Family Caregivers Coping with Mental Illness (Creative Pastoral Care and Counselling Approach)

About The Book

This book provides major traditions, theoretical approaches and the development in care and treatment of mental illness both historically and contextually. It also elucidates the clinical characteristics and treatment approaches of two major mental disorders namely, schizophrenia and mood disorders and discusses on the theories of family caregiving in the context of mental illness. The book provides the results of the empirical investigation on burden, coping patterns and wellbeing of family caregivers who are playing the primary role in caregiving for their loved ones with schizophrenia and mood disorders in Nagaland. A creative integrative approach of pastoral care and counselling along with family intervention models is proposed to address the predicament of people with mental illness and families. This book envisaged that the Church Caring Ministry has a unique role to facilitate 'presence and hope to families coping with mental illness in their journey towards recovery and wholeness. It advocates creative collaboration of Church caring ministry, mental health professionals, mental health policy makers, theological community and the wider community to work towards de-stigmatization, prevention and intervention measures to promote positive mental health for families with mental illness and the community at-large.

About the Author

Dr. Vibeituonuo Mere teaches Christian ministry and Counselling in Gospel & Plough Institute of Theology, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj. She earned her Doctor of Theology in Christian Ministry-Counselling from the United Theological College, Bangalore, Senate of Serampore (University). Her research interests include Women, Mental Health & Family, Pastoral theology & Counselling.

Earlier she served in the Angami Baptist Council of Churches (Women Department) in Nagaland, and also as a missionary teacher in Kolbari, Assam. She has been serving as a theological educator for the past 19 years in theological institution-till date. Besides teaching, she also involves in care and counselling ministry. She is married to N. Moatemjen Ao, Assistant Professor of History of Christianity. They are blessed with a son, Jangsen and a daughter, Sophia.

Preface

This book is an outcome of my Doctoral Studies of Theology (D.Th) initially motivated by my own personal journey as an indirect caregiver for a family member with a major mental health condition as well as my encounter with various families coping with the malady of major mental illness in Nagaland.

Major mental illness such as schizophrenia and mood disorders often lead to substantial impairment in a person's ability and they suffer not only from the private terrors of their symptoms, but also from the social and psychological consequence of being mentally ill. No doubt, the advent of psychotropic medicine and other modern methods of treatment have helped a large number of people to recover and manage the symptoms, yet many continue to live with the condition. Many others remain untreated largely due to inability to obtain the treatment resources for certain reasons such as: inadequate mental health professionals and infrastructure, lack of awareness or/and ignorance, misconception and age old stigma about the illness. In this situation, families are required to play multiple roles in caregiving in terms of managing their behavioural disturbances, diagnosis, treatment, supervising medications, rehabilitation, recurrent relapses and financial needs. In addition, social stigma, fear of discrimination and anxiety about the person often add to their distress. Hence, family caregiving in major mental illness is a devastating stressor in any family irrespective of its strength and available resources. To deal with the growing burden, caregivers often employ various coping strategies. Maladaptive/negative coping adversely affects them which may further lead to increased burden and lower wellbeing. Despite the growing debilitating impact of major mental illness upon the person and the families, it is observed that their concerns and needs are the least understood among all other issues and inadequately supported.

Therefore, this study has examined the condition of families by assessing burden, wellbeing and coping patterns of family caregivers coping with their loved ones suffering from major mental illness in Nagaland.

Foreword

I am delighted to write this foreword for the book Family Caregivers Coping with Mental Illness Creative Pastrol Care and Counselling Approach by Vibeituomuo Mere. I had the privilege of knowing Dr. Mere as a student at the United Theological College, Bangalore, during her Master of Theology and Doctor of Theology studies, for six years. Since she completed her Doctoral programme. we continue our professional interactions as she is in the faculty of an esteemed University. This book primarily is an outcome of the author's personal journey as a secondary caregiver with a family member living with mental illness, which also challenged her to listen to other families with similar struggles and agonies of coping with mental illness. This book comes with a unique and creative way of interpreting 'Presence and Hope as a theological framework for understanding and ministering to the mentally ill and their families.

This book explores in depth the diagnosis and treatment of mental illness from a historical perspective, traditional and modern, untold miseries of the primary caregivers, myths and distorted notions that make the communities unemphatic with the mentally ill and their families. Dr. Mere in great detail describes the multi-faceted problems and untold pains encountered by the families of the mentally ill in Nagaland. These include obtaining timely professional medical help, follow-up sessions, management of medication, dealing with bizarre hallucinational and delusional behaviour, antisocial activities, aggressive behaviour, social withdrawal and isolation, educational and career deficits, hygiene and grooming, personal appearance, self-destructive and suicidal tendencies.

I agree with Dr. Mere in her assertion that families often find themselves alone and tormented, mentally and emotionally, in coping with this extra-ordinary situation, with the absence of professionally caring institutions, including the church. The presence of mental illness in the family comes with huge mental and emotional costs, causing feelings of anxiety, guilt, shame, demoralization, depression, grief and frustration. Further, theological questions and spiritual struggles in understanding and coping with the mentally ill, that too in a context where the church has very limited attention. At the same time, the professional medical/psychiatric help from the Government and Non-Government agencies does not reach the large population suffering with mental illness. Hence, the author's argument that the church needs to re-focus her ministry reaching out to this population, is validated.

