The role of families in the recovery of people with mental disorders who are deprived of their liberty
The family is considered the basic unit of human society. It represents the fundamental center of the emotional and moral life of individuals. It is, therefore, a vital social structure in all communities.
Definitions of family have traditionally focused on blood ties and a shared system of values, but reality dictates that families are as diverse as the individuals who comprise them. The family is a dynamic social system and, therefore, can be a source of significant conflict as well as the best resources for support.
The family is the primary and most powerful emotional system to which human beings belong and constitutes the greatest potential resource, as well as the greatest source of stress (Fogarty , 1997).
The family system constitutes an educational and social space par excellence, and therefore a series of functions can be attributed to it: satisfaction of primary needs, support and helping relationship, upbringing and social regulation, socialization, cognitive guidance (education in values) and instrumental support (well-being, quality of life and autonomy).
When we talk about the role in recovery when a family member suffers from a mental disorder, the family experiences a decline in its quality of life in various dimensions: physical well-being, emotional well-being, interpersonal relationships, social inclusion (stigma), personal development, material well-being, self-determination and rights (not being heard/informed).
Our commitment to families
From the prison psychiatric rehabilitation units, the interdisciplinary teams that work with the families of those receiving care take these considerations very much into account and, therefore, must assume these commitments:
- Establish a relationship of empathy and active listening
- To positively reinforce the potential and goals achieved by families
- Respect, do not judge, value the needs that families perceive as their own
- Inform families, always with the prior consent of the adult being cared for
- Clarify expectations and enhance transparency in communication
- Respect the timing of families
- Do not offer guidelines but rather orientations and develop a support space where families can find information, training and emotional support.
It is very important that families understand aspects related to mental illness, the services and resources available, and to raise awareness of their crucial role as agents of change and social inclusion. Professionals must encourage families to share difficult situations that arise within their home environment to prevent, among other problems, social isolation and stigma.
The various psychiatric prison units we serve have a specific, yet comprehensive, program for supporting the families of individuals admitted to these psychosocial rehabilitation and community reintegration units . We believe that family and the social environment play a crucial role in an individual's life. Therefore, it is essential to understand their function in order to grasp their importance and influence on the rehabilitation and discharge plan from the prison system, which is individually designed for each person we serve.
Recovery, social integration and support upon leaving the prison
We start from the premise that families are, in many cases, the primary source of support and care for people with mental health conditions . Therefore, specific family support programs are aimed at all families, as well as individuals who are significant figures in the person's life. The program's main objective is to foster family involvement with the person receiving care, strengthening their role as agents of change and social inclusion.
How do we work with the families of people in prison psychiatric units?
Regarding the work methodology , we can distinguish three phases: intake, integration, and follow-up. The procedures used by the various interdisciplinary teams include interviews at prisons or healthcare facilities, home visits , and telephone follow-up . We consider it very important that families are aware of the different ways to contact the professionals so they can use them whenever needed.
Interviews at the prison or other healthcare facilities are usually the first in-person contact between the family and the professional team. These always take place with the consent of the person being treated. Exceptionally, an initial meeting with the family may be held at their home when the family's situation, for various reasons, prevents them from traveling to the different facilities. However, home visits generally occur when there is a good rapport between the family and the professional team and the goal is to prepare the individual for life after release. In the prison setting, this refers to furloughs for individuals with confirmed sentences and therapeutic releases for those under security measures.
In the third phase, when individuals receiving services have an individualized therapeutic plan and the process of reintegration into the outside world begins, families take on a more important role as agents of support, reintegration, and family and social integration. This phase is conducted through telephone communication between professionals and the family. This allows us to monitor how the individual is functioning within their family and social environment and facilitates the collection of information regarding difficulties, problems, conflicts, the individual's social skills, level of commitment, and other issues that may arise in each case. This information guides us and provides insights into how the work objectives proposed and agreed upon by the professional team, the individual receiving services, and the family are being met.
Our team of professionals conducts an evaluation of the process involving both the individual receiving care and their family. This is clearly a qualitative evaluation that allows us to assess the most relevant aspects of the individual and their support environment.
The most important factors collected are:
- Capacity for emotional support.
- Containment and limits.
- Capacity for social connection and resources.
- Economic capacity and quality of life.
- Ability to identify conflicts.
- Environmental factors and family-related factors.
It is important to highlight that prisons are located far from populated areas, which poses an additional challenge for many families. In many cases, the distance between the family home and the prison is very great, preventing regular visits to the incarcerated person, what we call "conjugal visits" or "visits" in prison terminology. The reasons for these difficulties can be economic, physical, and related to mobility (difficulty with transportation). It should also be noted that transportation options between prisons do not always meet the needs of families and can sometimes become interminable and unmanageable journeys for relatives.
Since the opening of the various prison psychiatric units, all the aspects described in this article have been carefully considered, and great importance is placed on the participation and inclusion of families in the therapeutic processes of the individuals we serve. Finally, we would like to emphasize that the twenty years of experience of these units confirms that the role of families is fundamental in the recovery of individuals suffering from a mental disorder who are incarcerated.
The chances of success increase if the family is present and understands the situation their affected relative is experiencing.
To achieve this, the team of professionals (comprised of professionals in the fields of psychiatry, psychology, social work, social education, nursing, auxiliary nursing care, and social integration) must be very aware of offering the families and individuals we serve a close, accessible, and transparent relationship so that a positive bond can be established, enabling collaborative work and shared objectives aimed at improving the various life situations of the affected individuals.
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