Families and mental illness: Contested perspectives and implications for practice and policy

Abstract Mental health research, policy, and service provision over the last 50 years have constructed families and their connections with mental illness in various and contradictory ways. Three distinct but intersecting perspectives derive from the clinical mental illness literature, the family advocacy movement, and mental health policy. Within the clinical literature, the perspective of families is largely one of blame and pathology. By contrast, the family advocacy movement has generated the perspective of the burdened family, whereas mental health policy has created the perspective of the obligated caregiver. The result is an ambiguous understanding of the role of the family in both contributing and responding to mental illness. Implications for policy and practice include the need for a commitment to the principles of partnership with families, a recognition of diversity within families, recognising the difference between carer and family positions, and a need for policy to reflect the position of family as both intimately concerned, but not necessarily responsible, for patient care.