engl 102_final draft of proposal_pdf

Proactive Integration

of Family Members in

the Patient’s Mental-

Health Treatment

Sessions Proposal for South Coast Community

Services in Orange County and San

Bernardino County, California

A mental-health patient and his/her closely linked loved ones would all

benefit from regularly attending psychotherapy, psychiatry, and case-

management appointments together and in smaller groups within

themselves. These family members, significant others, and intimate friends

can help the clinicians explore with the patient effective coping skills and

techniques, can help monitor medication times to prevent potential episode

relapse, and can obtain useful information about outside mental-health

resources and opportunities for greater patient success. This application

needs to start locally and extend outwardly, and the existing methods by

which South Coast Community Services already keeps family members and

others involved in the patient’s treatment need to be expanded, for the sake

of cognitive, dialectical, and behavioral healing on a grander scale, for all

included.

ENGL

102

Ellen Drummonds

Instructor Justin Mott

5/23/2016

Proactive Integration of Family Members in the Patient’s Mental-Health Treatment Sessions

1

Instructor Justin Mott | BY ELLEN DRUMMONDS

It is widely understood that family members and other close loved ones provide support

and comfort for the people in their lives—especially in times of need or distress. In the event of a

person’s diagnosis of mental illness, his/her family (genetic or non-) must then rally around the

new “patient” and confront the issue head-on. An ideal approach to the alarming discovery of a

psychiatric condition would be for the loved ones to act as an integral component to the

individual’s treatment. Although it is the choice of the family members to become involved in

their kin’s therapy at mental-health facilities, patients often “go it alone” in attending their

appointments by themselves, especially teenagers and older. The notion may be that the patient

by him-/herself is the one experiencing the mental, emotional, psychosocial, and/or behavioral

trouble, but that should not mean s/he needs to face the usually intense and thorough healing

procedures without a sound support system in place. Actually, members of the support system

physically attending the sessions on a regularly scheduled basis is best if both the closely

connected persons and the patient are prepared for all entailed in the steps to reinvigorated

health.

The patient’s family can help buttress positive-affirmation thinking, reassuring self-talk,

and assertive and mindful action in the patient’s everyday life while s/he also utilizes frequent

communication and his/her personal interests/hobbies to manage stress. They can also help

supervise the patient’s medication times and dosages each day and can ensure that s/he is able to

have them refilled as needed and often at the local pharmacy, in order to reduce the chance of

episode relapse. Lastly, the family figures—specifically those living in the same household as

the patient—can be given case-management resources that will assist the patient with

independent-living skills concerning housing, transportation, job-seeking, school applications,

and more.

One particular treatment center for mental-health programs is South Coast Community

Services, which operates in Orange County and San Bernardino County, California. The center

offers psychotherapy, psychiatry, and case-management sessions for children, teens, young

adults, and their families—numbering nearly 20,000 patients, according to the website (Ortiz).

The ideas and ideals being represented here are proposed as such and meant to be executed at

this particular treatment center, in a foundational grassroots, down-top movement to effect


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constructive change in the communities of South Coast’s ventures. While this program gives the

option of family integration, the assertion being made here is that the accessibility of such an

essential element is not eagerly and expressly proffered to the patients who may profit

exponentially from it. The scenarios and examples outlined below are unequivocally intended for

this local program but are also able and need to be enlarged to other treatment providers similar

to South Coast Community Services. The cerebral health of patients and their families depends

on it.

A predominantly deciding factor in a child’s brain development is his/her home

environment and exposure to stressors (England). According to the section on The National

Institute of Mental Health’s Blueprint for Change: Research on Child and Adolescent Mental

Health (2001), entitled “A Decade of Progress: Key Findings in Neuroscience, Behavioral,

Prevention, and Treatment and Services Research”, children’s brains are more likely to indicate

inhibited brain-cell survival and neuron density when their caregivers and others near to them are

abusing or neglecting them. This is precisely interrelated with children’s, and later, adolescents’,

cognitive, emotional, and behavioral functioning—and this is how more and more teens and

young adults are being diagnosed with a mental disorder. Sometimes, the detrimental behaviors

go unchecked until much later in life. At such a critical time of DSM1 classification, it is

imperative that the closely connected relatives and other loved ones in a person’s life become

actively involved and rather hands-on in ensuring the enhancement of the likely-young new

patient’s overall well-being. Loved ones may have played a significant role in creating and

reinforcing, through genetic history and behavior modeling, disordered thinking, speech, and

action patterns. They could have been part of the problem; now they have a chance to be part of

the solution.