This book critically and creatively examines the role of primary family caregiver in the families, the burden of care from multi-level perspectives, different types of coping patterns and wellbeing. The author presents a critical and comprehensive historical review of mental illness and the caring patterns in traditional and modern communities which is her unique contribution. She also points out brilliantly the success and gaps in diagnosis and treatment modalities.

Having found the tragic plight of the mentally ill persons and their families, through empirical research in the Naga context, the author critically examines the traditional approaches to pastoral care and counselling. She decries the absence of healthy support systems at the local and State level, pleading the church to spread its ministerial wings to those suffering with mental illness, as well as ministry to nurture mental health and wellbeing in families and communities.

A Creative Integrative approach in dealing with mental illness and their families, Dr. Mere succeeds in presenting a model of care with healing, sustaining, guiding, nurturing, reconciling empowering, and liberating as the primary agenda alongside family intervention models. She envisions the church and other helping agencies together taking this mission of creating psychosocial and medical support system.

In this book, the author weaves together the plight of the mentally ill and their families advocating for theoretical and theological framework to help. The theology of hope comes with ardent appeal for the ministers, counsellors, academicians and anyone else called to care pastorally for those struggling with mental illness.

Through the book, Dr. Mere provides valuable resources covering the components of pastoral care and counselling, particularly with reference to the psychosocial and spiritual wellbeing of the mentally ill, and the primary caregivers. It is my hope and expectation that this book will provide an effective learning experience and referenced resource for those interested in the mental health field in the years to come. This book comes as practical help for all engaged in mental health professions in Nagaland, as well as across India.

Introduction

In the context of high prevalence of mental disorders,' and inadequate mental health services, families of people with mental illness have been the key supports in caregiving in India in general and in the State of Nagaland in particular. Amidst the debilitating impact of caregiving, families continue to be the key sources through which treatment and recovery are channelized. Social stigma, misconceptions and cultural factors about mental illness, scanty mental health professionals and after care services are yet other pertinent issues in the State. Sadly, these families have remained a neglected lot, often ignored by the mental health providers and community at-large. The church caring ministry comes in the form of prayer support and charity and there has been no specific ministry of pastoral care and counselling rendered to this invisible groups. Family caregivers' strength, difficulties and needs have to be recognised, understood and nurtured as they are the key support in mental health care with inadequate knowledge about the nature and complexities of mental illness. Hence, this study aims to assess the burden, wellbeing and coping patterns of family caregivers in caregiving for their loved ones of with major mental health problems in Nagaland. It further aims to locate the role of pastoral care and counselling and relevant family intervention models to address the issue. It envisaged that the Church caring ministry can. be a potential powerful partner with families and mental health professionals in addressing the complex issue of caregiving in mental health problems. The reality on the complexity of major mental illness and the inadequacy of mental health services and psychosocial support calls for the Church to extent its ministry of care in the area of mental health.

1. The Prevalence of Mental Disorders.

Globally, major mental disorders such as Schizophrenia and mood disorders (bipolar disorders and major depression) are among the ten leading causes of disability. Major depression causes the fourth highest burden of all medical diseases. A study by the National Commission on Macroeconomics and Health (NCMH) shows that at least 6.5% of the Indian population has some form of serious mental disorders, with no discernible rural and urban differences. Among priority non-communicable diseases in India, mental illness constitutes 26 percent share in the burden of disease and it is also predicted that there would be a sharp increase in the years to come. A recent survey by the Indian Psychiatric Society (IPS) estimated that there were about 240 millions of people with mental illness after the first wave of the pandemic. Perhaps, second wave would have added few more millions."

With regard to the prevalence of mental illness in Nagaland, a report on "Mental Health Scenario in the North Eastern Region of India, 2007," shows that Nagaland with a population of 1988636 has an estimated case load of 19886 major mental Disorders and about 99430 minor mental disorders. The prevalence of major mental illness in the state is strongly supported by the report from the State Mental Health Institute, Kohima (SMHIK)," that a total number of patients of both outpatient (OPD) and inpatient treated (IPD) between 2008-2012 numbered to 4858, mostly with a diagnosis of Schizophrenia and Mood disorders." New cases from 2013-2015 numbered to 852, majority with t a diagnosis of Mood disorders and Schizophrenia. According to the report obtained from the Dimapur Civil Hospital, from the year 2009-2012, around 1445 outdoor patients had been given psychiatric treatment." It is also observed that a larger number of people with mental health problems in the State are without psychiatric treatment for the inability to access mental health services, social stigma, ignorance and misconceptions about mental illness. Many others relate mental illness to the presence of 'evil sprits' and prefer local quakes/traditional healers or prayer centres. Earlier research revealed that a vast majority of persons with mental illness in India live with their families and they play the major role in caregiving. For instance, research from two cross cultural studies reported that less than 50% of patients in the western world lived with their families, while the comparable figure in India was 98.3%. The grim reality is that the role of the families is crucial in a country like India which is apparent for various reasons: inadequacy of mental health professionals, rehabilitation and after care services are very few in numbers and are largely based in the urban set up." The Morung Express in its edition states that there are only about 8 psychiatrists for its 22 lakh population in Nagaland. All these indicate that the country in general and a State like Nagaland in particular have acute shortage of mental health workers, professionals and inadequate infrastructure. This poses a huge challenge for families, mental health services and church caring ministry.

**Contents and Sample Pages**