Most people find fulfillment in their relationships with others, and the promotion of community inclusion also focuses on helping individuals with psychiatric disabilities to do the same. Indeed, most people have a variety of relationships – with family members (as a child or sibling or uncle or aunt, for instance), or based on friendships (and both life-long friends you can talk to about anything and new acquaintances we’re just beginning to get to know), and in more romantic and/or intimate relationships. And, of course, many people with psychiatric disabilities are also parents – an important issue we deal with at in a separate section – under ‘parenting’ here and in the Resources portion of this website. Here, we interested in the strategies to help people reconnect with their families, their friends, and their romantic interests.
Most people fulfill a number of these significant social roles at the same time: at the same moment you are a devoted uncles/aunt your are also a trusted friend to others and a romantic partner to another. Such roles give us meaning and purpose, are the focus of strong commitments, and often provide resources for coping with daily troubles and life-stressors. The sense of belonging, personal well-being, and validation that stems from these roles is an important part of everyone’s mental health.
Like everyone else, individuals with mental illnesses play a variety of interpersonal or social roles. However, people with mental illnesses often face barriers to their ability to both give to and benefit from these relationships: the symptoms of mental illnesses and the side effects from medication can sometimes negatively affect how people with mental illnesses interact with their spouse, child, parent or friend. Changes in behavior, even positive ones, can create anxiety for friends and family members, who may feel responsible or guilty. For some, these everyday social roles have fallen away: family members are distant, friendships are rare, romance is only a memory.
Community inclusion programs seek to revive and/or strengthen those relationships, drawing on a recognition that family, friends, and romances can be both tremendous sources of support for the individual with a serious psychiatric disability and an opportunity for the individual to feel the joy and strength of giving to family, friends, and romantic partners.
Many individuals experience the first serious consequences of their mental illnesses as young adults. Parents, siblings, and other family members are often deeply concerned about a child or brother/sister who experiences a mental illness, and have to cope with many of the consequences of the illnesses, such as suicide attempts and incapacitation associated with severe depression, grandiose and careless behaviors associated with mania, or paranoia and isolation associated with schizophrenia.
Adults with a mental illness can experience a great deal of stress as their rights and ability to make their own decisions come into conflict with the well-intentioned attempts of those who love them to protect them from themselves. The resulting conflicts, and erratic behavior that sometimes occurs as a result of a mental illness, can drive a wedge between individuals and their families. This may partly explain estimates that 50% or more of individuals with a serious mental illness do not have contact with their families.
Community inclusion initiatives in this area try to revive or strengthen those relationships, finding a balance between the essential self-determination rights of individuals with psychiatric disabilities and the concerns of family members, between the supports everyone needs from their families and the ability to reciprocate and be a support to other family members. Programs that seek to reconnect people to their families can do a number of important things:
- family education programs – in which family members learn about psychiatric disabilities and their role in helping their loved one – have been demonstrated to benefit both those with mental illnesses and their family members;
- clarifying that individuals with mental illnesses do not lose the right to make mistakes and learn from them, like everyone else, can be important, and utilizing Psychiatric Advanced Directives (so that the family is aware of consumer preferences in a time of crisis) is useful;
- incorporation of the concept of “circles of support” in mental health care allows the individual with a psychiatric disability to choose those people who are important in their lives to participate in decision-making regarding the treatment and services they receive: family members who are included receive information about their loved one’s treatment as well as a voice, yet the individual with the illness maintains control and final decision-making ability over what services they receive; and
- emphasizing the important role that people with psychiatric disabilities play in the family – as a loving parent, trusted uncle or aunt, supportive cousin or as someone who can be counted on to help out when help is needed – is equally important.
Families can play a critical role in the recovery process, but only if families are involved and aware and consumers are prepared to play their a supporting role as well.
Friendships are a critical source of social support for everyone. Research on social support of those with serious mental illnesses has found positive relationships between social supports and social functioning; satisfaction with level of functioning; symptom alleviation; reductions in rehospitalization; and increased community tenure. There is little doubt that social support through meaningful friendship is critical to enhancing recovery and community inclusion of individuals with mental illnesses.
Unfortunately, the social support networks of individuals with severe mental illness have been found to be limited both in size and scope. The social networks of people with mental illnesses – which are only 50% the size of social networks for the general population – are also viewed as less supportive and less satisfying than those in comparison groups, and feelings of loneliness are greater among those with psychiatric disabilities than without. Individuals with a mental illness acknowledge dissatisfaction with their life circumstances and that a lack of environmental supports makes it difficult to achieve their daily needs and recovery. Indeed, the social support networks of individuals with psychiatric disabilities are often composed of ‘paid support staff’ – social workers and casemanagers and therapists, rather than friends and acquaintances.
Barriers to the development and maintenance of friendships include:
- Negative beliefs/prejudice that leads others to avoid people with a psychiatric disability;
- People with a mental illnesses avoiding others because of discriminatory treatment;
- Avoidance of others due to illness factors, including limited social skills;
- Diminished opportunities to interact with others due to fewer social roles (e.g., not working, not being a student, having fewer friends that results in fewer opportunities to meet people);
- Environmental factors, such as housing in impoverished, high-crime areas where social interactions among neighbors are limited; and
- Increased involvement with “deviant” groups (e.g., individuals who abuse substances, those engaged in criminal activity) who may be more receptive of others who are disenfranchised and disrespected by the larger community
Friendships, either with others with or without a mental illness, are a critical part of community inclusion and need to be promoted by addressing barriers and providing supports. These efforts can include:
- Increased efforts diminish the public’s negative beliefs, prejudice, and discrimination toward individuals with a mental illness;
- Offering social skills training on a routine, on-going basis;
- Providing opportunities for social interaction (e.g., coffee klatches, dances, movie nights, etc.);
- Encouraging the development of housing in communities with more resources, and less poverty, that have high community involvement and participation;
- Development of integrated housing where individuals live in apartment buildings and communities where persons without a mental illness also live;
- Encouraging volunteering in mental health- and non-mental health-related organizations and events;
- Increased funding for consumer-run services that involve a social component; and
- Insuring that people with psychiatric disabilities have the skills and resources to be a friend to others – to reciprocate.
Romantic or intimate relationships are associated with terms such as significant other, spouse, partner, or boyfriend or girlfriend. These relationships can be long-term or short-term, heterosexual, bisexual, homosexual, or nonsexual, but all are a central part of human experience. They can be a source of pleasure and enjoyment, contribute to a person’s sense of community, and provide support. In general, intimate relationships contribute to a person’s well-being.
Individuals with mental illnesses sometimes find it difficult to form these relationships. Consumers have identified a number of reasons why they may shy away from forming intimate relationships with another person or pursuing new romantic relationships, including: wanting to “protect” the other person from the effects of their illness; medication side effects including decreased desire or arousal; weight gain (also a common side-effect) resulting in a lowered self esteem; and concerns about reproduction and parenting. Some are too shy or too socially awkward to pursue romantic relationships, as well.
Many consumers feel a need to hide their mental illness when trying to establish new relationships because of the negative beliefs, prejudice, and discrimination associated with a psychiatric diagnosis. In addition, mental health providers and family members sometimes discourage the development of intimate relationships, either implicitly or explicitly, out of various concerns. But many of these concerns are not unique to individuals with mental illnesses and there is no evidence that people with psychiatric disabilities cannot sustain meaningful intimate partnerships.
People with psychiatric disabilities who are also gay may often face special problems, both in receiving treatment from uninformed or insensitive providers and in having the opportunity to address relationship issues within therapy.