Many mental-health treatment providers have already incorporated in their goal-planning

and -achieving methodologies a series of printed forms, with the possibility of only verbal

consent necessary, available to get family members absorbed in the patient sessions. However,

these clinicians often do not readily inform their patients/clients of this capability. Although, if

1 The DSM is The Diagnostic and Statistical Manual of Mental Disorders. It is published by the American

Psychiatric Association (APA) and is used frequently as a reference guide for clinicians in diagnosing and knowing

ways to approach various forms of mental illness when needing to treat them in patients.


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they do, they do not tend to emphasize the sheer import of having parents, siblings, close

extended family members, and/or significant others and best friends attend a session or two to

increase their capacity of helpfulness for the patient they love. All the rigamarole of completing

alphabet-soup-reminiscent forms—PHIs for “Protected Health Information,” AMRs for

“Ancillary Medical Reports”—can be confusing, especially to someone recently diagnosed with

a debilitating “mind disease.” But it doesn’t have to be. Parents and other relatives need to be

going to the counseling, psychiatry, and case-work appointments early on—not just for the sake

of the patient’s knowledge that the family is accepting and consoling of them, but also for the

purpose of strengthening the clinical workers’ treatment techniques. Comprehending in a

surface-level manner that the family practices orthodox Christian faith is one thing—but

apprehending the dynamic of all the household members strictly adhering to the religion while

the patient is “falling away” from it? That is another story. Core aspects of family interaction and

role-assumption are compelling to evaluate when the patient has just suffered a severe manic—

hyper-cognitive and -active, euphoric—break that happened to take place at a private Christian

university. The family is struggling to accept, causally or otherwise, the ramifications and

incidence of the episode. From a psychotherapy perspective, it is useful when realizing that the

patient manages harmful stress most competently when surrounded by like-minded peers, ones

who may be more religiously and ideologically diverse than the patient’s staunch relations. From

a psychiatric approach, the awareness can pertain to the family’s readiness to coexist with a

person who must partially rely on unfavorable psychotropic medications to maintain his/her

health and diminish symptomatologic occurrence. From a social-work angle, the reality may help

to establish patient access to outpatient groups or local clubs for persons with his/her diagnosis

and/or more free-thinking worldviews.

Some people may present the contention that a primary reason mental-health treatment

facilities do not make family incorporation more of a norm in their goal-sets is that families are

not so willing to attend the sessions with their nearest and dearest. The people likely somehow

implicated in a patient’s mental condition(s) may not want to “dwell in the past” or drudge up

old problems, and the patient him-/herself may feel the same way. In addition, some of the more

dominant figures in the patient’s history may not be playing an active part in it anymore—maybe


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even as a result of the seriousness of the episode that culminated into diagnosis. Feelings could

have gotten hurt, ill-will spread. Still, it is necessary to keep in mind that the betterment of the

patient’s cognitive-dialectical and dialectical-behavioral health is typically comprised of resolute

and widespread aid from people the patient cares about and spends time with the most. Healing

is not easy, but it is warranted—especially with the aim of focusing on therapeutic endeavors

while minimizing stressors/episode-triggers and utilizing tools developed for people in need.

Close relatives may know a person better than the self does—contrary to some general

presumptions. These people can help employ coping skills—perhaps mood diaries for patients

with bipolar or portrait-painting for persons with schizophrenia or stress-balls for the anxious—

domestically and outside the home. Their role in a patient’s life could inspire him/her to hone in

on what used to matter—and their compassion could mean the world. In her seminal

autobiographical work, An Unquiet Mind, Dr. Kay Redfield Jamison—who practices medicine in

the field of her manic-depressive-illness diagnosis—recounted her fear-provoking confession to

her then-boyfriend, David, of her condition:

David could not have been kinder or more accepting; he asked me question after

question about what I had been through, what had been most terrible, what had

frightened me the most, and what he could do to help me when I was ill. . . I

explained to him that, due to the relatively rare side effects of lithium that affected

both my vision and concentration, I essentially could not read more than a

paragraph or two at a time. So he read to me: he read poetry. . . Moment by

moment, with infinite patience and tact, his gentleness—and his belief in me, in

who I was, and in my basic health—pushed back the nightmare fears of

unpredictable moods and violence (145).

Dr. Jamison is the rare kind of clinician who can relate to her patients’ experiences on a deeply

personal level. She takes lithium, a commonly prescribed mood stabilizer and antipsychotic, and

before she composed her memoir, she even unknowingly took the pill in practically lethal

amounts. But staying on the medication was necessary, she knew, and it was coupled with

coping strategies that proved effectual, like being openly honest with her lover about the uneasy

state of her mind. Her aforementioned heart-stirring divulgence of such a private instance with


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her significant other illustrates that two people or more devoting time and energy into something

as simple yet stimulating as poetry recitation can unlock the powers of multifaceted healing.

