Many consumers of psychiatric services are parents, making these services the opportunistic point for supporting consumers' children. While evidence suggests that assisting such children improves their mental health, there is a large gulf between what psychiatric services should (or could) provide and what they do in practice. This paper summarizes the constraining barriers and issues for the psychiatric workforce according to: (1) policy and management; (2) interagency collaboration; (3) worker attitude,skill and knowledge; (4) the parent-consumer; and (5) the consumer's family, including children. Potential solutions are presented, with a particular focus on the hierarchical nature of these barriers. Recommendations are made, including organizational audits to identify the most pressing barriers that impede family sensitive practice.

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Family-focused practice in mental health care: an integrative review Highlights  In mental health services, family-focused practice is poorly defined concept  An integrative review was conducted to synthesize evidence in this area  Six core and inter-related family-focused practices were identified  Family as defined by its members provides a basis for "whole of family" care ABSTRACTWhile mental health services are increasingly encouraged to engage in family-focused practice, it is a nebulous and poorly understood term. The aim of this paper was to examine and synthesize evidence on the concept and scope of family-focused practice in adult and child and youth mental health care settings. An integrative literature review method was used. Medline, Embase, CINAHL, PsycInfo and Proquest electronic databases were systematically searched for abstracts published in English between 1994-2014. Data were extracted and constant comparative analysis conducted with 40 included articles. Family-focused practice was conceptualised variously depending on who was included in the "family", whether the focus was family of origin or family of procreation, and the context of practice. As a finding of the review, six core and inter-related family-focused practices were identified: family care planning and goal-setting; liaison between families and services; instrumental, emotional and social support; assessment; psychoeducation; and a coordinated system of care between families and services.While family is a troubled concept, "family" as defined by its members forms a basis for practice that is oriented to providing a "whole of family" approach to care. In order to strengthen family members" wellbeing and improve their individual and collective outcomes, key principles and practices of family-focused practice are recommended for clinicians and policy makers across mental health settings.

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Children of mentally ill parents are at high risk of developing problems themselves. They are often identified and approached as a homogeneous group, despite diversity in parental diagnoses. Some studies demonstrate evidence for transgenerational equifinality (children of parents with various disorders are at risk of similar problems) and multifinality (children are at risk of a broad spectrum of problems). At the same time, other studies indicate transgenerational specificity (child problems are specifically related to the parent's diagnosis) and concordance (children are mainly at risk of the same disorder as their parent). Better insight into the similarities and differences between children of parents with various mental disorders is needed and may inform the development and evaluation of future preventive interventions for children and their families. Accordingly, we systematically compared 76 studies on diagnoses in children of parents with the most prevalent axis I disorders: unipolar depression, bipolar disorder, and anxiety disorders. Methodological characteristics of the studies were compared, and outcomes were analyzed for the presence of transgenerational equifinality, multifinality, specificity, and concordance. Also, the strengths of the relationships between child and parent diagnoses were investigated. This review showed that multifinality and equifinality appear to be more of a characteristic of children of unipolar and bipolar parents than of children of anxious parents, whose risk is mainly restricted to developing anxiety disorders. For all children, risk transmission is assumed to be partly specific since the studies indicate a strong tendency for children to develop the same disorder as their parent.

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Government policy and organizational factors influence family-focused practice (FFP) in adult mental health services. However, how these aspects shape psychiatric nurses' practice with parents who have mental illness, their dependent children, and families is less well understood. Drawing on the findings of a qualitative study, this article explores the way in which Irish policy and organizational factors might influence psychiatric nurses' FFP, and whether (and how) FFP might be further promoted. A purposive sample of 14 psychiatric nurses from eight mental health services completed semi-structured interviews. The analysis was inductive and presented as thematic networks. Both groups described how policies and organizational culture enabled and/or hindered FFP, with differences between community and acute participants seen. This study indicates a need for policies and organizational supports, including child and family skills training, to promote a whole family approach in adult mental health services.