A qualitative analysis of relatives’, health professionals’ and service users’ views on the involvement in care of relatives in Bipolar Disorder

Abstract

BackgroundRelatives of people with bipolar disorder report that services do not meet their own needs, despite clinical recommendations for the development of care plans for relatives, provision of information regarding their statutory entitlements, and formal involvement in decision making meetings. Further, there is now conclusive evidence highlighting the benefits of relatives’ involvement in improving outcomes for service users, relatives, and the health system as a whole. This qualitative study explored the views of relatives of people with bipolar disorder, service users and healthcare professionals regarding the barriers and the facilitators to relatives’ involvement in care.MethodsThirty five people were interviewed (12 relatives, 11 service users and 12 healthcare professionals). Audio recordings were transcribed verbatim and common themes in participants’ narratives emerged using framework analysis.ResultsParticipants’ accounts confirmed the existence of opportunities for relatives to be involved. These, however, were limited and not always accessible. There were three factors identified that influenced accessibility namely: pre-existing worldviews, the quality of relationships and of communication between those involved, and specific structural impediments.DiscussionThese themes are understood as intertwined and dependent on one another. People’s thoughts, beliefs, attitudes, cultural identifications and worldviews often underlie the ways by which they communicate and the quality of their relationship. These, however, need to be conceptualised within operational frameworks and policy agendas in health settings that often limit bipolar relatives’ accessibility to opportunities for being more formally involved.ConclusionsInvolving relatives leads to clear benefits for relatives, service users, healthcare professionals, and the health system as a whole. Successful involvement of relatives, however, depends on a complex network of processes and interactions among all those involved and requires strategic planning from policy makers, operational plans and allocation of resources.

‘Between a rock and a hard place’: family members’ experiences of supporting a relative with bipolar disorder

“…Studies of severe mental health problems carried out in the UK have also highlighted issues raised in this study, such as confidentiality being used inflexibly, and an absence of crisis planning, suggesting these difficulties are particularly pertinent to the British system of care (Chatzidamianos et al, 2015;Wainwright et al, 2015). The results of this study support Chatzidamianos et al's (2015) assertion that UK services may be better equipped to support those with chronic, rather than episodic difficulties, with participants reporting a lack of responsiveness from crisis services. Participants' accounts also highlight how the nature of mania may pose significant challenges for family members, in that sufferers may not perceive themselves as unwell or in need of support, thus increasing their opposition to services' involvement (BPS, 2010;Doherty & McGeorge, 2014).…”

“…Despite the distinctive features of bipolar disorder, research about family members' experiences is less developed than that concerning relatives of those with schizophrenia or dementia (Chatzidamianos et al, 2015;Ogilvie, Morant & Goodwin, 2005;Van der Voort et al, 2007). As a result, there have been calls for further research, in order to enhance understanding of how interventions and services can best support family members and caregivers (Pompili et al, 2014;van der Voort et al, 2007).…”

“…Where family members have been involved in service-users' care, this can have substantial benefits for the service user and family member (Peters, Pontin, Lobban & Morris, 2011). However, numerous barriers to family members' involvement have been identified, including the service-user's desire for autonomy, the culture of mental health services, staff training and workload, and rules around confidentiality (Chatzidamianos et al, 2015;Peters et al, 2011).…”

“…The cyclical nature of the disorder, and rapid and extreme changes in mood, may mean that family members are put in a position of containing risk before services can be involved (Chatzidamianos, Lobban & Jones, 2015). Symptoms of mania such as risk taking and aggression, and the high risk of suicide associated with depressive episodes, are extremely challenging for family members to manage, and can place family relationships under substantial pressure Beentjes et al, 2011;Clements et al, 2013;Fletcher, Parker, Paterson & Synnott, 2013).…”

Концепти Комунікативного Ресурсу У Хворих На Рекурентний Депресивний Розлад Та Їх Референтних Родичів

“…Наскільки члени сім'ї здатні формувати адекватні стосунки та адаптуватись до нових умов життя залежить від їх особистісного комунікатив-ного ресурсу, до основних видів якого можна від-нести соціальний інтелект, емпатію, аффіліацію. Низький рівень комунікативного ресурсу сприяє формуванню пасивної дезадаптивної поведінки, соціальній ізоляції та дезінтеграції особистості [1,2]. Емпатія є важливим ресурсом подолання про-блемних та емоційно-стресових ситуацій.…”