Indiana Consortium For Mental Health Services Research Indiana University

Abstract

Reprint # 30: THE SOCIAL NETWORK CONTEXT OF CAREGIVING IN MENTAL ILLNESS

Eric R. Wright

INTRODUCTION

The shift from institutional to community-based treatment for people with severe mental disorders has brought about dramatic changes in the roles of community caregivers in the treatment process. More and more, family members and other community caretakers are being asked to provide critical support and serve as the "de facto therapists" for people suffering from severe mental illnesses (Goldman 1982; Thompson and Doll 1982; Doll 1976). Research has been instrumental both in documenting the impact of deinstitutionalization on families and in raising public awareness of the importance of caring for the caregivers (Lefley 1996; Cook 1988; Goldman 1982). Over the years, studies have generated a clearer picture of the family experience of severe mental illness and its many social dimensions. Indeed, this literature has documented the nature and extent of the burden and gratification of caregiving (Hoenig and Hamilton 1966; Biegel, Sales, and Schultz 1991; Horwitz and Reinhard 1992; Greenberg, Greenley, and Benedict 1994; Bulger, Wandersman, and Goldman 1993) and identified many factors that moderate caregiver stress (Gubman and Tessler 1987; Biegel et al. 1991; Lefley 1996). Most recently, researchers have demonstrated that social support-both informal social support and participation in formal support groups-can alleviate some of the burden and stress that caregivers sometimes feel (Spaniol 1987; Tausig 1992; Lefley 1996). With some exceptions (Tausig 1992), however, the bulk of this work has emphasized the functional dimensions of social support (e.g., perceptions of the amount of instrumental versus emotional support) with little regard for how the structural organization of the caregivers' support networks may affect their experiences (House and Kahn 1985).

This paper presents a theoretical framework for studying the organization of caregivers' support networks which blends insights from social support theory with the social network perspective. The model emphasizes how variation in different types of network resources construct meaningful network contexts of caregiving. These contexts are important, I argue, because they help clarify the ways support networks change over the course of the caregiving career. Using data from two studies of caretakers, one in which the caregivers are relatively early in the caregiver role and one in which they are more experienced, I compare and contrast these caregivers' network support systems using both standard analytic techniques and the proposed theoretical framework. I conclude with a discussion of the implications of these findings for future studies of the stress of caring for someone with a chronic illness and for research on network change.