Relatives' experiences of violence from people living with severe mental health conditions: a neglected and poorly understood issue

This article contains mentions of violence towards caregivers/relatives.

Emilie Wildman is a PhD student in the Department of Psychology at the Institute of Psychiatry, Psychology & Neuroscience, whose recent PhD study, published in Acta Psychiatrica Scandanavica, has explored the rates, types and impacts of violence towards relatives and informal carers by people living with severe mental health conditions (e.g., schizophrenia or bipolar disorder). In this blog, Emilie discusses the review’s findings, and why it is important to raise awareness of this misunderstood and often hidden problem.  

Millions of people across the world live with a severe mental health condition. For instance, Schizophrenia alone affects more than 24 million people. A large majority of people living with a severe mental health condition are supported and cared for by their relatives.

We know that most people living with a severe mental health condition are not aggressive, with research often showing that they are sadly more likely to be the victims of aggression and crime from others. However, we also know that, for some, engaging in violent and aggressive behaviours can be an additional challenge they experience as part of their mental health condition. When this happens, unfortunately it is their relatives, particularly those in caregiving roles, who are most often the victims, compared to the general public.

Our systematic review of 38 studies has identified that, in situations when relatives experience violence, they often do not receive the support they need. This can have a harmful impact on their mental health as well as the quality of the caregiving relationship, and the relationships they have with their wider family. It is vital that we look past the stigma around this topic, in order to address these issues and give greater consideration to the family network in future research and practice.

Mothers most likely to report having experienced violence

Our review revealed relatives’ experience of a range of different types of violence from their family member, which often occurred together. These included physical, verbal and psychological violence, as well as financial violence (including misuse or stealing of funds, property and/or assets), and violence directed towards property, such as damage to household objects.

Mothers were the group most likely to report having experienced violence, compared to other relatives. This is likely partly due to caregiving being a task that is largely undertaken by female relatives, and, particularly, mothers. The samples of most of the reviewed studies largely consisted of participants who were mothers. Although the majority of carers of this group are mothers, this isn’t always the case. Therefore, an important avenue for further research will be to capture the perspectives of other relatives who currently remain underrepresented, such as fathers, siblings, spouses, and children.

The quantitative and qualitative findings of our review illustrated the damaging impacts associated with relatives’ experiences of and exposure to violence. These mainly involved mental ill health (e.g., psychological distress, post-traumatic stress symptoms), and the deterioration, and sometimes the permanent breakdown, of family relationships and the family unit.

Our review also found that, due to insufficient external support, relatives often continued to provide care to their family member, despite risks to their own safety. This finding echoes the broader picture of informal caregiving in the UK, with the majority of carers providing support, whilst feeling unsupported. For example, in a recent survey, only 7% of UK carers expressed the view that they receive sufficient support in their caregiving role.

‘A frequently neglected and poorly understood issue’

To date, unfortunately, discussions of violence and mental health problems have often been derailed by poor, clumsy, inaccurate, sensationalist and largely stigmatising reports and narratives. This has typically left service users and their families with unmet needs in addressing the impacts of violence in their relationships and reducing future risk. Our review shines a spotlight on a frequently neglected and poorly understood issue, highlighting that violence by people living with severe mental health conditions can and does happen, with far-reaching negative consequences for whole families.

However, only through an improved understanding and awareness of this hidden problem, we will be able to address the support needs of affected families. This indicates that greater efforts to engage in research and discussions about family violence in the context of mental ill health are urgently required.

Research exploring carers’ and service users’ lived experience, and views on what constitutes helpful support is needed to develop interventions which effectively reduce the risk of violence and protect the wellbeing of families and service user groups. However, we know that professionals often fail to explicitly ask service users about issues of violence in their family relationships. Ignoring the issue and/or pretending it does not occur in some families and caregiving relationships benefits no one, least of all service users and their families.

Our review highlights the important need for key stakeholders (e.g., families, health and social care providers, family mental health advocacy groups), to proactively address the support needs of families who are affected by and dealing with parallel challenges of violence and mental ill health.

This review was carried out by researchers at King’s College London’s Institute of Psychiatry, Psychology & Neuroscience. The research was part-funded by the National Institute for Health and Care Research (NIHR), and by King’s College London.

To read the full review, visit: Prevalence of violence by people living with severe mental illness against their relatives and its associated impacts: A systematic review

If you’ve been affected by anything you’ve read in this article, the following organisations provide support and resources to help:

• www.rethink.org
• www.sane.org.uk
• www.samaritans.org/how-we-can-help/contact-samaritan
• eufami.org