NAMI Family-to-Family Program for African American Youth

Introduction: Mental Health Disparities Among African American Youth

African American youth are disproportionately affected by mental illness due to the social, economic, and political challenges pervasive in their communities. Black youth face a higher risk of developing mental health conditions than their white counterparts, driven by structural inequalities that adversely shape their lives. More than 9% of Black youth reported a major depressive episode in the past year, yet only 40% of this population sought treatment (National Alliance on Mental Illness, 2021). By comparison, 46% of white youth who reported a depressive episode received treatment. The CDC reported that suicide attempts among Black children between the ages of 10 and 19 increased by 73% from 1991 to 2007 (Klisz-Hulbert, 2021).

The low rates of treatment-seeking among African American youth with mental health challenges have been attributed in part to stigmatization of mental illness diagnoses, lack of awareness about mental health conditions, limited access to mental health facilities, and insufficient social support for pursuing treatment (Lucksted et al., 2012). The intervention examined in this paper is the National Alliance on Mental Illness (NAMI) Family-to-Family program, which uses education to equip families of diagnosed individuals with the skills needed to help their family member seek treatment, create a supportive home environment, and respond effectively to a mental health crisis.

Overview of the NAMI Family-to-Family Program

Dr. Joyce Burland developed the NAMI Family-to-Family (FTF) program in 1991. The program is a 12-week course taught by trained family members who have lived experience with mental illness. The curriculum focuses on developing skills and knowledge to support an ill family member, with an emphasis on self-care, education, social support, and problem-solving (Klisz-Hulbert, 2021). The program has been adapted into multiple languages, including Spanish, and tailored across different states to address unique cultural challenges that may affect the management of mental illness within families and communities.

The program has been implemented nationwide, with more than 300,000 people completing the course and approximately 3,500 certified trainers (Lucksted et al., 2012). Its efficacy rests on equipping both families and diagnosed individuals with the knowledge to identify symptoms, manage social relationships with the affected member, maintain family members' wellbeing, and understand the effects of medication on the person living with mental illness.

The NAMI program emerged in response to a prior cultural norm of "family blame," in which families were held responsible for failing to seek care or for the existence of the disorder itself — a predisposition rooted in widespread misinformation about mental health. In African American communities, for example, individuals advised to seek professional help may decline out of fear of being labeled "crazy" (Klisz-Hulbert, 2021). Caregivers of diagnosed children may also hesitate due to sensitivity to social stigma. In some cases, an early, unsatisfactory encounter with the mental health system makes it difficult for families to pursue appropriate treatment for their child.

Research Evidence and Program Outcomes

The Maryland Family-to-Family education program conducted a study to examine the efficacy of the NAMI FTF program for families with adult or young members living with a mental health condition. Researchers found that FTF reduced burden and distress while improving mental health awareness, self-care, empowerment, and overall family functioning. Participants were recruited through flyers, local NAMI websites, and mental health and social services across five boroughs in Maryland and New York City. New York was selected because it has the highest annual program enrollment — approximately 15,000 participants — and is considered a reliable representation of individuals living with mental illness at the local and state levels (Noonan, Velasco-Mondragon & Wagner, 2016). The New York division of NAMI has provided family training for more than 25 years and holds a substantial body of longitudinal data. The study supplemented primary data with secondary sources to more thoroughly evaluate the program's strategies.

Outcomes were measured using the Family Empowerment Scale, the McMaster Family Assessment Device general functioning subscale, the Brief COPE Inventory, and the Family Experience Interview Schedule. Self-care among program participants was assessed using the Self-Care Inventory and a knowledge index derived from the program's own curriculum (Noonan, Velasco-Mondragon & Wagner, 2016). The effects observed in Maryland were mirrored in New York. Key outcomes included improvements in coping, empowerment, family functioning, self-care, and mental health knowledge. The study also documented a reduction in subjective burden experienced by family members of diagnosed individuals, consistent with findings from the qualitative literature reviewed.

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