Academic journal article Health and Social Work

Resources and Supports for Mothers with Severe Mental Illness

Academic journal article Health and Social Work

Resources and Supports for Mothers with Severe Mental Illness

Article excerpt

Over the past 20 years, community mental health services have enabled individuals with severe mental illness (SMI) to spend more time in the community and to have greater opportunities to ace normal developmental life tasks. Currently, women with SMI appear to be as likely to have children as women in the general population. Although these mothers tend to be single parents, often live in inadequate housing, have small social networks, and lack social and emotional supports, they have received little treatment attention. This article presents a systematic review of literature published in the past decade that describes interventions for mothers with SMI. These interventions are critiqued, and implications for future interventions are drawn using a psychiatric rehabilitation framework.

Severe mental illness (SMI) refers to long-term and persistent disorders such as schizophrenia or major affective disorders that disrupt capacities to carry out primary aspects of daily life (Dennis, Buckner, Lipton, & Levine, 1991; Gonzales, Kelly, Mowbray, Hays, & Snowden, 199 1). Over the past 20 years, the goal of community mental health services has been to enable individuals with SMI to spend more time in the community and thus to have greater opportunities to develop personal skills necessary for coping with life tasks. Psychosocial rehabilitation can be used within the community mental health rubric to address this goal. It involves development of both specific individual skills and environmental resources to assist individuals with SMI in functioning successfully in the environments of their choice with a minimum of ongoing professional intervention (Farkas & Anthony, 1989). Theoretically, psychosocial re- habilitation can encompass any of the wide variety of domains in which individuals with SMI may choose to function.

Unfortunately, community-based interventions are often conceptualized as dealing with a clientele for whom gender and socioeconomic issues are unimportant (see, for example, Bachrach & Igadebon, 1988; Mowbray & Benedek, 1988; Mowbray Herman, & Hazel, 1992). Yet services to those with SMI must be sensitive to the individual characteristics of clients if they are to truly meet their environmental and social needs (Gonzales et al., 199 1). When treatment is generic, it may de facto be more appropriate for men than for women and for those in dominant rather than subordinate positions. Psychosocial rehabilitation techniques have concentrated primarily on vocational rehabilitation, with some consideration given to educational environments and housing or living arrangements. Only peripheral attention has been given to social relationships such as friendship, and rehabilitation needs in intimate or parenting relationships have been all but ignored. Indeed, the assumption present in the major text describing psychiatric rehabilitation is that the clientele of concern are younger adults, with family of origin being their only kinship bonds (Farkas & Anthony, 1989).

This article reviews programs for mothers with SMI described in the published literature from 1983 to 1992, reviewing what is currently being tried and with what effect. These programs are then assessed against a psychosocial rehabilitation perspective: the extent to which they focus simultaneously on developing needed skills and on ensuring supportive environments. From this review and assessment, we suggest improvements in service delivery to mothers with SMI. Ten articles describing interventions were reviewed. Diagnostic criteria change with time, are not completely reliable, and may be culturally biased. In spite of these difficulties, every attempt was made to include all studies describing programs for mothers with SMI and to exclude studies in which diagnoses were other than SMI. Some of the problems of the vagaries of diagnoses were ameliorated by focusing only on research conducted within the past decade. …

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