Learn how social factors promote mental health, influence the onset and course of mental illness, and affect how mental illnesses are diagnosed and treated. This course explores how our understanding of mental health and illness has been influenced by social attitudes and social developments in North America and around the world. The course begins by situating our contemporary mental health practices in historical context, then looks at different aspects of mental health, mental illness and mental health services and their connections to what’s going on in our social environment.
5.1 families and mental health
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From the course by University of Toronto
The Social Context of Mental Health and Illness
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From the lesson
Families, caregiving and mental illness
Meet the Instructors
Charmaine WilliamsAssociate Professor
Faculty of Social Work
Before we get into section one, I'm just going to remind you about the Family Guide
to Mental Health re-, Recovery, which we'll be revisiting through the lecture,
through the video clips that you'll be seeing.
This, this website actually has more videos available on it than the ones
you'll be seeing in the lecture, so if you'd like to see the rest of them,
they're available in the gallery that you see linked here.
You can also, you can also get to those videos by going to the front page of the
website, and we also have the website linked as one of the resources, bef-,
beside lecture 5.0. So we're starting with families and mental
health. And we're starting with families and
mental health, because I believe that promoting mental health is one of the
primary functions of families. On a basic level, families function to
promote the health, growth, and development of all of the family members,
and it does so by performing functions like the ones you see here.
Some like protection, physical nourishment and safety, are geared to securing the
survival of family members and others like love, nurturing and spiritual nourishment,
are geared toward promoting the happiness and well-being of family members.
Let's take a closer look at how families work.
In social work, we talk about the family as being a system that interacts with
other systems in the social environment. The family system must operate in certain
ways in order to carry out the functions that were suggested on the previous slide.
Some of the processes that must be in place are connections between the members
of the family, as indicated by the arrows I've put here.
These connections are important so that people feel connected to each other,
learning and information is transmitted between family members and emotional
safety is in place. These connections between family members
are also why the well-being of individual family members is tied up with the
well-being of others. If one part of the family system is
unwell, then others can become unwell. At the same time, when members of the
family system are well, then this can contribute to wellness for others.
The family system must also have boundary system within it, and around it.
The boundaries within a family system are to foster a sense of personal integrity
and independence, for each individual family member.
The boundary that surrounds the family system, is to ensure that members feel a
sense of connection within, and are given some protection from what is outside of
the family system. But these boundaries are not impenetrable,
it's important for there to be points of openness between family members, and also
between the family and the external environment.
Another thing that we see in family systems, is role differentiation.
This just means that different people have different roles and different things to
do. Families have tasks that need to be
carried out and the family functions effectively when there are people in place
to carry out those roles effectively and there's clar, clarity about who has what
role in the family system. Some would also say that hierarchy is
important in the family system, because there's a need to have some people who
carry extra responsibility for insuring the family system is operating smoothly.
In many families, this will be the parents, or maybe grandparents in a
multi-generational family. But the person who assumes more
authoritative roles, and the importance of hierarchy and chains of authority within a
family system, is very much determined by culture.
And when I say culture, I'm thinking about Ethno-culture, but I'm also thinking about
just the culture of the family itself. In psychiatry there have been attempts to
actually measure how functional families are by using scales that evaluate how
they're dealing with various challenges and responsibilities, that families must
address. An example of such a scale is the McMaster
Model Of Family Functioning. It's very much based in a Judeo-Christian
organization, or sorry orientation to family functioning, and based on questions
about family structure, organization and interactions, which help us to
characterize families in terms of their health and effectiveness.
The McMaster Model is oriented to identifying strengths in families, but
it's also able to identify areas of difficulty, challenge, or even severe
problems. The sixth categories for evaluation are
listed here. Problem solving, is this a family that is
able to solve problems, and has a usual set of steps for doing so?
Communication, Is there effective communication among family members?
Roles, is there clarity, clarity about who does what, and how things get done, and do
they get done? Affective resposiveness, is this a family
that's able to share and communicate appropriate emotional responses to each
other? Affective involvement, are members of the
family interested and concerned about each other, invested in each others well-being?
And finally, behaviour control, does this family have some kind of internal controls
in place that set the boundaries and the latitude for acceptable behavior?
Okay I just want to pause for a moment here to emphasize the point that I made
earlier about, culture. So, the McMaster Model of Family
Functioning, gives you a framework for thinking about families and what they have
to accomplish. And, you can see that it defines
healthiness in terms of things like being able to communicate directly with people,
in terms of, the way that people express affection around each other, this sort of
thing, right. But that's very much embedded within a
particular cultural context. So if we're thinking more generally about
families, it means that the McMaster Model for Family Functioning may not trans-,
translate very well to other cultural context, we don't know, it will translate
better to some than to others. But in a more general sense, when we're
thinking about the health of families, I think on a fundamental level we want to
know,is this family functioning in a way that promotes the health and well-being of
all of its family members. And if you see a family that is
functioning in a way that does not promote that health, does not promote their
security and safety, does not promote their well-being, then you start thinking
about, well what's going on with this family that's getting in the way of that.
So I just wanted to make sure that we were clear that there isn't one model for
effective family functioning. So what happens to families when a family
is affe-, when a family member is affected by mental illness?
Well the health promoting functions of the family remain the same, but there are new
challenges introduced. The personal resources that each family
member brings to the family system may not be at a sufficient level to promote family
health. The entire family system may be depleted,
by the impairment of one or more family members and the effects that, that has on
everyone else. In addition, for reasons that we will
discuss later in the lecture, supports and resources that had been outside the family
in the external environment, which helped at the function effectively, may not be as
available anymore and this will have an effect on the families' health promoting
capacity, too. Families do not necessarily know how to
deal with having a member that is mentally ill.
Attitudes toward mental illness, specifically stigma, get in the way of us
talking openly about mental illness. And some of the consequences of that, are
that there is little preparation for individuals to know how to deal with being
diagnosed with a mental illness, and also little preparation for families to know
how to deal with having one of their members diagnosed.
Despite the challenges, families play an important role in promoting mental health
in the context of mental illness. This is discussed by a family member in
this first segment from The Family Guide To Mental Health Recovery.
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