In the aftermath of the tragic Bondi knife attack, Joel Cauchi’s parents have spoken about their son’s long history of mental illness, having been diagnosed with schizophrenia at age 17. They said they were “devastated and horrified” by their son’s actions. “To you he’s a monster,” said his father. “But to me he was a very sick boy.”

Globally, one out of every eight people report a mental illness. In Australia, one in five people experience a mental illness in their lifetime.

Mental illness and distress affects not only the person living with the condition, but family members and communities. As the prevalence of mental health problems grows, the flow-on effect to family members, including caregivers, and the impact on families as a unit, is also rising.

While every family is different, the words of the Cauchis draw attention to how families can experience distress, stress, fear, powerlessness, and still love, despite the challenges and trauma. How can they help a loved one? And who can they turn to for support?

The role of caregivers

Informal caregivers help others within the context of an existing relationship, such as a family member. The care they provide goes beyond the usual expectations or demands of such relationships.

Around 2.7 million Australians provide informal care. For almost a third of these the person’s primary medical diagnosis is psychological or psychiatric.

It has long been acknowledged that those supporting a family member with ongoing mental illness need support themselves.

In the 1980s, interest grew in caregiving dynamics within families of people grappling with mental health issues. Subsequent research recognised chronic health conditions not only affect the quality of life and wellbeing of the people experiencing them, but also impose burdens that reverberate within relationships, caregiving roles, and family dynamics over time.

Past studies have shown families of those diagnosed with chronic mental illness are increasingly forced to manage their own depression, experience elevated levels of emotional stress, negative states of mind and decreased overall mental health.

Conditions such as depression, anxiety disorders, bipolar disorder, and schizophrenia can severely impact daily functioning, relationships, and overall quality of life. Living with mental illness is often accompanied by a myriad of challenges. From stigma and discrimination to difficulty accessing adequate health care and support services. Patients and their families navigate a complex and often isolating journey.

The family is a system

The concept of family health acknowledges the physical and psychological wellbeing of a person is significantly affected by the family.

Amid these challenges, family support emerges as a beacon of hope. Research consistently demonstrates strong familial relationships and support systems play a pivotal role in mitigating the adverse effects of mental illness. Families provide emotional support, practical assistance, and a sense of belonging that are vital for people struggling with mental illness.

My recent research highlights the profound impact of mental illness on family dynamics, emphasising the resilience and endurance shown by participants. Families struggling with mental illness often experience heightened emotional fluctuations, with extreme highs and lows. The enduring nature of family caregiving entails both stress and adaptation over an extended period. Stress associated with caregiving and the demands on personal resources and coping mechanisms builds and builds.

Yet families I’ve interviewed find ways to live “a good life”. They prepare for the peaks and troughs, and show endurance and persistence. They make space for mental illness in their daily lives, describing how it spurs adaptation, acceptance and inner strength within the family unit.

When treating a person with mental illness, health practitioners need to consider the entire family’s needs and engage with family members. By fostering open and early dialogue and providing comprehensive support, health-care professionals can empower families to navigate the complexities of mental illness while fostering resilience and hope for the future. Family members express stories of an inner struggle, isolation and exhaustion.

Shifting the focus

There is a pressing need for a shift in research priorities, from illness-centered perspectives to a strengths-based focus when considering families “managing” mental illness.

There is transformative potential in harnessing strengths to respond to challenges posed by mental illnesses, while also supporting family members.

For people facing mental health challenges, having loved ones who listen without judgement and offer empathy can alleviate feelings of despair. Beyond emotional support, families often serve as crucial caregivers, assisting with daily tasks, medication management and navigating the health-care system.

As the Cauchi family so painfully articulated, providing support for a family member with mental illness is intensely challenging. Research shows caregiver burnout, financial strain and strained relationships are common.

Health-care professionals should prioritise support for family members at an early stage. In Australia, there are various support options available for families living with mental illness. Carer Gateway provides information, support and access to services. Headspace offers mental health services and supports to young people and their families.

Beyond these national services, GPs, nurses, nurse practitioners and local community health centres are key to early conversations. Mental health clinics and hospitals often target family involvement in treatment plans.

While Australia has made strides in recognising the importance of family support, challenges persist. Access to services can vary based on geographic location and demand, leaving some families under-served or facing long wait times. And the level of funding and resources allocated to family-oriented mental health support often does not align with the demand or complexity of need.

In the realm of mental illness, family support serves as a lifeline for people navigating the complexities of their conditions.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

Amanda Cole, Lead, Mental Health, Edith Cowan University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What’s the difference? is a new editorial product that explains the similarities and differences between commonly confused health and medical terms, and why they matter.