Sometimes it does not take much to hold sympathy or even empathy toward an individual or

group’s plight—it just requires a special connection and also, perhaps, a certain degree of

discernment into coping skills—for Jamison, medicine, itself—that can help a person grow and

feel nurtured.

The very thing that has helped a counselor deal with his/her own delicate matters in the

past could be of use to the patient undergoing treatment. Deep-breathing techniques and

daily/nightly meditation have been verified as beneficial approaches to calming the mind and

body (Harvard University). When the body is relaxed, so can be its governing center for thought,

word, and deed, which leads to a more fluid “stream of consciousness” to advance one’s life into

a dimension of positivity and curative self-care. This could develop into the treatment provider

and the patient’s realization that the long-forgotten pastime(s)—the choir performances, the

science-fair projects, the inventions—the patient once enjoyed, in disregarding them over time,

could actually be a contributing reason the person is depressed and listless.

On the opposite end, spending too much time with those hobbies and interests could

launch a patient into a long-term state of elevated mood, which is also dangerous when

excessive. Behavioral rehabilitation has a great deal to do with balance and moderation,

especially when evaluating one’s alcohol use or shopping sprees or nonstop online gaming,

which could be signs and/or even triggers of mental upset and specific behavioral addictions

(Grant, Potenza and Weinstein). When it is evident that a patient seeks immediate gratification

from and experiences trouble controlling impulses with certain activities, then it may be time to

reassess them as prospective coping mechanisms. These recreational habits may very well be

addictions or otherwise unhealthy behaviors underneath their disguise. Nonetheless, one practice

that is often done in exorbitant quantities and with extreme frequency, and probably illicitly—

drug use—could also be a patient’s solution for the alleviation of his/her symptoms of mental

affliction. This is where the psychiatrists come in.

Prescription medications are not a panacea, but they do act as facilitators for neurological

processes (Mayo Clinic Staff). When a script for certain medications—mood stabilizers,


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antipsychotics, antidepressants, anti-anxiety capsules, etc.—is written by a doctor of psychiatry,

it is critical that the closely involved persons in a patient’s sphere of influence know about it.

This is in part due to possible and injurious medication interactions, such as over-the-counter

antihistamines with antidepressants (Doheny). Perhaps more important, however, is the fact that

some patients can prove to be noncompliant when asked to hold fast to a specific daily and/or

nightly medication regimen, which necessitates the commitment on the part of family members

and dear friends to monitor medication times with the patient. This may be elective, but if the

patient struggles to keep to the schedule and dosages and specifications of taking the pills—such

as doing so with food and/or not with any other psychoactive medication—then it is crucial that

there be friendly reminders given by the people in the household. The possibility for increased

health is greatly lowered in the patient when s/he is inconsistent with or completely “goes off”

the meds. The primary point of taking them—aside from assuaging the symptoms and signs of

illness—is to circumvent potential relapse.

All the while, closely linked persons can identify “triggers” for their kin, such as a

debilitating break-up or even one night of alcohol use, that could lead said person toward a

mental breakdown and/or avoidance of taking medications as prescribed, or even mixing them

intentionally. These family figures can also determine if arguments between them and/or family

tension as a whole could be causative factors in the patient’s psychological stressors. They can

point out what usually occurs right before a “full-blown” episode, like going days with little or

no sleep and/or barely eating or giving away his/her possessions. This intuition can add a

tremendous amount to family-focused therapy sessions and enlighten the treating psychiatrist as

to whether the current medication arrangement is working for the patient, when compared

against times of “baseline” normalcy.

Correlated with aforesaid coping skills underscored in psychotherapy discussions,

psychiatrists can iterate throughout the course of treatment the sheer import of medication

conformity as such a strategy. Furthermore, the patient and the family can report to the doctor

possible and actual issues with the medications, as they arise. One such concern could be weight

gain or hand tremors or memory loss, and the doctor and the patient—with the occasional input

from the directly tied family members—could collaborate on risk/benefit analysis of the existing


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and potentially addable prescriptions. A decidedly helpful aspect of these sessions is that the

psychiatrist and patient could customarily combine or subtract medications as they both see fit.

