A Balancing Act: A Systematic Review and Metasynthesis of Family-Focused Practice in Adult Mental Health Services

Abstract

Parental mental illness is a major international public health concern given its implications for whole families, including children. Family-focused practice (FFP), an approach that emphasises a “whole-family” approach to care, provides an opportunity to mitigate the significant risks associated with parental mental health difficulties. The positive benefits associated with FFP have led to a shift in policy and practice towards prioritising FFP within adult mental health services. However, evidence suggests that FFP remains scarce and is not routine. Research has identified the important role of practitioners in facilitating FFP. The current review identified, synthesised and appraised the international qualitative literature examining adult mental health practitioners’ implementation experiences of FFP. It aimed to provide an evidence-informed account of practitioner experiences of FFP delivery and to identify key recommendations to enhance future FFP outcomes in AMHS. Ovid Medline, PsycInfo, CINAHL plus, EMBASE and Web of Science Core Collection were searched systematically, in line with PRISMA guidance, up to January 2022. The Critical Appraisal Skills Programme (CASP) was used to undertake the quality appraisal prior to a thematic synthesis being conducted. The review was registered on PROSPERO. Nineteen papers, spanning 17 years of research with 469 practitioners, were included. Three main themes and 14 subthemes were developed, representing different aspects of practitioner experiences of FFP delivery. Practitioners’ approach to FFP was variable and influenced by their beliefs about FFP, perceived roles and responsibilities, competence, service setting, and personal parenting status. Practitioners engaged in a balancing act to maintain a dual focus on their service-users and their children, to navigate powerful emotions, and consider multiple perspectives in a biomedical organisational structure that advocates individualised treatment. Although working together unified teams, a greater need for external interagency collaboration was identified. The use of strength-based approaches with clients and dedicated staff resources, within clear guidelines and frameworks, was reported to be necessary to maximise FFP delivery. This review proposes a complex FFP dynamic whereby practitioners engage in a constant balancing act between FFP stakeholders to achieve meaningful FFP outcomes for service-users and their families. Service recommendations are provided.

Parenting and Serious Mental Illness (SMI): A Systematic Review and Metasynthesis

“…The current review consolidates such findings and offers insights into how to target such barriers, by moving away from siloed and risk-focused approaches in which practitioners and policymakers are at the centre of decisions, and towards a system in which practitioners and other stakeholders scaffold compassionate, goal and strength based and collaborative support around parents, and the systems they live within. Our findings suggest that policy guidance underpinning clinical practice may inhibit professionals from providing the type of care that would allow parents to meaningfully engage with services, as explored recently by Tuck et al ( 2022 ). Echoing Bronfenbrenner’s Ecological Systems Theory (Bronfenbrenner, 1992 ) that views psychosocial processes to be influenced by multiple levels of the surrounding environment, our study findings highlight that change is needed at multiple systemic levels to promote better relationships between parents and their children, families, HCPs, and wider cultural and political networks.…”

“…Previous research has highlighted factors that inhibit parents from accessing support, including lack of policy and practice guidelines, lack of integration between adult and child services, crisis-orientated service provision, fears about child loss, and approaches that present a parenting ‘fix’ (Jones et al, 2016 ; Mulligan et al, 2020 , 2021 ; Tuck et al, 2022 ; van Esch & de Haan, 2017 ). The current review consolidates such findings and offers insights into how to target such barriers, by moving away from siloed and risk-focused approaches in which practitioners and policymakers are at the centre of decisions, and towards a system in which practitioners and other stakeholders scaffold compassionate, goal and strength based and collaborative support around parents, and the systems they live within.…”

Parents' experiences of receiving their child's diagnosis of congenital heart disease: A systematic review and meta‐synthesis of the qualitative literature

“…Results were presented in words and numbers (No = 0, Partially agree = 0.5, Yes = 1). In line with other meta-syntheses (e.g., Harries et al, 2023;Tuck et al, 2023), quality/risk of bias was then categorized as high (>8-10), moderate (6-8) and low (<5). The methodological quality of all studies was assessed by the first author and an independent researcher; their agreement was 100%.…”

An integrated family approach in the practice of adult and child mental health care

“…Organizational policy barriers include limited or no resources for professionals to work according to a family focused approach. Issues that they face are: provision of time needed for collaborative work; high workloads; the issue of money, and lack of possibilities for supervision of family interventions ( 18 , 19 ). The therapeutic point of view within the service can be another barrier for professionals, such as a one-sided orientation on individual mental disorders.…”