Session Three: Mental Health Problems

Partnering With Families Affected by Concurrent Disorders - Facilitators' Guide

Session Goals

Provide an overview of mental health problems.
Help participants understand mental health issues affecting their family.
Develop a better awareness of what it is like to have mental health issues and why substance use and other addictive behaviours might be something to which that person is especially susceptible.
Encourage identification of practical approaches to addressing the issues of daily living.

Content Outline

Why do people develop mental health problems?
Mental health disorders.
Personality disorders.

Activities

3-1: Identifying Mental Health Problems

Leaders’ Notes

Family members may have a lot of information about mental health problems, particularly the health issues of the ill family member. However, this knowledge is often spotty and ill-formed. Consequently, it is important to offer participants an overview of these issues so that they begin to understand how mental health problems arise, and how to address them effectively.

Discussing the complexity of problems

In this session mental health problems are organized along four dimensions—psychosis, anxiety, mood and impulsivity. For participants with family members with a severe and persistent mental illness, this may represent an expanded view of mental health problems. The presence of a powerful diagnosis such as schizophrenia or bipolar disorder may mask other problems, so that the complexity of symptoms are reduced to one overarching problem rather than a number of issues, each of which could be addressed in its own right. For example, someone who has schizophrenia could also have a social anxiety problem, which could be addressed using social skills training.

Discussing diagnosis

We found that family members are often preoccupied with “the diagnosis.” They may already feel frustrated and confused because of their previous experiences of seeking care for their family member. They want someone to tell them what is wrong and what needs to be done. They often have stories of misdiagnosis—and as result misprescription of medication. They sometimes talk of multiple diagnoses, some of which compete with one another.

This is another instance where we found it useful to start discussing the issue in this early session and then pick up the discussion again in Session 7 (Navigating the Treatment System). One point to reinforce is that these problems are complex. Because these issues often vary in their presentation, “what’s up front at any point in time” (as one participant put it) will vary also. It is usually only over time that the service provider gets an accurate picture, so it is understandable that families may have had negative, unsatisfying experiences in their search for understanding and help.

Respect the frame of reference and belief system that participants may have. Some may have trouble accepting a particular diagnosis because it means the ill family member might need to take prescription medication; others might have trouble seeing that many people need an active, well-supported approach to psychosocial issues as well as medication. Facilitators need to anticipate that family members will share their beliefs and options and to develop a plan to deal with the issues constructively.

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