Beyond the Individual: Reframing Mental Health Crisis As Relational through Feminist Ethics of Care and Family Caregivers’ Voices

Background and Purpose: Mental health crises are predominantly conceptualized as individualized events defined by biomedical symptoms and risk thresholds, a framing that often marginalizes family caregivers’ experiences and ethical struggles. Within dominant legal, clinical, and policy frameworks, crises are typically recognized only when individuals meet criteria of dangerousness or severity, leaving caregivers to manage escalating risks without institutional recognition or support. Drawing on feminist ethics of care, which emphasizes interdependence and relational responsibility, this study challenges the individualized conceptualization of mental health crisis. It reframes crisis as a relationally constituted phenomenon embedded within caregiving relationships. This study examines how family caregivers understand, experience, and navigate mental health crises that are frequently dismissed as “not sick enough” to warrant intervention. We ask: What constitutes a mental health crisis from the perspective of family caregivers, and how do crises unfold relationally within caregiving contexts?

Methods: This qualitative study employed in-depth, semi-structured interviews to explore caregivers’ relational experiences of mental health crises. Nineteen family caregivers in Taiwan participated, including one parent, eight adult children, six siblings, and four intimate (ex)partners of individuals who had experienced mental health crises. Participants were recruited through purposive and snowball sampling via social media and community networks. Interviews were conducted between October and December 2023, either in person or online, and lasted 60–120 minutes. Audio-recorded interviews were transcribed verbatim. Data were analyzed using thematic analysis, guided by feminist ethics of care as an analytic lens, with attention to relational practices and concerns of caregivers’ during mental health crisis.

Results: Analysis identified four interrelated and entangled dimensions of relational mental health crisis: protective vigilance, affective conflict, loss of connection, and systemic instability. Protective vigilance describes caregivers’ constant monitoring of risk motivated by relational responsibility and anticipatory concern for loved ones’ future regret or loss. Affective conflict captures emotionally intense interactions, including hostility, coercion, and high-arousal relational rupture arising within caregiving relationships. Loss of connection refers to caregivers’ experiences of relational grief and disconnection when loved ones appear to have “become someone else,” disrupting emotional intimacy and identity recognition. Systemic instability highlights how crises destabilize broader family and social systems, producing financial strain, disrupted routines, and social stigma that caregivers must manage. These dimensions often co-occur and transform into one another, revealing crisis as a dynamic relational process rather than an isolated individual event.

Conclusions and Implications: This study demonstrates that mental health crisis is not solely an individual psychiatric breakdown but a relational phenomenon that entangles caregivers ethically, emotionally, and materially. By centering caregivers’ lived experiences, it challenges dominant individualized crisis paradigms and advances a feminist care‑ethical framework that conceptualizes crisis as relational rupture. Drawing on Taiwan as a familialistic context, the study offers a critical lens for re-examining individualized models of mental health crisis prevalent in global mental health social work scholarship, highlighting how crises are relationally produced and governed through caregiving. Recognizing relational distress and caregiver suffering as legitimate sites of crisis intervention may enable earlier and more equitable support in practice and policy.