About 5 million Americans experience severe mental disorders yearly. Most current statistics indicate that 214,000 outpatient severely mentally ill clients are minorities, most of which are assumed to be African-American. There has been increasing recognition and investigation of the support families provide. Completed studies have generally omitted investigation of ethnic/racial variations. However African-Americans have shown variations in family caregiving with other disease processes and differences in family dynamics. The purpose of this study was to explore the experience of the African-American caregiver of the severely mentally ill adult. Fieldwork methods were based on principles of ethnographic research. Sixteen participants were interviewed regarding their experiences using a semi-structured interview guide. Twelve participant observation experiences were part of the data collection process. Cyclic analysis of narrative data was facilitated by the Ethnograph computer program. Participant observation experiences were analyzed. The reiterative process included coding and categorizing data to the point of saturation. The study findings focused on the caregiver experience; family structure, and process of caregiving; caregiving family interactions in the African-American community; perceptions of, and interactions with the mental health system: and family caregiver role within the larger environment. African-American caregivers demonstrated both similarities and dissimilarities in caregiving when compared to the findings in the current literature. Family caregivers were female, and were wives, spouses, sisters and daughters of the mentally ill adult. The caregiver/care recipient family relationship influenced both family structure and family processes. These variations in family structure and processes greatly influenced caregiving. The world view of these family caregivers affected interactions with the environment. Socioeconomic factors influenced many aspects of the caregiving process. Community resources such as religion, and law enforcement were extensively utilized. Family caregivers showed limited involvement in other environmental resources such as support groups, and political activity related to mental health care. Nursing implications include application of findings toward further investigation, nursing education, community education, advanced nursing practice and policy development.
