Family Coping During Psychiatric Hospitalization

When a family member is hospitalized in a psychiatric ward, the entire family goes through a difficult time. Usually, the moment of hospitalization comes after months, and sometimes years, of dealing with the family member's complex condition. During this period, you have probably dealt with severe symptoms, decreased functioning, and also with conflicts inside and outside the home. Therefore, at this point you may feel very tired from attempts at treatment and help, frustrated that the situation has not changed or has even deteriorated, angry at your family member and even at yourself, and feelings of guilt that you were unable to prevent it. It is important to know that all of these feelings are legitimate and completely natural.

During this complex period, family members also need support, information, and the feeling that they are partners in the process.

The family as part of the recovery process

The family is a significant factor in coping and in the treatment and recovery process, both during and after hospitalization. Coping with a serious mental disorder is often accompanied by emotional challenges, effects on interpersonal relationships and the division of roles within the family, as well as additional implications across social, occupational, and community spheres.

Family members are often the primary caregivers, especially during periods of acute flare-ups of the disorder. When coping with a severe and prolonged psychiatric illness, this involvement may be daily and last for years, including aspects of treatment management, functioning, guidance, and emotional support.

Involving the family and treating it as an integral part of the therapeutic process stems from clinical necessity, since family members know the person best, have cared for them over many years, and will likely continue to provide guidance and support after discharge from hospitalization. Good family involvement predicts and increases the chances of recovery. In addition, the family itself has needs – to process and understand what they are going through, to receive assistance and emotional support, and to acquire tools and skills that can help with family coping and with navigating and exercising rights.

The family's emotional journey on the way to hospitalization

Hospitalization in a psychiatric ward following an acute mental crisis usually occurs at a stage when the family has already gone through a complex period together with the person coping, dealing with intense symptoms and mental distress, functional decline, and often conflicts. At this point, the decision to seek hospitalization can be very difficult for the family, sometimes accompanied by feelings of guilt and failure for not having been able to help or prevent the deterioration – especially when it is a first psychiatric hospitalization.

Alongside this, once the decision to hospitalize has been made, the person arrives at the emergency room and the professional team begins the treatment process, the family may also experience a sense of relief. This may be due to the transfer of burden and responsibility to a professional team, or due to help in processing and understanding the current situation, the treatment plan, and the construction of next steps – restoring a sense of control, order, a clearer picture of the future, and therefore hope.

At this point, the family also needs support in order to:

• Receive information and explanations about the family member’s condition.
• Understand the hospitalization process and the expected next steps.
• Process everything that has happened so far.
• Receive tools that will help them support the person coping and also take care of themselves.

The family as a therapeutic resource

Family dynamics surrounding coping at home and during hospitalization can be a central therapeutic resource and promote a return to functioning and recovery. On the other hand, due to the great power and significance the family holds in the life of the person coping, ineffective handling of the crisis may hinder the process.

Difficulty in coping often characterizes these situations, as families may arrive tired and frustrated, sometimes angry at the situation, at the person coping, or at themselves. Feelings of guilt and loss of control may also arise. Therefore, the therapeutic team plays a critically important role at this point of crisis – to recognize this vital family resource and realize its potential as a central therapeutic factor with substantial impact.

For example, in the distant past, families – and especially mothers – were considered an etiological (causal) factor in the development or exacerbation of psychiatric disorders such as schizophrenia or eating disorders, leading to alienation, disconnection, and guilt. In recent decades, we now understand that families and mothers are not to blame for the development of mental illness, but rather are a key resource and partner in treatment who can help and promote recovery.

Therapeutic approaches that integrate the family

Today, there are therapeutic approaches that integrate the family as an inseparable part of treatment:

• Open Dialogue – for the treatment of severe mental disorders.
• FBT (Family-Based Treatment) – for the treatment of eating disorders, where the closest support system is an integral part of the therapeutic process.
• Balanced inpatient departments – based on Soteria principles and involving the family in the daily and therapeutic routine of hospitalization.

There is no doubt that family coping during hospitalization is a challenging and complex process, but it is also an opportunity for you to be an active and vital part of the treatment and to influence the recovery journey of the person dear to your heart.