Exploring Relationships Between Young Adults with Mental Illnesses and Those That Support Them

Purpose: Supportive relationships are instrumental for youth development (Scales & Gibbens, 1996) and may be salient for mentally ill (MI) young adults formerly served by public systems of care, however, few studies have examined such relationships. We asked the following: 1) Do young adults with MI have supportive relationships?; 2) Who are the supportive individuals?; 3) Do they also live with MI?; 4) What is the duration of these relationships?; 5) What qualities of the relationships are valued?; and, 6) What is the nature of the support provided?

Methods: The sample consisted of fifty young adults with mood and emotional difficulties (65% female; 63% youth of color; Mean age=22) all of whom were diagnosed with a major mood disorder during childhood and utilized mental health services and at least one additional public system (e.g., foster care) during childhood. A semi-structured interview was utilized with nine open-ended questions (e.g., what kinds of things did/does _____do to help you transition with emotional problems?) and quantitative items focused on one selected key helping relationship. Initial codes for the narrative interview data were established by three analysts through an iterative process working with a sub-sample of transcripts (n=5). Initial coding was followed by constant comparison (Boeije, 2002) of quotations, codes and grouped codes, leading to a codebook. Additional transcripts were analyzed using the codebook, adding and modifying codes as needed. The remaining cases were analyzed and discussed by the team. Analysts constructed a concept matrix (Miles & Huberman, 1994) to detect patterns in the themes. Frequencies were examined for quantitative items.

Results: Eighty-five percent reported the presence of a key helper; the majority of participants reported that they either knew or perceived that their helper lived with mood/emotional problems. Relationships had lasted, on average, 9.7 years (range=1-30 years). The greatest percentages of helpers were family (41%), professionals (23%) and friends (18%). Highly valued relationship qualities were constancy and mutual understanding, the latter particularly in relationships with those who also live with mental illnesses (“‘Cause he's bipolar and I'm bipolar, and like we just understand each other more”). Among the cases in which the helper identified was a professional, almost half (44%) valued the ways this person helped by facilitating growth and moving beyond previous trauma. Various forms of social support specifically related to mental health/illness were described, with common ones including advice (“avoid relationships that are triggering”) emotional support (“is there for me when I have an episode”) and instrumental (“gives me rides to treatment”). Relationships were not always positive; youth also reported helpers were “shaming”, “confusing,” and “critical.”

Conclusions/Implications: The majority of participants were in a relationship with a key helper who assisted them in managing their mental illness. Data from this study suggests that various types of social support specifically directed toward managing MI were available to and valued by respondents in these relationships. The vast majority of this support was provided by informal helpers, suggesting the benefit of interventions to link, coordinate and strengthen informal helping relationships with this population.