Siblings are considered logical replacements for aging parental caregivers of persons with severe mental illness. For workshops on future planning conducted with 400 elderly parents, 60 siblings answered a survey regarding their future caregiving expectations, anticipated difficulties, and need for help. Nearly all expected to be involved, but were more likely to provide social and emotional support than the instrumental support offered by their parents. Nearly half indicated that the consumer's hostility and lack of cooperation were major barriers to effective care. It was suggested that siblings need education and help from professionals in assessing behaviors, interacting appropriately, and conferring control of their own lives to their ill relatives. For consumers, social skills and self-esteem training in psychiatric rehabilitation programs should address the area of sibling relationships and reciprocity. Such issues should be dealt with early, rather than later in the course of illness

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Although mental health professionals have shown much enthusiasm for the concept "expressed emotion (EE)," little critical analysis of the concept has appeared in the literature. Placing families in dichotomous categories of high EE and low EE amounts to stereotyping; such an approach does little to help professionals in understanding the complexities of family life with a mentally ill relative. High EE is seen as a factor that maintains mental illness in a relative. Once more, families feel hurt and alienated. Once more, families feel negatively labeled, but not empathically understood.

Older parents of adults with long-term mental illness need professional help with planning for their offspring's future. This assistance should focus on mechanisms such as estate planning to enable case management and other services after parents' death. The involvement of nondisabled siblings in planning should also be encouraged.

To meet the exigencies of coping with the onset of schizophrenia in the family, caregivers sought out an array of professional and nonprofessional supports. The respondents to a questionnaire, all members of a self-help group, reported considerable merit to the help of friends, relatives, and group members. In contrast, the various forms of therapy were valued little; nearly half found no value at all. These findings are better understood when needs of families are expressed. Of highest priority are understanding of the illness, practical guidance in patient management, and community resources such as housing. These are not typical functions of therapy. Self-help groups may serve these needs better.