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However, the evidence base for social interventions that are at the disposal of mental health social workers is small, incomplete and disproportionate in size to that available to psychologists or psychiatrists Webber, , In the South African context, psychiatric services are still fragmented and it is often the mental health social worker in the MDT who becomes the link to the community resources and even the coordinator of services within the MDT. If the rest of the team is 'stuck', the patient's problem often becomes a 'social' issue and other team members may become frustrated with the lack of progress.

As hospitalisation of psychiatric patients has become increasingly brief nationally and internationally and as patients are discharged in quite unstable clinical states, the burden on the caregivers has become considerable. Vieta , 52 emphasises the importance of establishing and maintaining a therapeutic alliance. Treatment should be based on a collaborative relationship with the patient and family. It is clear that an integrated, holistic approach is essential. It has been observed that the MDT focuses mainly on the patient, whereas the partners, families or caregivers are often neglected.

An important role of the mental health social worker in a psychiatric hospital is to reach out specifically to the significant others, because they are the secondary sufferers of the mental illness. If their needs are addressed, the patient also benefits.

Edited by André F. Carvalho and Eduard Vieta

How well families do in the face of a severe mental illness may depend to a significant extent on how well their needs for support are met Hatfield, b: Caregivers and caregiver burden. A caregiver can be considered as any lay person who cares about and is in frequent contact with the person diagnosed with BD. Caregivers of people who have been diagnosed with BD have certain emotional reactions to the illness, but also certain needs that pose definite challenges. These needs can include developing an ability to deal with their own emotions in relation to the illness, to be educated about the BD and.

The emotions, needs and challenges will differ, depending on the role of the specific caregiver in the system. The patient must be observed within the context of his or her interpersonal environment and the stressors within this environment. The caregiver is part and parcel of the patient's environment. A caregiver can also be a child of the person diagnosed with BD.

Caregiver burden is described as the presence of problems, difficulties or adverse events which affect the life lives of the psychiatric patient's significant other s , e. Family, caregivers and needs. The ways in which families respond to mental illness varies as a function of time. Any response undergoes its own patterned temporal development, a pattern that transcends individual differences in response disposition Terkelsen, b: Terkelsen b mentions the following stages: ignoring what is coming, the first shock of recognition, stalemate, containing the implications of illness, transformation to official patient status, the search for causes, the search for treatment, the collapse of optimism, surrendering the dream, picking up the pieces.


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Belardinelli, Hatch, Olvera, Fonseca, Caetano, Nicoletti, Pliszka and Soares are of the opinion that BD is a familial disorder which is influenced by genetic and environmental factors. Among the environmental factors considered as most important is the family environment. Previous studies link a disordered family environment with a poor prognosis for BD.

Mondimore and Aiken , agree and refer to the fact that BD does not affect just the individual with the diagnosis of the illness. Inevitably, family and friends are affected in countless ways, both directly and indirectly. When a family member has BD, the illness may profoundly affect the whole family. It is a sad fact, but BD not only destroys the mind; unfortunately, due to lack of understanding, it can also destroy the dynamics of relationships.

Lefley refers to the necessity of what cross-cultural researchers call the "emic" approach; that is, the outsider must learn to perceive the situation through the eyes of the subject, rather than superimposing his or her own external model of reality. This involves learning the family's experience of the illness, their theories about causes and their views of roles. Rather than observing a putatively maladaptive "system" through the lenses of theory, the therapist helps the family build survival skills within the framework of their expressed needs. In this study it was also very important to discover the real needs of the caregivers.

In the seminal study by Hatfield assessing the needs of families of mentally ill patients Hatfield, a found the following needs were most prominent:. If the professional is aware of these needs, there is a better chance that unrealistic expectations will not be placed on the caregivers and that professionals too will have more tolerance towards the demands presented by caregivers. Profile of participants. Participants in the collective case study encompassed a wide spectrum of people:. It is argued that women perform the role of caregiver better, although this would be a generalisation.

Children are severely affected by a mentally ill parent - even when they are adults. This was clear when the children of mentally ill persons reflected on their lives. The parent participants were all mothers and their unconditional love for their children was clear.

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There were two families involved in the study where the wife and child of the patient were interviewed, providing different perspectives. Figure 1. The category needs, with the theme needs of participants and sub-themes derived from the transcribed interviews, is presented in Table 1.


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These are supported by narrative verbatim quotes from the interviews and literature to substantiate the findings. Theme: Needs of participants. As suggested by Ogilvie et al. This theme contains nine sub-themes. Sub-theme 1: Acknowledgement. This sub-theme is reflected in the participants' comments below. But what about the person, do you think that is just superwoman or super husband standing there?

Participants felt that the patient always receives all the attention and that the caregiver is often ignored. They put the patient's interests above their own. Sub-theme 2: Sacrificing one's own needs. The participant comments below reflect this sub-theme. Her needs are more important than mine. Hers are much more intense than mine. Supporting a person with BD who is very ill may prove exhausting, often to the point where a person might neglect their own needs Aiken, Sub-theme 3: Support emotional and financial.