The terms “shyness” and “social anxiety” are often used interchangeably because they both involve feeling uncomfortable in social situations.

However, feeling shy, or having a shy personality, is not the same as experiencing social anxiety (short for “social anxiety disorder”).

Here are some of the similarities and differences, and what the distinction means.

How are they similar?

It can be normal to feel nervous or even stressed in new social situations or when interacting with new people. And everyone differs in how comfortable they feel when interacting with others.

For people who are shy or socially anxious, social situations can be very uncomfortable, stressful or even threatening. There can be a strong desire to avoid these situations.

People who are shy or socially anxious may respond with “flight” (by withdrawing from the situation or avoiding it entirely), “freeze” (by detaching themselves or feeling disconnected from their body), or “fawn” (by trying to appease or placate others).

A complex interaction of biological and environmental factors is also thought to influence the development of shyness and social anxiety.

For example, both shy children and adults with social anxiety have neural circuits that respond strongly to stressful social situations, such as being excluded or left out.

People who are shy or socially anxious commonly report physical symptoms of stress in certain situations, or even when anticipating them. These include sweating, blushing, trembling, an increased heart rate or hyperventilation.

How are they different?

Social anxiety is a diagnosable mental health condition and is an example of an anxiety disorder.

For people who struggle with social anxiety, social situations – including social interactions, being observed and performing in front of others – trigger intense fear or anxiety about being judged, criticised or rejected.

To be diagnosed with social anxiety disorder, social anxiety needs to be persistent (lasting more than six months) and have a significant negative impact on important areas of life such as work, school, relationships, and identity or sense of self.

Many adults with social anxiety report feeling shy, timid and lacking in confidence when they were a child. However, not all shy children go on to develop social anxiety. Also, feeling shy does not necessarily mean a person meets the criteria for social anxiety disorder.

People vary in how shy or outgoing they are, depending on where they are, who they are with and how comfortable they feel in the situation. This is particularly true for children, who sometimes appear reserved and shy with strangers and peers, and outgoing with known and trusted adults.

Individual differences in temperament, personality traits, early childhood experiences, family upbringing and environment, and parenting style, can also influence the extent to which people feel shy across social situations.

However, people with social anxiety have overwhelming fears about embarrassing themselves or being negatively judged by others; they experience these fears consistently and across multiple social situations.

The intensity of this fear or anxiety often leads people to avoid situations. If avoiding a situation is not possible, they may engage in safety behaviours, such as looking at their phone, wearing sunglasses or rehearsing conversation topics.

The effect social anxiety can have on a person’s life can be far-reaching. It may include low self-esteem, breakdown of friendships or romantic relationships, difficulties pursuing and progressing in a career, and dropping out of study.

The impact this has on a person’s ability to lead a meaningful and fulfilling life, and the distress this causes, differentiates social anxiety from shyness.

Children can show similar signs or symptoms of social anxiety to adults. But they may also feel upset and teary, irritable, have temper tantrums, cling to their parents, or refuse to speak in certain situations.

If left untreated, social anxiety can set children and young people up for a future of missed opportunities, so early intervention is key. With professional and parental support, patience and guidance, children can be taught strategies to overcome social anxiety.

Why does the distinction matter?

Social anxiety disorder is a mental health condition that persists for people who do not receive adequate support or treatment.

Without treatment, it can lead to difficulties in education and at work, and in developing meaningful relationships.

Receiving a diagnosis of social anxiety disorder can be validating for some people as it recognises the level of distress and that its impact is more intense than shyness.

A diagnosis can also be an important first step in accessing appropriate, evidence-based treatment.

Different people have different support needs. However, clinical practice guidelines recommend cognitive-behavioural therapy (a kind of psychological therapy that teaches people practical coping skills). This is often used with exposure therapy (a kind of psychological therapy that helps people face their fears by breaking them down into a series of step-by-step activities). This combination is effective in-person, online and in brief treatments.

For more support or further reading

Online resources about social anxiety include:

• This Way Up’s online program for managing excessive shyness and fear of social situations
• Beyond Blue’s resources on social anxiety
• a guide to looking after yourself if you have social anxiety, from the Western Australian health department
• social anxiety online program for children and teens from the University of Queensland
• inroads, a self-guided online program for young adults who drink alcohol to manage their anxiety.

We thank the Black Dog Institute Lived Experience Advisory Network members for providing feedback and input for this article and our research.

Kayla Steele, Postdoctoral research fellow and clinical psychologist, UNSW Sydney and Jill Newby, Professor, NHMRC Emerging Leader & Clinical Psychologist, UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.