All together now: The magic and mess of families

CrossCurrents

by Betty Miller

Betty Miller is co-ordinator of the family council: empowerment for families in addiction and mental health at the Centre for Addiction and Mental Health in Toronto.

My four siblings and I were caught completely off guard when our parents died unexpectedly within seven weeks of each other. I remember my sister screaming at the nurses,“Don’t you understand that I just lost my father?” as she dove into mom’s hospital bed and tried to shake her out of her coma. There was my sister, usually so generous, funny and practical, causing quite a scene. She was a mess.

The thing about families is that they are messy. They push and pull us. Up and down, good and bad, tender and vicious. Sometimes we are “in,” sometimes “out.” So many of our dreams, expectations and fears are carried out in this puzzling environment. So puzzling, in fact, that we are challenged even to say what family is.

There are nuclear families, which are related by bloodlines or adoption and which usually include a spousal relationship and children. There are also chosen families, where people are not related through biology but have a strong mutual commitment. Friends can be family. There are also extended families, which can include grandparents and more-distant relatives. And let’s not forget blended families that combine individuals from different families.

A person can have no family. Or several families. Or every imaginable combination of biological, chosen, extended and blended elements. What is important to remember is that each individual ultimately decides who is and who is not one of the family.Yes, it’s messy.

When we toss mental health and addiction concerns into the family mix, a unique blend of mess and magic emerges. Families tend to “hang in.” Imperfectly, haltingly, with hopes and fears, we hang in together. Not necessarily every time, but over time.

Families had to hang in together during the bad, bad days when we were blamed for creating mental illness. Mothers especially bore the brunt of responsibility for ruining their children’s mental health. The “experts” pronounced these moms to be cold and unloving, the families dysfunctional.

But the pendulum has swung. The latest trend holds us to a framework where mental health problems are attributed to biology, genetics and brain chemistry. The disease is almost always unending, debilitating and frightfully hopeless. Biology, genetics and brain chemistry are also believed to play a key role in substance use problems. But clients are told that they can recover. They may have relapses; but they can lead a good life – work, play, love, fail, laugh, have homes and families.

The tradition of addiction recovery holds that people rarely heal in isolation and that isolation leads to serious health problems. Programs and services are established in large part to triumph over isolation. In the mental health and addiction systems, how many clients and family members feel isolated in their problems?

In an effort to combat this isolation and better understand the needs of families, the Community Support and Research Unit of the Centre for Addiction and Mental Health (CAMH) in Toronto recently gathered and distilled current research about the role of families in the mental health and addiction system. The group created an important document with relevant information for everyone concerned with healing and recovery. The research discovered what families have been saying for years: The most effective and cost-efficient mental health and addiction services must engage families in three ways: by involving them in their loved one’s plan of care, by providing professional services directly to families and by connecting families to peer supports. Achieving these goals requires a family-friendly health care system.

To push families to the centre of care, the Family Council and the Community Support and Research Unit at CAMH created the Family-Centered Care Initiative. The project spans the breadth of the organization’s mental health and addiction programs. Members of the project come from all of the clinical programs and include family members, clinical staff, physicians, nurses and managers. As we broaden our thinking, the future may involve staff from other parts of the system, as well as community representatives.

We are pushing the system to create a family-friendly philosophy of care. That includes, by definition, a client-centered approach to care that is grounded in the hope, belief and practice of recovery.

Mental health and addiction services are on their way to becoming integrated. The future for us relies partly on how well we do this. It also relies on how well we decrease the isolation and discrimination that people with mental health and substance use problems endure. As families, we want our offerings to be recognized. And in case no one noticed, we will advocate, quarrel, plead, schmooze and jump through almost any hoop to give our loved ones, and ourselves, the best shot at life. This can look, on the outside, at least, quite messy.

It’s not the families that are cold and unloving – it’s the system. Let’s work together to warm it up.