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SUMMARYBurbach describes the content of a phased approach to delivering family work in psychosis. Clinicians would find it helpful to have guidance on how to address the challenges they face in clinical practice, such as engaging all family members in the process and how to deal with confidentiality conflicts. Implementation challenges are also likely to affect their ability to deliver this intervention. It may also be useful to consider the role that family members can play in co-production and training, and in delivering support to other families through a carer peer support model.DECLARATION OF INTERESTNone.

The purpose of this audit was to explore the experiences of 42 professionals trained over a three‐year period as trainers in behavioural family therapy. Trainers completed a questionnaire designed to explore their motivations, frustrations, sources of support and benefits they experienced through involvement with the Meriden Family Programme. Quasi‐qualitative, thematic analyses were performed on the data. The audit found numerous intrinsic motivations for being a trainer, as well as a wide range of benefits, including belief in the approach, wanting to help families, enjoyment of teaching and professional development. Frustrations encountered were disinterest of staff, lack of support and restrictions on the trainers' role. Trainers were resourceful and used various solutions to overcome these. Recommendations are made on how to manage and maintain enthusiasm and support of trainers, or other family work champions.

Interpretative phenomenological analysis (IPA) is an approach to qualitative research that is now well-established in British psychology. This approach is concerned with understanding people's experiences of the world and of themselves. The aims of IPA studies have been met most frequently through the use of one-on-one interviews. Relatively few studies have used focus group discussions as the basis for IPA studies, but focus groups may provide rich experiential data. In this article, we describe a process for integrating focus group data into an IPA study. We developed this during a study of the experiences of carers of people with mental health problems. Here we outline the various steps of our analytic process and discuss how these might be employed and adapted by other researchers wishing to apply IPA's concern with personal experience to the analysis of focus group data.

With more than 160,000 carers in Ireland, there is a considerable need to provide support and coping strategies to reduce the burden of care on both the individual and the economy. Government policies are increasingly involving carers within health services, as they provide real‐life insights into the needs of service users and carers. Further, healthcare professionals and carers can benefit from training delivered by the carers themselves.The current report was a highly successful initiative where carers and professionals from both sides of the border between Northern Ireland and the Republic of Ireland worked together effectively to deliver an 11‐week programme of support to carers of those with mental health problems. This innovative initiative aimed to achieve health gain and social well‐being in the border areas, as well as to build constructive partnerships. The participants were relatively inexperienced in delivering training prior to the training course, but acquired the skills and knowledge neede...

Family interventions for psychosis are not routinely available, in spite of a robust evidence base, clear policies and guidelines, and requests from service recipients. The reasons for this are complex involving three key groups: service recipients, clinicians and organizations. This paper first of all identifies barriers to implementation in relation to each of these groups. It then outlines a range of strategies that may be employed at a number of levels to bring about change in each of these systems. The strategies are drawn from current research in the area, and from experiences over a seven-year period in the Meriden West Midlands Family Programme.

Background: Strong evidence exists to support the use of psychoeducational approaches in psychosis. However, engagement of families in such approaches is problematic.Aims: The aim of the qualitative study described was to establish what therapists and families believe to be helpful (or otherwise) in the engagement of families in behavioural family therapy (BFT). In addition, the nature of the relationship between workers and families was explored.Method: Data were collected via interviews with trained therapists and family members engaged in BFT. A grounded theory approach was used in the analysis of interview transcripts.Results: A model of engagement from the therapist perspective was developed. A core category of humanity emerged. The model is described and discussed in relation to the implementation literature regarding psychoeducational family interventions.Conclusions: Qualities possessed by the practitioner are key in engagement of families and the application of psychoeducational approaches. Furth...

In June 2005 it became mandatory for psychiatric trainees to receive training directly from people who experience mental health problems and their carers. This will be checked on approval visits to all training schemes, and accreditation may be withheld until this aspect of training is in place. For many of those who are responsible for training, this may be a new undertaking. We outline some of the issues that trainers need to consider when involving service users and carers in their training programmes, including background issues, how to prepare both those delivering and those receiving training, and logistical considerations. It is hoped that this paper will alert trainers to issues that need to be considered if such training is to be successful.

