Families A Help or Hindrance in Recovery Introduction This articles outlines how traditionally many families have not been given the information or strategies for helping their families in the recove

							Families: A Help or Hindrance in Recovery

Introduction
This articles outlines how traditionally many families have not been given the
information or strategies for helping their families in the recovery process. As a result,
families have tended to unwittingly be a hindrance in their relative’s recovery. The
Family Outreach and Response Program in Toronto, Canada has created a program that
teaches and supports families in developing a critical perspective of the mental health
system and to create a recovery environment in their family.

Background
Families of those recovering from serious mental health issues are probably one of the
last groups within the mental health community to embrace the vision of recovery. Their
experience of the mental health system is one of despair, hopelessness, helplessness,
alienation, isolation and discrimination. Families are often told by psychiatrists and
family support programs to grieve the loss of their loved one as they knew them, to lower
all expectations of their relative’s future and to make sure their family member takes their
medications. This leads to a family environment that does not promote recovery but
rather may hinder the recovery process. How can a family nurture a recovery atmosphere
when they feel their lives are full of hopelessness, sadness, anger and power struggles?

Traditionally, family support and education programs mostly focused on teaching
families about diagnosis, symptoms, medical treatments, mental health resources, crisis
intervention, communication skills and self-care. There was little, if any, mention of
recovery and no critical examination of the mental health system from a trauma-informed
and anti-oppression perspective. These programs created like-minded thinking between
families and mental health professionals, which further reinforced the limiting idea that
mental illness is a disease and must be treated with medication or otherwise, recovery is
not possible.

In North America, the alliance of mental health professionals and family organizations
has entrenched the medical model of mental health distress and has led to an extreme
over-reliance on psychiatric medications and coercive mental health legislation. A
collateral damaging consequence has been the divisiveness between the psychiatric
survivor organizations and family groups. Psychiatric survivors have been highly
skeptical of family involvement in the recovery movement. Often survivors have felt both
the controlling and paternalistic (and often traumatizing) experience of both their own
families as well as those of large family advocacy organizations.

However, most people who are in extreme distress want the love and support of their
families and most families want to be helpful in a caring way. This is the underlying
principle of the Family Outreach and Response Program (FOR). FOR believes that
families can be exceedingly helpful in their relative’s recovery when given education,
support and skills based on a critical recovery perspective.
The Family Outreach and Response Program – A Family and Recovery Approach
The Family Outreach and Response Program is a non-profit, community family initiative
located in Toronto, Canada. Since its inception in 1997, the program has worked together
with consumer/survivor advocacy organizations and fought against coercive mental
health legislation and refused any funds from the pharmaceutical industry. However, the
program’s values of self-determination, choice, respect, and anti-oppression did not
always fit well into its practice with families on an individual or group level. Like many
of its fellow family programs, FOR had fallen into the net of using traditional “best
practice” family psychoeducational approaches.

In 2001, FOR decided to create a family education and support program that would be
based on both a recovery approach and a critical psychiatric perspective. A staff team
comprised of a psychiatric survivor and a family member began by conducting a
literature review of recovery and critical psychiatry. The only article they could find
written about families and recovery was the Windhorse Guide for Families by Constance
Packard. This article which was published on the Windhorse Associates website gave
FOR the basic foundation for a curriculum. The Guide speaks about the disservice the
medical model does to families and gives a clear message to families that recovery is
possible and, most importantly that their attitudes, beliefs and behaviors are important to
that recovery process. The article suggests that families create an attitude of acceptance,
respect and hope.

FOR’s course content was based on the research and stories of what psychiatric survivors
said they needed to recover: hope – belief that recovery is possible; self-determination –
people need to be in charge of their own recovery journey; choice – people need to have
real choices about their supports; recovery education – knowledge and tools/strategies
for recovery; support – to give and receive mutual support.

The course has structured into a 10 week, 2 hour program which uses a number of adult
education strategies – lecture, small and large group discussion and exercises, role plays,
videos, self reflection exercises, homework and readings. Almost all of the resources
used have been written or produced by psychiatric survivors. The maximum number of
family members is 12 per group. The definition of family member is broad and includes
any significant person in the live of someone recovering from extreme emotional distress.
The majority of participants have been parents. Typically, a psychiatric survivor and
family member co-facilitate the group.

The program uses two textbooks for the course: A Mental Health Recovery Reader for
Providers, Survivors and Families (Compiled by Ann Thompson, Canadian Scholars’ Press Inc.
Toronto, 2006) and Pathways to Recovery Self-Help Workbook (Priscilla Ridgway, Diane
McDiarmid, Lori Davidson, Julie Bayes & Sarah Ratzlaff, University of Kansas School of Social Welfare,
Lawrence, Kansas, 2002)

The course outline includes:
   • Introduction to Mental Health Recovery –what are people recovering from?
   • Pathways to Recovery and Barriers
   • Hopelessness and the Power of Hope
   •   Role of Family and Tapping Resilience
   •   Power and the Role of Family
   •   Understanding Motivation and Stages of Change
   •   Having a Strengths Perspective
   •   Self-Reflection and Self-Care
   •   Family Recovery Action Planning
   •   Recovery – the Evidence and the Practice

The Results
The key messages that families report taking away from the course are that: recovery is
possible even without any professional intervention (for many families this is the first
time they have heard this message); hope is the cornerstone to recovery – it is almost
impossible to recover without hope and the family’s role is to “hold the hope”; to avoid
creating learned helplessness by being overly-involved; to support risk-taking and giving
the relative the dignity and freedom to fail like any other human being; to let go of
controlling relative’s choices – this is their recovery journey; to stop viewing everything
from a problem orientation and start building on strengths; to view madness as a human
experience; don’t use coercion or forced treatment; explore alternatives and use advanced
directives.

Families also have reflected back on the importance of the group process in learning
about recovery and their own behavior. Families want a place that does not perpetuate
their guilt or shame about their own role in wounding their relative but helps them to
acknowledge their role and behavior and help them to make change in a safe
environment. Many families acknowledge that they started this journey as either
uninformed or misinformed and that often their natural intuition as to how to be helpful
was actually counter-productive. Families also become aware of their own internalized
discrimination or mentalism about people with mental health issues. Families learn to use
language that does not hurt or hinder recovery.

Future Challenges
Toronto is one of the most diverse ethnoracial cities in the world, with over 100
languages spoken. (www.toronto.ca) This poses challenges for understanding family
structures, dynamics, beliefs and attitudes that are different from the dominant culture
particularly with respect to notions of autonomy, extended family and community. FOR
is now partnering with specific ethnoracial communities to learn more about how
recovery makes sense in their communities.

The program also needs to create ongoing mechanisms for recovery education and
support. Like all of us who work from a critical perspective, families confront opposition
and sometimes hostility from the mental health system. They need support to maintain
their hope, strength and resilience to create a recovery environment at home and to make
change in the system.

The Family Outreach and Response Program has seen the transformation of individual
families adopting a recovery approach. Family members have healthier relationships as
power struggles are greatly reduced. These family members know that their relatives are
in charge of their own recovery and as a result there is less coercion to use unwanted
medications or to force hospital admissions. FOR believes that these families can make
useful allies with survivors in creating change within the mental health system.


This article was written by Karyn Baker and appears in Alternatives Beyond
Psychiatry, 2007, P. Stasny & P. Lehmann editors (p. 254-260)