Because of systemic changes in mental health treatment since deinstitutionalization, parents have taken on more involved roles for their children with serious mental illness (SMI), even when their children have reached young adulthood. However, the changes in parental roles and relationships with their adult children with SMI, and the grief that stems from those changes, have not been adequately reflected in research or treatment interventions. Studies primarily focus on individual perspectives and neglect the relational nature of grief within a family. The absence of a family perspective in treatment systems leave parents to navigate grief and loss on their own. In this article, we systematically review 12 papers on the grief experiences of parents of an adult child with SMI. Through a thematic analysis of the findings it becomes clear that there is a need for employing a family theoretical perspective to address the inherent relational nature of grief. Ambiguous loss theory provides a relationally grounded model which expands our understanding of parents' grief and gives direction for more effective interventions for families.
K E Y W O R D S adult children, grief, parents, serious mental illnessAccording to the National Institutes of Mental Health (n.d.), serious mental illness (SMI) 1 impacts approximately 4.5% of the US population. Research on SMI has largely been studied from a biomedical perspective, with a primary treatment focus on the reduction of an individual's symptoms. Systemic shifts in the treatment of SMI from institutionalization to 1 The National Institutes of Mental Health (n.d.) define SMI as "a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities." The American Psychological Association (n.d.) also provides guidance on specific diagnoses which could be included in SMI (e.g., schizophrenia, schizoaffective disorder, or bipolar disorder). For this systematic review, the definition used for SMI is a mental health impairment that lasts for 2 years or longer, and/or a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder.