No abstract

Mental illness has far-reaching effects on other family members, as individuals and as members of a social system. While the study of the family impact of mental illness has been reported in the specialized mental health literature, it has not received much attention from sociologists. This article applies an illness behavior perspective to the study of family burden, reviews knowledge, and invites research by defining a number of issues, substantive and methodological, that need to be addressed. These include the definition and measurement of burden, diagnosis and course of illness, residence and kinship, social class, context, and coping, and the evaluation of social interventions designed to reduce burden and strengthen family supports. The article concludes with a discussion of family burden in terms of normative forces operating at the macro level.

The purpose of this article is to suggest dimensions for conceptualizing continuity of care and to propose some appropriate and useful measures. The dimensions considered include discharge planning, successful and rapid transfer, and implementing individualized service plans. Because discontinuity is more easily measured than continuity, most of the emphasis is on gaps, lags, and interruptions in the system of care. All are relevant to effective management of psychosocial rehabilitation programs. To illustrate, we describe the use of these measures in a study of 100 persons in transition from hospital to community living in western Massachusetts. Defining and Measuring Continuity of CareAlthough it has a long history in general medicine, in mental health continuity of care is a relatively new concept (Steinwachs, 1979;Rogers and Curtis, 1980). The first comprehensive review of its use in the mental health literature did not appear until 1981 (Bachrach, 1981). The recent emergence of the concept coincides with the growing decentralization of mental health services and the multi-faceted problems of the chronically mentally ill whose need for care is ongoing as well as episodic (Test, 1979).The concept is used both negatively and positively. In its negative form, the expression "continuity of care" calls attention to communities and program staff being unprepared to provide appropriate services to the many patients discharged from mental hospitals, and to the inability of community mental health centers to provide food, shelter, clothing, and opportunities for social interaction. In its positive form, "continuity of care" is used to signify an ideal to be fulfilled. While strategies vary for improving continuity in the system of care, all involve the development of a continuum of services and psychosocial interventions to help those who have been in institutions for many years adjust to community living (Johnson Foundation, 1985).Although the concept is in broad use, in both negative and positiveThis document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Recent changes in social policy toward the mentally ill highlight the role of the family, particularly as deinstitutionalization shifts a greater part of the burden to family members. Research by sociologists in the 1950's indicated that family members go through predictable stages in response, but there has been little recent attention to this issue and few ideal types have been proposed. Based on intensive interviews with 30 families of mentally ill persons, the present study led to tentative identification of nine stages of response: (1) initial awareness of a problem; (2) denial of mental illness; (3) labelling; (4) faith in mental health professionals; (5) recurrent crises; (6) recognition of chronicity; (7) loss of faith in professionals; (8) belief in the family 's expertise; and (9) worrying about the future. Implications of this ideal type are discussed in terms of the role of the family and relationships with mental health professionals.

Data provided by case managers in community support programs are used to analyze the problems of families providing shelter to mentally ill relatives. Factors affecting complaints in 345 family households are contrasted with factors leading to complaints in a subsample of 622 other residential alternatives. Behavioral problems are the best predictors of complaints from all households regardless of type, but some causal factors identified are unique to family residences, notably failure to perform household chores and infrequently socializing with friends. Active and passive rule violations, encompassing both do's and don'ts, are more important than clinical history and social background in understanding complaints.