it can negatively impact life trajectories by leading to relationship and family breakdown, unemployment, homelessness and exclusion from society. For this reason, if the recovery concept is to be meaningful it must inspire hope within the individual but also challenge wider society to make opportunities available which help give life meaning for the individual in recovery.

*All information is correct at the time of publishing. Use of this material is subject to your acceptance of our terms and conditions.

Nic Bowler

Welsh Care and Social Services Inspectorate Specialist

Dr Nicholas Bowler is a researcher and consultant to government-level [Welsh Government Review of Secure Services, 2009] – specialising in QA/compliance focused projects. He has interests in clinically relevant training, service development and research. He enjoys working with clients to support them in identifying problems and initiating projects to improve practice.

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