Provider-Family Communication in Mental Health Treatment of Adults with Mental Illness

Background

Families play a crucial role in helping adults with mental illness access treatment and manage their care. However, family caregivers often encounter treatment barriers, largely due to poor communication with providers, which limits family involvement in care and negatively affects people with psychiatric disability (PWPD) and family well-being. More research is needed to understand individual and contextual factors that influence provider–caregiver communication to enhance care. Our study applied a systems framework to explore individual and contextual factors associated with provider–caregiver communication regarding PWPDs’ mental health care. We hypothesized that contextual factors such as stigma and poor social support and community services would be associated with reduced provider–caregiver communication about PWPD care beyond PWPD and caregiver factors.

Methods

Data came from an online 2015 national cross-sectional study of caregivers of adults with psychiatric disorders. A subsample of 1,457 family caregivers were included in this analysis. Pearson bivariate correlation analyses examined whether relationships between variables were significant and helped us develop a parsimonious model for our primary analyses. We used hierarchical linear regression (HLR) as the primary analytic strategy to test the study hypothesis using the following steps: individual PWPD variables (e.g., age, diagnosis, suicide risk), individual caregiver variables (e.g., age, length of caregiving, emotional distress), and contextual variables (e.g., stigma, PWPD social support and community services).

Results

Caregivers’ average age was 58 years and PWPDs’ average age was 60 years (48% in 18–34 age group). Most PWPD (80%) were diagnosed with a serious mental illness (i.e., schizophrenia spectrum, bipolar, major depression). Most caregivers (66%) reported that a provider informed them that they could not discuss their loved one’s care. Correlations supported significant relationships between several PWPD, caregiver, and contextual variables, which were included in the HLR analysis. The overall model significantly predicted reduced provider–caregiver communication about PWPD care, F(9, 1,447) = 17.97, p < .001, R² = .10. PWPD variables accounted for 2.7%, caregiver variables represented 4.2%, and contextual variables reflected 3.1% of the variance in provider–caregiver communication score. Specifically, younger PWPD age (β = -.05, p = .04), concern about PWPD suicide risk (β = .09, p < .001), older caregiver age (β = .07, p = .01), and higher caregiver emotional distress (β = .14, p < .001) remained significant predictors in the final model. Contextual factors of higher stigma (β = .10, p < .001), lower PWPD social support (β = -.06, p = .03), and lower caregiver satisfaction with quality of community services for PWPD (β = -.13, p < .001) also had significant relationships with decreased provider–caregiver communication.

Implications

Provider–caregiver communication is a multidimensional issue influenced by individual and contextual factors. Caregivers most in need due to emotional distress and concern about PWPD suicide risk and poor social support and community services often experienced limited communication with providers. These findings can enhance our understanding and inform systemic practices aimed at improving provider–caregiver communication, ultimately supporting the well-being of both families and PWPD.