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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

Minding Your Mind Minding Your Mind

Helping Families Understand Mental Illness

March 26, 2014

By Michael Craig Miller M.D.

Harvard Medical School

Mental health clinicians receive rigorous training before treating patients with psychiatric disorders. Family members, on the other hand, may find themselves suddenly thrust into a crisis with a loved one, struggling to understand an illness they know little about — all while dealing with their own powerful emotions.

The result, not surprisingly, is that families often do not know how to respond effectively when a loved one develops a mental illness. Anger, guilt, shame and other negative emotions may hinder families' ability to support patients. And society’s continuing stigma about mental illness doesn’t help. Clinicians would like to better involve and support family members. But dealing with patient privacy, overbooked schedules and insurance paperwork can be daunting for loved ones.

Fulfilling a Need

Recognizing the challenges, the National Alliance on Mental Illness (NAMI) offers a free 12-week course, the Family-to-Family Education Program. Participants get the latest information about major depression, bipolar disorder, schizophrenia, obsessive-compulsive disorder, panic disorder and substance use disorders.

The developers of the program recognize that severe mental illness is painful for the family as well as the person who has the illness. The idea is to help family members better appreciate the experience of the person who has the illness. The program is designed to change family members' awareness of the illness itself.

The course has been offered since 1991. Randomized controlled trials (the gold standard of medical research) have shown that the Family-to-Family program significantly improves a person's ability to cope by increasing their knowledge about and acceptance of mental illness.

In one study, published in 2011, 300 family members were recruited to participate in the research when they signed up for a Family-to-Family course. Family members were randomly assigned to either take the class immediately or wait for the next one (the control situation). All participants underwent a 60-minute structured interview before classes began and three months later, to gauge the impact of the course. Individuals assigned to take the class also participated in a follow-up interview six months later.

People assigned to take the Family-to-Family course were significantly better able to cope with problems and to resolve them. They also had a better understanding of mental illness and were less anxious than those assigned to the wait-list control. A follow-up analysis (published in 2013) suggests that the benefits continued for at least six months.

Family education about mental illness is considered an important part of treatment. The Family-to-Family program enables us to put this into practice. And this evidence-based treatment option is free.

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How the Program Works

The course is taught by other family members who are trained volunteers. Participants meet with instructors once a week for two to three hours at a time.

Participants first learn about the biological causes of mental illness. They come to understand that mental illnesses are brain disorders that have a physical basis, like any other medical illness. The illnesses are nobody’s fault. They are not caused by bad parenting. Participants learn why physiological problems in the brain can show up as troubling symptoms and behaviors. They also learn how these disorders are diagnosed and treated.

Most of the classes are lectures. Participants get to share stories related to the topics or to participate in skills-building sessions. For example, participants learn and practice reflective listening techniques, so that they understand the emotions the person with the illness is expressing as well as the words he or she is using.

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Building Community, Building Mental Health

The research is particularly encouraging because it shows the program’s enduring effects. Families feel less distress. And they have more problem-solving skills, coping, empowerment and knowledge.

The authors point out that people who attend the course can view it as a worthwhile long-term investment rather than a short-lived pat on the back.

No doubt, there is great value for participants in experiencing mutual kindness and support from people who have faced similar challenges. The teaching and learning does appear to increase the power of the program. This is a terrific example of the impact of helpers helping helpers.

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Michael Craig Miller, M.D. is the former editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 30 years.

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