Specifically, if a mother sees that her daughter is more irritable on Lamictal than she was on

Abilify—brand names for mood stabilizers—, then that is an important perception, as well—and

something that the teenage girl may not have pointed out to the doctor on her own. In addition,

the psychiatrist can explain the purpose(s) and dosage of each medication and highlight with the

family the typical protocol if any moderate to severe side effects were to appear and/or the plan

of action if the family believes the patient has stopped taking the medication(s) as prescribed. It

is clear that the family’s attentiveness to the patient’s medication list and schedule and possible

interactions and side effects is irreplaceable. This is especially accurate when considering the

likelihood of regression into symptom-presentation given the etiology and rate of incidence of a

specific mental condition. Staving off a harbingering hallucination or dramatic delusion or

crippling catatonia or panicky paranoia is more readily accomplished with medication

consistency and the efficaciousness of the psychotropic drugs’ properties and potencies.

Once the patient and his/her kin, friend, and/or partner have attended the indispensable

psychotherapy and medication-related appointments, case-management becomes all the more

relevant and endorsing of the patient’s unique capacities for self-improvement and self-

empowerment. A noteworthy component of a generally categorized social worker’s job, for

instance, is outlined on the San Bernardino County Human Resources Department website as

that which can “assist individuals and families in recognizing dysfunctional behaviors and in

taking corrective action by developing service plans, treatment plans, goals and objectives; locate

and arrange to utilize community resources; provide counseling to identify alternatives and

encourage behavior modification” (Smith). They also have it in their power to “investigate adult

or child abuse, neglect, and endangerment allegations to substantiate charges and assess service

needs.” This is a central reason it is so vital that a family be involved in these sessions if at all

possible or conducive to patient health: these people can identify domestic relationships and past

traumas that could have culminated into mental disturbance in the patient, and even other family

members. Then, the task at hand is to go about correcting the perturbed behavior patterns.


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Due to the fact that mental illness is largely inherited and can be traced to a person’s

DNA, it would immensely help the clinical workers on a particular case to know if conditions or

at least indications of mental illness—such as a history of suicide attempts or also actual

“success”—run in the family. This genetic predisposition could diametrically heighten risk

factors for poor stress management and probable episode recurrence in the demonstrable features

of the patient’s behavioral disorder. Case managers and social workers in the mental-health arena

can put this information to good use by seeking out preventative—pre-problem-occurrence—and

not just treatment-based—post-problem-occurrence—measures and establishing applicable

objectives. If alcoholism seems to be hereditary and a first-resort not-so-effective crisis-solver

for the patient, the worker and the client—alone or, even better, with his/her family on some

occasions—can have a plan set in place for times when the individual may be inclined to want a

drink. Undue stress is often associated as a preceding marker for addictive conduct.

So, here is where a case manager really shines. S/he builds a framework of state- or

federally- or internationally-funded resources—such as the patient’s registration in an Alcoholics

Anonymous program—and also connects him/her with neighboring programs such as Our Place

Clubhouse—specifically the one with that name located in Redlands, California—, which is

organized by facilitators belonging to South Coast Community Services. It is also run by

members, persons with one or more diagnoses, who have available for use a billiards table, arts

and crafts, Internet-capable computers, kitchen-access, outpatient-style group sessions on various

topics like increasing self-worth and living in a codependent relationship, and more. This is one

chief model for not only patient proactiveness but also family amalgamation, as many of the Our

Place associates/members have closely connected persons in their lives who bring and prepare

food for parties and help coordinate games and other activities for the people who go to the

Clubhouse. New members are made to feel like people, not patients on a chart, when they go

there. They find it as a source of homey and welcoming warmth and care—which is the kind of

sentiment that should be pervasive throughout psychotherapy, psychiatry, and case-management

meetings.

South Coast’s Our Place also directs its members toward independent-living specialists at

programs like San Bernardino County social services organization Rolling Start, Inc. This


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program is designed to help disabled persons find their own places to live and learn ways to

budget finances and receive assistance for their distinct combination of needs (RollingStart.com).

Rolling Start is also affiliated with and aware of other disabled-person-serving programs, such as

Valley Transportation Services, which is based in Upland, California, and serves residents of San

Bernardino County, and offers travel training and a “volunteer driver program.” The latter allows

a designated driver of a person—one who would typically be unable to get around town on

his/her own—to be partially reimbursed by VTrans for gas based on miles the disabled person

was transported by the volunteer driver each month (VTrans.us.com). Family figures are often

deciding to involve themselves in processes like these, because there are so many community

resources straight for the taking that can truly help a mentally or otherwise disabled person take

the reins of his/her life and allay stresses on and concerns within the family, itself. A happy

patient is a healthy patient, and this is principally certifiable when his/her loved ones are able to

make this person more autonomous, which does much to increase self-efficacy and, even, hope.