The involvement of family, social networks and those who are important in the life of the person presenting with difficulties is core in early interventions. When intervening early, it is much more likely that the individual will be functioning at a level where they are still engaged with families and relatives. The extent of involvement will vary depending on where the person is on the continuum of lifespan development. Clearly, there is recognition that for children with difficulties, the family must be involved, and this also applies at the other end of the age spectrum where older people are often dependent on family for support and care. It makes sense from several perspectives to support people in using those resources that are naturally there in their lives, particularly where this results in the avoidance of dependency on expensive secondary and tertiary services. The evidence presented in this chapter confirms that people are willing to engage in family-based approaches, with a high rate of treatment retention when families are involved. The involvement of those who are significant in the person’s life fits with models of recovery, and clearly, if an individual is deprived of this support, they are missing a key resource that could aid their recovery. Fostering competencies that can be incorporated into everyday environments and activities in both the individual and those who are close to them makes it more likely that gains will be maintained. Family-centred approaches tend to have a number of core values such as a non-blaming attitude towards families, collaborative working relationships between family members and professionals, the empowerment of families by emphasising concepts of choice and control, an emphasis on strengths

The research on psychoeducational family interventions is reviewed, outlining the key findings of the early intervention studies, and summarizing what later studies contribute to our knowledge. Questions of relevance to clinicians are addressed. The author draws attention to pertinent issues in relation to training and supervision of therapists, and highlights difficulties which must be overcome if family interventions are to be provided routinely in clinical services.

The efficacy of psychoeducational family interventions in schizophrenia is well established with clear evidence that they result in reduced relapse rates and costs of care. Gaps remain in our knowledge with regard to their applicability to early psychosis or psychoses other than schizophrenia. Questions as to how they can be implemented in routine clinical settings remain unanswered. development of these interventions has been a decline in research on family burden or caregiving. The needs of family caregivers is their own right rather than as agents of rehabilitation received little attention in the 1970s and 1980s, although there has been a welcome revival of interest in the present decade. The challenge of the next century is to look at how the different 'camps' can be integrated to produce better services for those with psychosis and their families, as comprehensive services which meet the needs of all of those involved are rare worldwide.

The efficacy of family interventions in schizophrenia is now well established. Major reviews of the literature all conclude that family psycho-educational interventions result in reduced relapse rates, hospitalisation rates and costs of care, in improved compliance with medication, and that they are applicable across cultures. However, there is no evidence that family approaches to schizophrenia are being offered on a global scale in mental health services. A number of studies have shown that clinicians can be trained effectively in family intervention skills, but there are major obstacles to the implementation of these interventions in routine clinical practice. The present study describes the results of a survey of 86 therapists who received training in Behavioural Family Therapy (BFT); 70% of therapists reported that they had used the approach in their work, but the mean number of families seen per therapist was only 1.7. Forty per cent of the families were seen by 8% of the therapists trained...

Psychoeducational family approaches are effective in improving the quality of life for both those with mental health problems and their families, but implementation of these approaches within health services has been limited. The Meriden Family Programme has provided training and support for over 3,900 therapists and 242 trainers in Behavioural Family Therapy (BFT) to encourage widespread delivery of effective services for families with a member who has psychosis or other serious mental health problems.This article synthesises healthcare professionals' and carers' views on the implementation of family work and ways of increasing family involvement in services.During the Meriden Programme's 10th anniversary year, three Masterclass groups (n = 27) were conducted with healthcare professionals and carers involved with the programme over the past 10 years.A collaborative approach between management, commissioners, BFT trainers, therapists, carers and service users encourages and ensures the delivery of family work. The most effective types of support, methods of training and organisational factors in supporting family work implementation are illustrated.Best practices in implementing family work are identified to support and better inform those responsible for providing family work within their services.

Os autores fazem uma retrospectiva da utilização de psicoterapia comportamental em famílias de pessoas com doença mental grave, nomeadamente esquizofrenia, focando o modelo de Falloon e colaboradores (Terapia Familiar Comportamental). Trata-se de uma intervenção unifamiliar, psicoeducativa, de inspiração comportamental, que pretende melhorar a capacidade de resolução de problemas no seio da família. Os resultados estão bem documentados em termos clínicos (menores taxas de recaída), psicossociais (melhor funcionamento socio-ocupacional, menor sobrecarga familiar) e económicos. Estas intervenções estão amplamente difundidas na Europa e EUA, e as suas indicações têm sido alargadas a diversos campos da psicopatologia do adulto, bem como da infância e adolescência. Em Portugal, o treino neste tipo de intervenções tem vindo a ser feito desde 1996, ainda que, paradoxalmente, sem tradução significativa na prática clínica de rotina. As dificuldades de implementação são parcialmente comuns a outras intervenções com famílias, constituindo uma área merecedora de investigação específica. Behavioural interventions have been used with families where there are severe mental health difficulties. Behaviour Family Therapy (Falloon and colleagues) is an effective family intervention for schizophrenia with clear-cut aims. Evidence regarding outcome has been established, either in clinical terms (reduced relapse and hospitalisation rates), psycho-social factors (better social and occupational functioning, reduced family burden) or economic terms (reduced cost of service). It’s a family intervention delivered to individual families within a ‘strengths framework’ – the approach is psychoeducational, and there is a focus on the family acquiring specific coping skills. Behavioural psychoeducational interventions are practiced worldwide, and seems helpful in a wide range of mental health conditions. In Portugal, training in this kind of intervention began in 1996, although with scarce impact in regular clinical practice. Implementation difficulties are shared with other forms of family work and this undoubtedly deserves specific high-quality research. info:eu-repo/semantics/publishedVersion

