Working Collaboratively with Families

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  • This article was downloaded by: [University of Wisconsin-Milwaukee]On: 07 October 2014, At: 18:32Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number:1072954 Registered office: Mortimer House, 37-41 Mortimer Street,London W1T 3JH, UK

    Social Work in Health CarePublication details, including instructionsfor authors and subscription information:http://www.tandfonline.com/loi/wshc20

    Working Collaborativelywith FamiliesAgnes B. Hatfield PhD aa University of Maryland , USAPublished online: 12 Oct 2008.

    To cite this article: Agnes B. Hatfield PhD (1997) Working Collaborativelywith Families, Social Work in Health Care, 25:3, 77-85, DOI: 10.1300/J010v25n03_07

    To link to this article: http://dx.doi.org/10.1300/J010v25n03_07

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  • Working Collaboratively with Families

    Agnes B. Hatfield, PhD

    SUMMARY. Research studies indicate that significant tension char- acterizes the relationships between providers and families whose relative is being treated in the mental health system. The author recommends that genuinely collaborative relationships be developed in order that people receiving treatment receive optimal care. Collab- oration is defined, barriers identified, and ways to overcome these barriers suggested. [Arlicle copies available for afee fmm The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinjb@ haworth.com]

    The role that families play in the support and care of their relative with mental illness has gained increased attention in the past two decades. It is now generally recognized that people with mental illnesses do substantial- ly better in life if they have the interest and concern of their families. It is also recognized that the personal cost to the family in providing support and care can be high and burnout is likely if providers do not provide appropriate support and information.

    The way families of mentally ill relatives are viewed has shifted so markedly in the past few years that it has often been called a paradigm shift. Providers have shifted from seeing families as causing mental illness to viewing them as victims of it with their suffering being almost as great

    Agnes 8. Hatfield is Professor Emeritus, University of Maryland. This paper was presented at the First International Conference on Social Work

    in Health and Mental Health Care, The Hebrew University of Jerusalem, Jerusa- lem. January, 1995.

    [Hawonh co-indexing entry note]: "Working Collaboratively with Families." Hatlield. Agnes B. Co-published simultaneously in Social Work in Health Cam (The Hawonh Press, Inc.) Vol. 25. No. 3, 1997, pp. 77-85; and: Social Work in Menlal Health: Tiends and Issues (ed: Uri Aviram) The Haworih Press, lnc.. 1997, pp. 77-85. Single or multiple copies of this article are available for a fee from The Hawonh Document Delivery Service [I-800-342-9678. 9:00 a.m. - 500 p.m. (EST). E-mail address: getinfo@hawonh.com].

    O 1997 by The Haworth Press, Inc. All rights reserved. 77

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  • 78 SOCIAL WORK IN MENTAL HEALTH: TRENDS AND ISSUES

    as that of their disabled relatives. Instead of seeing families as a part of the problem, they are now seen as part of the solution. No longer do profes- sionals focus on the pathology of families, but rather on their strengths. The view that families need treatment has given way to the view they need support, information, and practical assistance. The goal is to empower families, not diagnose and label them as clients or patients.

    SOCIAL CHANGES LEADING TO ATTITUDINAL CHANGES

    The recent profound attitudinal changes toward families were a result of a number of interrelated social changes. Of special importance were:

    (1) A shift from psychological to biological explanations of mental illness. Through modem technology much progress has been made in understanding the nature of the brain and the way that certain brain anom- alies explain the symptoms of mental illnesses (Andreason, 1984). Well designed psychosocial research has not supported earlier notions of family causation of mental illness (Howells & Guirguis, 1985; Hirsch & Leff, 1975).

    (2) A shift in the locus of care of mentally ill individuals from institu- tions to communities. During the period of the asylum, it was possible to keep families at arms length, but once people were returned to the comrnu- nity, professionals began relying on families for much of the necessary caregiving. It was no long tenable to view families as competent in care- giving and at the same time consider them pathological and noxious to their relative.

    (3) The growth of the family consumer movement. The National Al- liance for the Mentally Ill (NAMI) in the United States has grown rapidly in sophistication and influence since its beginnings in 1979. For the first time in history, there was a vocal group of families insisting that their voices be heard. For the first time providers came to understand the tre- mendous burden of mental illness to the family and how families defined their problems and needs. They made clear that they wanted: (1) empath- ic understanding; (2) information and education rather than treatment; (3) partnership with professions in the treatment of their ill relatives (Hat- field & Lefley, 1987; Hatfield, 1990; Lefley & Johnson, 1990; Marsh, 1992).

    PROFESSIONAL RESPONSES TO FAMILY NEED

    Of the three family demands noted above, probably most progress has been made on the first two. Understanding of the family dilemma has been

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  • Agnes 6. HaiJield 79

    significantly enhanced by a plethora of studies about the way that mental illness affects the whole family (Cooke, Lefley, Pickett, & Cohler, 1994; Hatfield, 1978, 1979; Hoenig & Hamilton, 1955; Lefley, 1987; Tessler, Killian, & Gubman, 1987).

    Numerous educational programs and a variety of support groups have been created in all parts of the country as a response to the problems and needs identified by families (Hatfield, 1990, 1994; Marsh, 1992). While not yet available everywhere, there is growing evidence that families value these programs a great deal (Hatfield, Coursey, & Slaughter, 1994).

    The third concern of families for genuine partnerships with providers in the treatment of their relatives, however, has not been fully realized. In fact, several studies have reported consistently negative feelings about fami- ly relationships with providers (Hatfield, 1978, 1979; Holden & Lewine, 1982; Johnson, 1984; Terkelsen, 1990). Johnson found that families were not satisfied with either the information that professionals provided them or with the services received. Holden and Lewine (1982) reported that a majority (74%) of families were dissatisfied with mental health services and Lefley (1985) noted that mental health professionals who had mentally ill relatives were as dissatisfied as other families.

    Additional studies have suggested that professionals were unaware of the degree of dissatisfaction of families. These studies demonstrated wide '

    discrepancies between the way that families evaluated services and the way professionals viewed them. Families surveyed by Hatfield (1983) reported that there was essentially no relationship between their needs and what professionals chose to address in sessions with them.

    McElroy (1987) found significant differences between families' and nurses' perceptions of the degree to which families were stressed by vari- ous aspects of their relative's illness. Other researchers (Spaniol, Jung, Zipple, & Fitzgerald, 1987) r