Family members are as much a part of the formulation of a person in the same household

or so intimately related in life as they are a part of the reformation and validation of the person

who is now a mental-health patient. Keenly encompassing the integral family and friend figures

as primary role-players in psychotherapeutic, psychiatric, and social-services sessions will

manage, prevent, and redirect periods of mental un-wellness into states of undeniable progress

and higher acuity, which are more advantageous in a more family-oriented and holistic approach

toward psychological remedy. This is especially germane in terms of using coping mechanisms

in and outside psychotherapy, understanding episode occurrence as it is affected by medication

management in psychiatry, and taking advantage of the lengthy lists of patient resources offered

locally and elsewhere that are readily obtainable in the sector of case-work. To begin with, and to

spread out horizontally along other mental-health treatment centers, South Coast Community

Services would reap exceptional rewards vis-à-vis greater patient-success outcomes if it would

more systematically assimilate parents, siblings, some extended-family members, friendly

confidants, and romantic partners into the patient’s goal-attainment tactics. This is because

families can prove as underlying ingredients in the shaping of mental illness, by way of extreme

domestic discord and/or outright abuse and neglect; they can act as suppliers of valuable insight


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into promising coping skills and techniques for relapse evasion and utilitarian community

resources to tap into; and they can be instrumental in bolstering the patient’s overall health.

Family members’ presence in individual therapy, psychiatric, and case-management

engagements restores a person’s confidence in him-/herself and one’s capability to experience

true and profound healing; this can enrich the general family-based feeling of security and relief

from psychosomatic grief.

A family that learns together loves together, and a family that stays together and

constantly involved in the midst of wearisome trials is more apt to ascertain better means of

mending such a major bond. While some may be hesitant or reluctant or reticent in going to these

appointments with their loved one, clinicians at places like South Coast ought to remind them

that healing the mind originates in healing with those who have direct access to the heart. What

better way to do this than to set aside specific times and subject matters—such as the patient’s

emotions of abandonment by the father or his/her recent near-death experience with a best

friend—for which to have the appropriate loved one attend a session? Printed and signed

treatment plans can be magnetized to the communal refrigerator, prescription medication lists

can be kept in a parent’s and a patient’s wallet, and contact numbers for the National Alliance on

Mental Illness—NAMI—and/or the Department of Behavioral Health’s Access Unit can be

stored in key family members’ address books on their phones.

A person’s stable mental health could have most everything to do with participating in a

favorite mode of entertainment when gloom fills the room. It could be ensured supplementally

with a bedside med following a hearty meal. It could be further permitted by taking the step of

editing a résumé for a new job posting on display down the street at South Coast’s office. Such

vitality could stem from a fun few hours drawing in charcoal with a sibling, or shopping for

groceries with a beloved aunt for yummy food that will help the medicine go down. It could

come from enlisting the priceless expertise of the professional-recruiter cousin in forming the

bare-bones of a winning cover letter for that intriguing mental-health unit volunteer job at

Redlands Community Hospital. The possibilities continue on. Unquestionably, the family is a

requisite component of a person’s whole well-being, especially in the evidence of the persons’

unvarying support. Home is where the heart is, and a strong mind does a loving home make.


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Works Cited

Doheny, Kathleen. 7 Dangerous Drug Mistakes. 29 September 2006. Website. 26 May 2016.

England, Mary Jane. The National Institute of Mental Health: The National Advisory Mental

Health Council Workgroup on Child and Adolescent Mental Health Intervention

Development and Deployment. Washington, D.C., 2001. Electronic Source.

Grant, Jon E., et al. "Introduction to Behavioral Addictions." The American Journal of Drug and

Alcohol Abuse September 2010. Electronic Source.

Harvard Health Publications, Harvard Medical School. 26 January 2015. Website. 26 May

2016.

Jamison, Kay Redfield. An Unquiet Mind. New York: Random House, Inc., 1995. Book.

Mayo Clinic Staff. Mayo Clinic: Diseases and Conditions: Mental Illness. 13 October 2015.

Website. 26 May 2016.

Ortiz, Rick. South Coast Community Services: Who We Are. 2013. Website. 25 May 2016.

Rolling Start, Inc. Independent Living Resources. Website. 2016. 27 May 2016.

Smith, Dena M. San Bernardino County Human Resources Department. 2015. Website. 27 May

2016.

VTrans.us.com. Volunteer Driver Program (TREP). 2016. Website. 27 May 2016.

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