The participant comments below support this sub-theme. At times I feel just that I could go and talk to somebody who knows precisely how I am feeling, who has got the same, who knows precisely how a person with BD or depression works, or who can give me practical advice on how to sort out my own feelings. I don't know and you sort offeel, where am I going now? I just had enough of being the strong one all the time, being the mother andfather of this child and know that I don't have any support at that stage of any emotional or yes the financial means of an income, but the emotional support I really needed more at that stage.

It is evident from these quotes that caregivers need support on different levels. Families need opportunities to relate to persons with similar experiences. How well families do in the face of a severe mental illness may depend to a significant degree on how well their needs for support are met Hatfield, a, b The following participant comments reflect this sub-theme.

Actually I will grab them with both hands for sure. The little book doesn't exist but that would have been nice. Participants' need for initial and ongoing psychoeducation on a practical, understandable level was indicated. They also need to know how to access information. Families need to know about their relative's illness if they are to be informed consumers and expected to help the recovering individual McElroy, Family members of people with BD are usually hungry for information about the disorder, particularly during or after a manic or depressive episode, whether or not the episode involves hospitalisation.

Relatives may harbour many misconceptions about the illness. Well-meaning relatives who do not understand the disorder may view drug treatment or psychotherapy as crutches. They should understand that at least a portion of the patient's behaviour is biologically and chemically determined Miklowitz, , , , It is important that everyone in the family learns as much about the illness as possible in order to know what they are dealing with Aiken, Sub-theme 5: Skills, tools and coping mechanisms.

The participant comment below supports this sub-theme. And Ifind that it is more practical for me if somebody tells me I did this and this. Participants were unsure of what to do - sometimes not realising that there is no recipe. Caregivers do have a need for skills such as how to communicate with the ill BD patient or what to do if the patient becomes suicidal, as well as other coping skills. The participant comment below reflects this sub-theme. That is what our agreement is.

I am very glad that she is offering me that time. I think if she wasn't offering me that time, it wouldn't have gone the way it is going now. I can't. I have got my outlet, four hours on a Sunday that is a little bit of an outlet. It became clear that caregivers need some time away from the caring situation. Sub-theme 7: Order and stability. The following comment reflected the participant's need for order and stability.

If he just was stable. At the moment the only way I see that stability will come is when he is not around. But where does he go? Caregivers long for stability in their own lives amidst the chaos that can be created by a bipolar patient. Sub-theme 8: Need for programme. This sub-theme is reflected in the participant comment below. So the need for training in the form of a specific programme was expressed. Sub-theme 9: The future. This sub-theme is substantiated by the following participant comment.

What if I have it? CAMH refers to the caregiver's fear about what the future holds. The uncertainty of the future thus may create anxiety with relatives Miklowitz, Caregivers may also be concerned about the future because bipolar illness is largely a genetic disorder and might affect the couple's children. The unpredictable nature of this illness can be a huge obstacle to making future plans. Uncertainty about the future may cause a caregiver to feel as if they are in limbo unable to move forward owing to the fear that the illness will spring up Last, , On occasion, it can prove impossible to plan ahead of time because of the varying episodes of the sufferer's mood Aiken, Families' lack of understanding of the mental illness and how to deal with it affects the rehabilitation outcome negatively.

The significant other, be he or she the parent, child, spouse or other relative, also has to deal with the multiple losses that accompany the illness. It is therefore important to adopt a broad view, as is provided by the integrated biopsychosocial framework. This also puts more strain on caregivers. Although hospitalisation can be traumatic for caregivers, discharge of a loved one may also challenge the caregiver, family and patient.

This sometimes results in caregivers giving up, while families become less vocal - they just become silent. If their needs can be addressed, the patient will also benefit. A non-blaming stance broadens the possibilities of working with families as partners. It may range from a private decision by an individual to adopt a certain strategy, through to a formal document drawn up by an individual to consult family, friends and health professionals.

Suicide prevention could form part of the wellbeing plan. It is also important to develop an advance directive relapse plan. It is important to contract with the caregivers in terms of their roles and responsibilities. Aspects such as these can be undertaken by an auxiliary social worker and patients should be empowered to do things for themselves. Dependency should never be encouraged.

Family experiences of bipolar disorder: The ups, the downs and the bits in between. London: Jessica Kingsley Publishers. Family environment patterns in families with bipolar children. Journal of Affective Disorders, BERK, L. Living with bipolar: A guide to understanding and managing the disorder. Bipolar disorder: An information guide.

Psychoeducation as a core element of psychological approaches for bipolar disorders. West Sussex: Wiley-Blackwell.

Health & Wellbeing Collection: Depression & Bipolar Disorder

Psychoeducation manual for bipolar disorder. New York: Cambridge University Press. Checkout Your Cart Price. Description Details Customer Reviews Although depression is the most common presentation of bipolar disorder, correct diagnosis presents a formidable challenge. Review This Product No reviews yet - be the first to create one!

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