The Need for a Framework of Family Inclusion as Age 18 Arrives

At 18 years of age in the United States, a young person not only acquires the right to vote. Among other facets of legal majority, he also acquires the right to prevent disclosure of details of his ongoing health status, including of course mental health care. Up to a point, he (or she) need answer to no one in asserting that right.

This abrupt shift in the landscape can and does unsettle a cornerstone of mental health care–communication with concerned family members about the affected individual’s clinical care. Too often this is detrimental for young people and their caregivers alike.

The 2007 New Zealand Mental Health Commission study, reviewed data not only from New Zealand, Australia, Pacific Polynesia, Canada and the United States, reporting that family inclusion in some manner was valuable in mental health care in a variety of major mental illnesses, including schizophrenia and borderline personality disorder. Studies of young people in foster care also reflect the vital importance of preserving a warm familial bond as these youth reach 18–the so-called year of “transition”.

Dr. William Beardslee of Harvard Medical School, in his book Out of the Darkened Room (2002), writes:

“In far too many families, depression is neither recognized as a serious illness nor understood, and many of the misunderstandings are compounded by guilt and blame, by trying to make sense of the sufferer’s behavior and not knowing how to.”

This forms a kind of:

shared history that millions of families know all too well. They may be going through it unconsciously. They may be unable to talk about it, and they may have no awareness of how other family members experience the same events, but they are, in fact, going through it together.”

“Breaking the silence together allows for the expression of feelings like those just described, but in a way that is not disruptive. The kind of family meeting we advocate allows for an exchange of points of view to let family members get inside one another’s experience.”

There is no one-size-fits-all method to achieve family inclusion. But clearly as our legal system and privacy laws converge at age 18 to sever young people from their family, something important can be lost in the young person’s care and healing. It is ludicrous to believe that suddenly, at 18, a young person becomes magically independent of any need for family support, ideas, questions, concern and guidance. There is no reason to believe this is any less true for the many young persons going through mental health challenges.

Accordingly, what is needed is a clinical care framework to support continuing family inclusion; and it must, at a minimum, be flexible enough to ensure that 18-year-old persons needing help will not reject it out of hand.

For more information, see THIS ORIGINAL ARTICLE by Roger Greebaum at NAMI California.

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