Family Involvement In Mental Health Care

People often think of mental health treatment as a one-on-one process in which a client talks to a therapist alone in a room. However, psychological difficulties typically aren’t solitary experiences. In many cases, they can both affect and be affected by interpersonal relationships, especially the dynamics within a family. So is there a role for family members to play in individual mental health treatment?

As we’ll discuss, a growing body of research suggests that more family involvement in mental health services often leads to better outcomes for patients and increased understanding and empathy on the part of their loved ones. Family psychoeducation may be a particularly effective option with which to begin, as simply learning more evidence-based information about mental illness can help increase a person’s ability to support someone about whom they care on their path to improved mental health. Family-based therapies may also improve the prognosis for conditions ranging from substance misuse to bipolar disorder. Read on for an overview of research on the topic.

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The complex relationship between family and mental health

The clichéd image of a psychiatrist talking about a patient’s relationship with their mother exists for a reason. It’s long been understood in the field of psychology that family relationships can contribute to mental health challenges.

This effect may be easiest to see in cases of severe dysfunction, such as when there is interpersonal violence or abuse within the family. Research suggests that children who witness domestic violence at home are at significantly greater risk of conditions like depression and post-traumatic stress disorder (PTSD). 

Abuse and the development of bipolar disorder and schizophrenia

Other studies indicate that those subjected to abuse from their caregivers early in life are more likely to develop a serious mental illness such as bipolar disorder or schizophrenia.

Less extreme interpersonal difficulties within a person’s family may also promote poorer mental health outcomes. For example, findings from a 2023 study of university students suggest that those who reported poor communication between family members in childhood had higher odds of experiencing psychological challenges, even in adulthood. 

Major family changes and susceptibility to mental illness

Both children and adults may also be more susceptible to mental illness following major family changes such as marriage, divorce, the birth of a child, or the death of a family member. 

All of these findings suggest that examining family-related factors might sometimes be helpful in uncovering the origins of a person’s mental health concerns—and that involving and/or also treating the family might improve and support the individual’s treatment process. 

Is it appropriate to involve family in my mental health journey?

That said, it’s not always appropriate. In most cases, you can decide whether you want to involve a given family member in your care, and your provider can help you decide if involving them may be helpful if you’re not sure. If you don’t have or are not in touch with your biological or adoptive family members, it may be helpful to involve chosen family members like a partner or close friends instead. 

Potential benefits of family involvement in mental health treatment and recovery

An increasing number of studies suggest that mental health services may be more effective when they engage family members in the care process. Healthcare policy recommendations are shifting in response. For example, when the World Health Organization released its updated Comprehensive Mental Health Action Plan in 2021, increasing communication between patients, their loved ones, and their treatment providers was among its major objectives. 

Here are a few of the beneficial effects that family involvement in mental health treatment may provide. 

More effective care planning and speedy recovery

Improving mental health often involves making changes to your self-care habits, communication style, living situation, and other aspects of daily life, if possible. Involving family members in planning these kinds of changes may help them accommodate and support your efforts while making it easier for your care provider to suggest practical and achievable strategies.

This may be especially beneficial for people with serious mental illnesses whose relatives may need to help make decisions about topics such as hospitalization and medication management. In these cases, greater family engagement with care professionals may have positive effects like fewer relapses, less frequent hospitalization, and shorter inpatient stays.

Improved insight into relational dynamics

Incorporating a client’s loved ones in the care process can also enable mental health professionals to observe relationship dynamics firsthand. This may improve their awareness of both emotional pressures and sources of support in a patient’s life, increasing their ability to understand the person’s pathology, ask insightful questions, and give helpful advice.

Increased emotional support to tackle mental health difficulties

Improved outcomes for those with mental illness like PTSD and bipolar disorder

Some studies suggest that this may improve treatment outcomes for those experiencing various conditions. Substance use disorder, for instance, may sometimes respond better to family therapy than individual therapy. Similarly, a 2018 study suggests that symptoms of post-traumatic stress disorder improved following family involvement in treatment.

How to get your family involved in mental health services

The following strategies may help if you’re receiving treatment for a mental health condition and would like your family to become more involved.

