After engagement with these eLearning materials you will

  • have an understanding of how the concept of stress manifests in families who are affected by mental health problems.
  • be able to consider different perspectives of how to support families affected by stress.
  • be able to try different ways to support stressful situations in families struggling with mental health problems.

Most families experience burden when someone in a family is affected by mental health problems. Living close to a person with such problems can put the family in situations where they have to make, often difficult, choices between their own wishes and the sick person’s needs (Weimand, Hall-Lord, Sällström, & Hedelin, 2013). Family members must use different ways to cope with the stressful situations and it is of decisive value to identify the families’ different kind of need of support and information provide the family members with pertinent information. Traditionally the mental health services have concentrated on the needs of the individual without including the family and this is problematic because families and lay carers are often the sole support mechanisms for people with mental health problems in the community (Tranvag & Kristoffersen, 2008).

Mental health nurses need to learn to work in collaboration with families and carers, and establishing partnerships with them where the service user is central to the relationship between the two entities and the principles of partnership and mutual concern guide the relationship between all parties. Additionally, to involve the family members in the care and treatment of persons´ with mental health problems is crucial, as close family support often plays an important part in the recovery process for persons’ with mental problems (Pharoah, Mari, Rathbone & Wong, 2006). It is a conscious way of working with preventive mental health for the families and thus prevents different kind of crisis.

Stress is a multidimensional concept which describes the stressors, the current states of the organism, and their subjective experience. Stress is the experience of a disruption of meaning, understanding and smooth functioning with possible consequences for the person, in the form of harm, loss or challenge (Benner & Wrubel, 1989).

A transactional view of stress allows for flexible definitions of coping at the expense of specific information with which to make decisions about optimal coping strategies (Lazarus & Folkman, 1984). The central concept in these models is that a given event or situation may be perceived in different ways by different individuals. It is the subjective perceptions – rather than the objective stressors – which are seen as the main determinants of effects on subsequent behaviours and health status. This approach to understanding stress can fit well in a family experiencing stress, including people of all ages and in different situations.

Lazarus and Folkman's interpretation of stress focuses on the transaction between people and their external environment and is known as the Transactional Model. You can learn more about the Transactional Model by watching the following video.

The model conceptualizes stress as being a result of how a stressor is appraised by the individual and how that individual appraises his/her resources to cope with the stressor. The model breaks the stressor-stress link by proposing that if stressors are perceived as positive or challenging rather than as a threat, and if the stressed person is confident that he/she possesses adequate rather than deficient coping strategies, stress may not necessarily follow the presence of a potential stressor. The model proposes that stress can be reduced by helping stressed people change their perceptions of stressors and providing them with strategies to help them cope and improving their confidence in their ability to do so. See figure of Lazarus & Folkmans transactional model as an example of possibly pathways for a person that is experiencing major depression (Skärsäter 2002, p 26).

However, although all individuals experience stress, people interpret and react to it differently. Some stressors are viewed as challenges creating stimulation and excitement. Other stressors are viewed negatively, perhaps because they are considered undesirable, uncontrollable, or emotionally distressing. Many people remain healthy despite being exposed to stressful circumstances, and some people mature more rapidly after effectively managing stressful life events (Benner & Wrubel, 1989).

A central assumption underlying all stress process formulations is the existence of factors that mediate the experience of stressors and the expression of symptoms of ill being or dysfunction. These mediating factors either intervene between stress and illness or have interactive or buffering effects that moderate the impact of stressors on distress and mental health. Social resources or social support, coping resources, and coping responses or behaviours are some critical groups of mediating factors. Thus, social supports, such as family and friends, and individual coping styles have all been shown to moderate the effects of stressors on depression (Brown & Harris, 1978; Lazarus and Folkman, 1984).

  • Think about some stressful event that you have experienced in your own family. Was your experience different from your family members? If so, why do you think that you had different feelings or experiences? How can you explain it from the theoretical perspectives as described by Lazarus & Folkman respectively Benner?

  • Find out what methods that are available for healthcare personal when trying to assess the needs of families and carers in a systematic way.

While the family can be a great source of support, it can also be source of stress, which can be heightened if one or members are affected by mental distress. Each family member can feel alone in their family, and have difficulties articulating their needs and thoughts or they may feel that they are not being listened to. In a crisis situation it is important to have access to people that a person can rely upon if needed, the crisis can be even larger, when trust in someone in the family is questioned.

Positive social support (family or friends) plays an important role in one’s ability to make healthier choices in crisis situations. The support of the family and friends during a crisis has long been seen to have a positive emotional effect on people.

As a mental health nurse you can support a person in a crisis situation by helping them to maintain structure to their day which can lead to healthier living. You can support or remind the service user to:

  • Keep an ordinary day rhythm, such as staying awake during the day and sleeping at night
  • Keep medical appointments
  • Follow medical instructions
  • Get regular exercise
  • Eat healthier foods

You can encourage family and friends to provide practical support, such as lifts to the service center, doctor or pharmacy, going to the supermarket, and offering childcare during health care visits. The encouragement of friends and co-workers can motivate people who experience stress to become more active and take steps to get back to work etc. more quickly.

Families living close to someone affected by mental health problems might experience many challenges, although some can be descriptions of positive perceptions of caring experiences, there are also perceived as negative and disrupted the family members’ sense of equilibrium, and thus perceived as a burden. Many emotions such as fear, self-doubt and anger can appear as a consequence of a lack of understanding about what was happening to the service user. Also, family members can feel a loss of sense of self which risk to impact on the participant’s self-confidence and their ability to cope. In addition, when family members encountered the mental health services, they often faced negative attitudes towards them, thus increasing the stress in the families. Although people experience stress, we know that people interpret and react to it in different ways. Some challenges can create stimulation and excitement, other stressors are experienced as negative and emotionally distressing. Social support is a well-known source of support, but in times of illness, when a family member is affected by mental distress, mental health nurses need to be sensitive to the needs of families who care for people with mental health problems. In addition they need to treat families with dignity and respect, be positive in their attitude and approach and should demonstrate awareness of their needs.

Beardslee, W. R., Gladstone, T. R., & O’Connor, E. E. 2011. Transmission and prevention of mood disorders among children of affectively ill parents: A review. Journal of American Academy of Child and Adolescent Psychiatry, 50, 1098–1109. doi:2011.07.020

Benner, P. & Wrubel, J. 1989. The primacy of caring: Stress and coping in health and illness. Menlo Park, CA: Addison-Wesley.

Brown, G. W. & Harris, T. O. 1978. Social origins of depression: A study of psychiatric disorder in women. London: Tavistock.

Lazarus, R. S., & Folkman, S. 1984. Stress, appraisal and coping. New York: Springer Publishing Company, Inc.

Pharoah, F., Mari, J., Rathbone, J. & Wong, W. (2006). Family intervention for schizophrenia. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD000088. DOI:10.1002/14651858.CD000088.pub2.

Skärsäter, I. 2002. The importance of social support for men and women suffering from major depression. A descriptive and explorative study. Doctoral dissertation from Sahlgrenska Academy at Göteborg University.

Tranvag, O. & Kristoffersen, K. (2008) Experience of being the spouse/cohabitant of a person with bipolar affective disorder: A cumulative Process over time. Scandinavian Journal of Caring Science 22, 5 – 18.

Weimand, B.M., Hall-Lord, M.L., Sällström, C., & Hedelin, B. (2013a). Life-sharing experiences of relatives of persons with severe mental illness – a phenomenographic study. Scandinavian Journal of Caring Sciences, 27(1), 99-107.

The European Commission support for the production of this publication does not constitute an endorsement of the contents which reflects the views only of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein.