"They Are My Backbone, My Advocate": Assessing the Nature of Social Support Among Parents with Severe Mental Illness

Background and Purpose:

A large body of research has explored the powerful influence that relationships have on the physical and mental health of the general public. Social support refers to the positive functions assumed by members of one's social network, typically including three broad categories: instrumental, emotional and informational. Particularly for individuals with severe mental illness (SMI), social support has been linked with fewer hospitalizations and improved quality of life.

However, there is scant literature that examines the effects of social support among parents with SMI. These individuals face unique challenges from the dual demands of facing mental illness while simultaneously attempting to fulfill parental roles. Given increased risk of custody loss, divorce/separation, or unemployment, the importance of social support has become increasingly recognized. A qualitative study was conducted to assess topics including strengths, challenges, and related issues among parents who served by Assertive Community Treatment (ACT) teams. This analysis explores the nature of social support available to parents with SMI, particularly with respect to caregiving of their children.

Methods:

Fifteen in-depth individual interviews were conducted with eight mothers and seven fathers receiving ACT services in New York City from August to December of 2017. All interviews were audio recoded and transcribed verbatim. Content analysis was used to thematically code and analyze the data. In this analysis we focus specifically on findings relating to instrumental, informational, and emotional support.

Findings:

Average age of participants was 38.8 years (SD=13.4) and had an average of two children (SD=2.5). Most participants did not live with their children; however, 11 indicated that they share parenting responsibilities. Participants had been receiving ACT services on average of 4 years.

Results indicate that family is the most important source of social support for parents with SMI. Various members of the family (parents, siblings, grandparents, in-laws and cousins) provided instrumental supports such as childcare, financial assistance or housing. Moreover, family members often took on the role of caregiver or foster parent to the children when parents experienced a psychiatric crisis or Child Protective Service involvement. Parent consumers with limited natural social support, described significant social support from the ACT team. One parent stated, "It's good to have them (ACT team) because before I felt just alone in the world". In addition to providing tangible aids such as medication or house supplies, ACT providers offered valuable advice, encouragement, motivation and empathy regarding parenting.

Conclusions and Implications:

This analysis contributes to understanding the range of social support that parents with SMI experience from their social network. Findings highlight the importance of instrumental support provided by family in regards to parent consumers maintaining a healthy relationship with the children and ensuring their wellbeing. Furthermore, we found that ACT teams provide a significant source of emotional support for parent consumers without strong ties to natural social supports. Interventions aimed at enhancing parent consumer's social support should be tailored to each individual's current state of social network, while considering the needs and resources of the individual.