Discuss it with your treatment provider

Your therapist, psychiatrist, or other care provider may help you develop a detailed plan for implementing family involvement, if you’re interested in and comfortable with that. You might discuss questions like:

• What aspects of your diagnosis and treatment process are you comfortable sharing (or having your provider share) and what would you rather keep to yourself?
• Would you like your loved ones to participate in some therapy sessions, or do you simply want to help them better understand your challenges and how they can support you? 
• Are there specific family dynamics you’re hoping to address?
• What aspects of your treatment do you think could benefit from having more family involvement?

Let your family members know you could use support

Though this might seem like the simplest step in the process, many people find it difficult to open up about mental health challenges—even with those with whom they’re closest. You might find it helpful to remember that you don’t have to share every detail right away (or ever), and that you can choose how much involvement to request and allow.

Starting with one or two highly trusted people—such as a parent, a significant other, a sibling or cousin with whom you’re very close, or a chosen family member like a cherished friend—may be advisable. You might open with a general statement such as:

• “I’ve been under some stress lately, and talking about it with a therapist has helped.”
• “I’m getting counseling to help me with some difficult feelings I’ve been having.”
• “There are some things I’m trying to work through in therapy.”

Tell them what family involvement in mental health treatment means to you

Next, you might let them know that they mean a lot to you and that you’d appreciate their support in your mental health journey. You may want to be clear that you’re not asking them to fill the role of a therapist, but that being able to speak openly with them about your treatment process would help. If they’re receptive, you can start talking with them about how exactly you’d like them to get involved. 

Start with education about mental health care

Psychoeducation, or sharing evidence-based information on mental health, is often an effective first step in engaging family support for treatment. This approach can help those close to you understand what you’re experiencing, clear up misconceptions, and inform them about research-supported ways they can offer help. One systematic review on the topic suggests that a psychoeducation-based family intervention may help improve patient functioning and increase the well-being of their loved ones as well.

As your therapist if you can get your family involved in mental health services

If you’re currently seeing a therapist trained in family or group psychoeducation, you can ask them if they’d be willing and able to provide this service for you. Or, you might prefer to keep your individual treatment and family interventions separate. In that case, you could ask your treatment provider for a referral to a qualified family psychoeducation practitioner. You could also seek out resources like the NAMI Family-to-Family program, an eight-lesson course provided by the National Alliance on Mental Illness. 

Ask family members to accompany you to visits

If you’re seeing a psychiatrist or other medical professional regularly in relation to your mental illness, asking a trusted loved one(s) to come with you to appointments could be another good way to increase their engagement, if you’re comfortable. They don’t necessarily need to sit in on your therapy sessions, but encouraging them to be present and ask questions when you talk with your doctor or psychiatrist about things like recent changes in symptoms, medication side effects, and behavioral strategies you’re trying out might help them be more effective sources of support.

Consider family therapy

Various types of therapy involve family members working on mental health challenges as a group, and clinical research indicates that they can be effective in addressing a wide variety of symptoms and challenges. Examples include:

• Family-focused therapy (FFT). This treatment for bipolar disorder heavily incorporates psychoeducation and may speed up the process of symptom reduction compared to other common treatments.
• Systemic family therapy. Systemic therapies take into account how a person’s social role and interactions can reinforce negative patterns of thinking and behavior. Evidence suggests that they may be effective in treating conditions like mood disorders, eating disorders, psychotic disorders, and obsessive-compulsive disorder (OCD). 
• Narrative family therapy. This approach encourages family members to share their own stories about the past, present, and future of their family relationships to enable healing. Research suggests it may be particularly helpful for improving marital satisfaction and couples’ mental health. 

If you decide to pursue family therapy, it’s generally recommended that you seek a treatment provider certified in a specific evidence-based therapy option that aligns with your needs and treatment goals.

What if you’re having trouble finding mental health care?

Here, we’ve talked mostly about how to involve family members in an ongoing mental health care process. However, not everyone is at this step yet, as many people face barriers to locating a treatment provider. Long waitlists, difficulties with insurance, and regional care shortages can be obstacles to mental health care.

If you’ve been encountering difficulties locating a therapist with whom you feel comfortable, you might want to try online therapy. Remote mental health care platforms can put you in touch with a wider pool of licensed professionals and pair you with a provider whose expertise matches your needs. Scientific evidence increasingly indicates that this can be an effective form of mental health care. For instance, one review of past clinical research suggests that online cognitive behavioral therapy can be both a useful and cost-effective method of treating illnesses like depression, anxiety, OCD, PTSD, and more.