Family Carers' Experiences in Striving for Medical Care and Finding Their Solutions for Family Members with Mental Illnesses

Authors: Yu-Yu Wang, Shih-Hua Hsieh, Ru-Shian Hsieh

Abstract:

Wishes and choices being respected, and the right to be supported rather than coerced, have been internationally recognized as the human rights of persons with mental illness. In Taiwan, ‘coerced hospitalization’ has become difficult since the revision of the mental health legislation in 2007. Despite trend towards human rights, the real problem families face when their family members are in mental health crisis is the lack of alternative services. This study aims to explore: 1) When is hospitalization seen as the only solution by family members? 2) What are the barriers for arranging hospitalization, and how are they managed? 3) What have family carers learned, in their experiences of caring for their family members with mental illness? To answer these questions, qualitative approach was adopted, and focus group interviews were taken to collect data. This study includes 24 family carers. The main findings of this research include: First, hospital is the last resort for carers in helplessness. Family carers tend to do everything they could to provide care at home for their family members with mental illness. Carers seek hospitalization only when a patient’s behavior is too violent, weird, and/or abnormal, and beyond their ability to manage. Hospitalization, nevertheless, is never an easy choice. Obstacles emanate from the attitudes of the medical doctors, the restricted areas of ambulance service, and insufficient information from the carers’ part. On the other hand, with some professionals’ proactive assistance, access to medical care while in crisis becomes possible. Some family carers obtained help from the medical doctor, nurse, therapist and social workers. Some experienced good help from policemen, taxi drivers, and security guards at the hospital. The difficulty in accessing medical care prompts carers to work harder on assisting their family members with mental illness to stay in stable states. Carers found different ways of helping the ‘person’ to get along with the ‘illness’ and have better quality of life. Taking back ‘the right to control’ in utilizing medication, from passiveness to negotiating with medical doctors and seeking alternative therapies, are seen in many carers’ efforts. Besides, trying to maintain regular activities in daily life and play normal family roles are also experienced as important. Furthermore, talking with the patient as a person is also important. The authors conclude that in order to protect the human rights of persons with mental illness, it is crucial to make the medical care system more flexible and to make the services more humane: sufficient information should be provided and communicated, and efforts should be made to maintain the person’s social roles and to support the family.

Keywords: Family carers, coercive treatment, independent living, mental health crisis, persons with mental illness.

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1130925

References:

[1] Chang, J. and Hsu, R. F. (1995). “The Process of Hospitalization of Persons Who May Have Serious Mental Illness,” in Chinese Journal of Health, Vol. 14, No. 5, pp.438-445.
[2] Chen, C. Y., Hsu, S. K., Chen, C. C., and Lai, C. H. (1996). “The Needs and Social Support of the Main Carers of Outpatient Mental Health Patient,” in Chinese Journal of Health, Vol. 15, No. 2, pp.27-44.
[3] Large, M. Ryan, C. Nielssen, O., & Hayes, R. (2008). “The danger of dangerousness: why we must remove the dangerousness criterion from our mental health acts”, in Journal of Medical Ethics, 34, 12: 877-81.
[4] Lee, C. B., Hsiao, S. C., Liao, S. C., Lee, Y. L., and Liu, W. Y. (2008). “A Preliminary Study of the Community Care for Mental Health Patients Program,” in Mental Health Nursing, Vol. 3, No. 1, pp. 20-27.
[5] Liu, R. T. (2007). “Care Model of Community Integration of Clients with Mental Disability.” In Nursing Journal, Vol. 54, No. 5, pp. 11-17.
[6] Shen, S. H., Shen, S. J., Chang, D. R. and Yen, M. F. (2005). “The Mental Health Education Needs of The Main Carers of Community Mental Health Patients,” in Health Promotion and Education, No. 25, pp.89-108.
[7] TaipeiLife of Heart Association, (2011). “The history of the Mental Health Community Visits,” Available at: www.心生活.tw/mediafile/.../2011-5%5C2011-5-23-13-56-8-nf1.doc Accessed on 2/18/2017.
[8] Tang, Y. C., Wu, H. C., Chen, S. Y., and Chang, L. S. (2011). “The Concept of Compulsory Treatment – A Human Rights Perspective,” in Disability Studies, Vol. 9, No. 1, pp. 1-16.
[9] United Nations (1991). Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care. Geneva: United Nations.
[10] Wu, H. C., Lin, W. Y, Chang, L. S. and Tang, Y. C. (2012). “The Function of Review Board for Mental Health Compulsory Hospitalization and Community Treatment – A Study of the Committee Members with Social Work Background,” in Soochow Journal of Social Work, vol. 23, pp. 9-46.
[11] Yang, M. R. (2003). “The Review and Refinement of Community Rehabilitation Model,” in Annals of the Taiwan Mental Health Prospects Conference, pp.76-96.
[12] Yang, T. T. and Wei, C. W. (2008). “The New Mental Health Act and Compulsory Treatment,” in Yuan-Yuan Nursing, Vol. 2, No. 2, pp.11-17.