A qualitative research design combined with a quantitative analytic technique, concept mapping, was used to examine and address barriers to African-American families' involvement in the treatment of their family members with mental illness. Focus groups were formed with lay and professional informants. The focus groups recommended a variety of strategies for improving caregiver supports and increasing the involvement of caregivers in the treatment process. The implications of these findings for mental health professionals are discussed.
Overcoming Barriers Faced by African-American Families with a Family Member with Mental Illness*
David E. Biegel**, Jeffrey A. Johnsen, and Robert Shafran
Family members of persons with severe mental disability can play critical roles in enhancing the treatment and care of their ill family members. However, the ability of families to fulfill their caregiving role is negatively affected by a number of barriers, including significant levels of perceived burden experienced by many caregivers and a lack of perceived support from mental health professionals and from caregivers' own informal social networks (Biegel, Milligan, Putnam, & Song, 1994). A major gap in the literature is a lack of full understanding of the role of race and ethnicity in family caregiving for persons with mental illness. There is a large body of research evidence documenting the fact that different groups of individuals meet needs and solve problems in differing ways and that there are often obstacles-systemic and personal-that differentially affect the ability, opportunity, and willingness of specific population groups to participate in organized help-seeking and receiving activities (Giordano, 1973; Naparstek, Biegel, & Spiro, 1982; Neighbors & Jackson, 1996; Padgett, 1995). Nevertheless, the role of race and ethnicity has received relatively little attention in the mental health family caregiving literature (Davis, 1982; Davis & Proctor, 1989). Thus, a fuller understanding of obstacles and barriers faced by minority populations in family caregiving for persons with mental illness is needed.
Understanding the barriers facing African-American family caregivers is of particular concern to mental health professionals for several reasons. First, African-American consumers with severe mental disability would appear to have even greater needs for family support than do Caucasian consumers, given the fact that they have higher rates of use of in-patient mental health services. In addition, African-American consumers have lower utilization and higher drop-out rates for out-patient mental health services than do Caucasian consumers (Snowden & Cheung, 1990). Second, the samples of only a few research studies have included a sufficient number of African-American family caregivers to allow a specific examination of their problems and needs (Biegel, Milligan, Putnam, & Song, 1994; Pickett, Vraniak, Cook, & Cohler, 1993; Struening, Stueve, Vine, Kreisman, Link, & Herman, 1995).
Conceptual Framework and Research Questions
This study specifically focused on ways to enhance the involvement of African-American families in the treatment and care of their family member with mental illness. A systems theoretical orientation underlies the design of this study. General systems theory (Bertalanffy, 1969) broadly defines a system as a complex of interacting elements which function together to manage the environment. Individual system elements or components are embedded within a web of interlocking relationships such that change in any one element ultimately affects the entire system. In order to truly understand the functioning of any one system element, it must be examined from within the context of the system of which it is a part.
The key informants targeted in this study-family caregivers, mental health consumers, agency case managers, and staff of the county mental health board authority-each represent major components of the local mental health system which have the greatest direct impact on the day-to-day conduct of family caregiving to persons with severe mental disability. …