In the field of pychoeducational interventions in schizophrenia, terminology is sometimes misleading and further efforts are needed to specify and operationalise terms such as psychoeducation or family intervention, especially wherever they are adapted, for example, for use in non-English speaking countries. On the other hand, in spite of growing evidence of their clinical effectiveness, family interventions for schizophrenia are still not routinely implemented in real life clinical settings. Furthermore, the current poverty of original literature or replication studies in Portugal in the field of family interventions is astonishing. Several high-quality review papers have been published in the last two decades, summarising or meta-analysing data concerning efficacy, effectiveness and efficiency of these family interventions worldwide, but mostly in Anglo-Saxon literature. These findings were indeed incorporated in several clinical guidelines, namely in the United Kingdom. But there seems to exist, in a considerable number of settings, a lack of will to implement scientific findings established for more than twenty years. In developed countries, this should be addressed as a true paradox.

Subjective and objective burden, psychiatric symptoms and coping strategies in a sample of 90 key relatives and other relatives of patients with schizophrenia, living in two European countries, were explored by means of well-validated questionnaires. The levels of burden on key relatives did not differ significantly from those on other relatives. Moreover, the risk of developing psychiatric symptoms was similar in the two subject groups at both centres. Significant correlations were found between key relatives and other relatives concerning the adoption of emotion-focused coping strategies. These data contrast with the current belief that family burden in schizophrenia is mainly a burden of key relatives, and they emphasize the need to provide supportive interventions for as many relatives as possible.

The burden, the coping strategies and the social network of a sample of 236 relatives of patients with schizophrenia, living in five European countries, were explored by well-validated assessment instruments. In all centres, relatives experienced higher levels of burden when they had poor coping resources and reduced social support. Relatives in Mediterranean centres, who reported lower levels of social support, were more resigned, and more often used spiritual help as a coping strategy. These data indicate that family burden and coping strategies can be influenced by cultural factors, and suggest that family interventions should have also a social focus, aiming to increase the family social network and to reduce stigma.

The impact of social and clinical factors on the choice of coping strategies of a sample of 236 relatives of patients with schizophrenia, living in five European countries, was explored using well-validated questionnaires. The adoption of problem-focused coping strategies was more frequent among young relatives and among relatives of younger patients, and was associated with higher levels of practical and emotional social support and of professional help. In contrast, emotion-focused strategies were more frequently adopted by relatives who had been living longer with the patient and who had poorer social support. It is suggested that supportive and educational interventions should be provided as early as possible to relatives of patients with schizophrenia, which, in addition to having a practical focus, should also have a social focus, aiming at extending the family's social network.

The literature on depression in marriage and the effects of depression on the patient's spouse is reviewed. Current treatments for depression frequently do not result in long-term recovery. Relatives experience a considerable burden but their needs are often ignored. Typically, they receive very little information from professionals about the patient's illness or how to cope with the difficulties they face. Marital difficulties are sometimes present and may either result from or contribute to one partner's depression. However, problems of an interpersonal nature are usually not addressed once clinical improvement has been achieved. Psychosocial interventions are used only following several relapses. The need for broader assessment and outcome criteria is emphasized. Long-term recovery may be more likely if interventions are directed at the various problems which exist, rather than concentrating solely on symptom relief. The methods used in the schizophrenia intervention studies and and with “normal” couples may be applicable when one partner is depressed. The few studies which have employed marital therapy as a treatment for depression, either alone or in combination with other therapies, show promising results. Further research is needed to ascertain which approach or combination of approaches is most successful in achieving long-term recovery in depression.

BACKGROUND: To date, only few data are available on how family burden in schizophrenia changes over time. In addition, no study has explored how such factors as coping styles and social support influence burden over time. This paper presents the 1-year follow-up data from the BIOMED I study on family burden and coping strategies in schizophrenia. METHODS: A sample of 159 relatives of patients with schizophrenia living in five European countries was followed up prospectively for 1 year with regard to burden and coping strategies, using validated questionnaires. RESULTS: In the sample as a whole, the burden was stable. A reduction of family burden over time was found among relatives who adopted less emotion-focused coping strategies and received more practical support from their social network. In addition, family burden decreased in relation to the improvement of patient's social functioning. CONCLUSIONS: When relatives of patients with schizophrenia are able to improve their coping strategies, it is possible for burden to be reduced even after several years. This points to the necessity to provide families of chronic psychotic patients with psychoeducational interventions emphasising the adoption of an effective coping style.