Families and Psychosis

Onwumere, Juliana; Smith, Ben; Kuipers, Elizabeth

doi:10.1002/9780470684214.ch9

Cited by 4 publications

(4 citation statements)

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“…Practitioners of FPE adopt a positive and non-blaming attitude towards families (Onwumere 2010). Thus, families are regarded as having made their best efforts to support their relative, as articulated in the manual for practitioners of one FPE model, behavioural family therapy (Falloon 2004).…”

Section: Principles Of Fpementioning

confidence: 99%

“…This is because a minority of these individuals are married and the dominant cultural emphasis is on adults, whether married or unmarried, leaving their family of origin to become more ‘independent’. However, a large majority of people with schizophrenia live with and/or maintain close contact with family and other support people (Onwumere 2010). For example, the 2010 Australian survey of people with psychosis showed that frequent face-to-face contact with family members in the previous year was the norm: 56.5% had almost daily contact and another 17.1% had at least weekly contact (Morgan 2012).…”

Section: People With Schizophrenia and Their Relationships With Familymentioning

confidence: 99%

“…Barrowclough 1999; Gleeson 2010; Hayes 2014). Further, according to some US studies, the links between carer EE and poor outcomes for their relative with schizophrenia may not be uniform across all cultural groups (Onwumere 2010). These more nuanced findings with regard to EE status and relapse risk are reflected in recent clinical practice guidelines.…”

Section: Development Of Fpe and The Role Of Expressed Emotionmentioning

confidence: 99%

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Family psychoeducation for people living with schizophrenia and their families

Harvey¹

2018

BJPsych advances

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SUMMARYMost people with schizophrenia have frequent contact with their families. Therefore, the family should be involved in their relative's treatment and care wherever possible, so that they can contribute to that person's recovery and the family's own needs for information, support and treatment can be addressed. Family psychoeducation refers to a group of structured psychotherapeutic interventions that involve the person with schizophrenia and their family as partners in care. Trained practitioners adopt a collaborative approach to information sharing and provide training in coping, communication and problem-solving skills. This article describes the common principles and techniques of family psychoeducation (FPE), along with the substantial evidence for its benefits for families, especially reduced relapse rates for the person with schizophrenia. Despite recommendations in clinical practice guidelines, FPE is not widely available throughout the world. The current challenge is to address this through systemic approaches to practice change and tiered approaches to family service delivery. LEARNING OBJECTIVES• Appreciate the needs of families and recognise how these may be addressed by family psychoeducation • Understand the evidence for family psychoeducation • Delineate the key elements of family psychoeducation and consider how it may be applied in practiceNone.The treatment of schizophrenia has involved psychotherapeutic work with families since the 1950s. Different models have developed, informed by psychoanalysis, systems theory, behavioural and cognitive-behavioural psychology, educational approaches and the family advocacy movement (Farhall 2012; Killackey 2015).Family psychoeducation (FPE) describes a number of closely overlapping interventions provided to people with schizophrenia and their families. These structured psychotherapeutic interventions were originally developed with the primary aim of decreasing the number of relapses of illness. A strong evidence base has been generated for these various forms of FPE in supporting people with schizophrenia to achieve this outcome. It has also become apparent that FPE offers other benefits to all family members, such as improved relationships within and outside the family. Terminology

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Section: Principles Of Fpementioning

confidence: 99%

Section: People With Schizophrenia and Their Relationships With Familymentioning

confidence: 99%

Section: Development Of Fpe and The Role Of Expressed Emotionmentioning

confidence: 99%

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Family psychoeducation for people living with schizophrenia and their families

Harvey¹

2018

BJPsych advances

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“…It would be inappropriate to force families to assume an unreasonable amount of responsibility for mentally ill relatives. Family involvement is, however, crucial for many patients with psychiatric disorders in the context of deinstitutionalization (Onwumere, Smith, & Kuipers, 2010). Because cohabitation with family can be a kind of social integration in Japan, it would be worthwhile to explore the factors that encourage families to cohabit with those who are psychiatric patients.…”

Section: Discussionmentioning

confidence: 99%

Families’ opinions about caring for patients with psychiatric disorders after involuntary hospitalization in Japan

Noguchi

Tachimori

Naganuma

et al. 2015

Int J Soc Psychiatry

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Culturally adapted Family Intervention (CaFI) for African-Caribbean people diagnosed with schizophrenia and their families: a mixed-methods feasibility study of development, implementation and acceptability

Edge

Degnan

Cotterill

et al. 2018

Health Serv Deliv Res

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BackgroundAfrican-Caribbean people in the UK experience the highest incidence of schizophrenia and the greatest inequity in mental health care. There is an urgent need to improve their access to evidence-based care and outcomes. Family intervention (FI) is a National Institute for Health and Care Excellence-approved psychosocial intervention. Although clinically effective and cost-effective for schizophrenia, it is rarely offered. Evidence for any research into FI is lacking for ethnic minority people generally and for African-Caribbean people specifically.Aims(1) To assess the feasibility of delivering a novel, culturally appropriate psychosocial intervention within a ‘high-risk’ population to improve engagement and access to evidence-based care. (2) To test the feasibility and acceptability of delivering FI via ‘proxy families’.DesignA mixed-methods, feasibility cohort study, incorporating focus groups and an expert consensus conference.SettingTwo mental health trusts in north-west England.ParticipantsWe recruited a convenience sample of 31 African-Caribbean service users. Twenty-six family units [service users, relatives/family support members (FSMs) or both] commenced therapy. Half of the service users (n = 13, 50%), who did not have access to their biological families, participated by working with FSMs.InterventionsAn extant FI model was culturally adapted with key stakeholders using a literature-derived framework [Culturally adapted Family Intervention (CaFI)]. Ten CaFI sessions were offered to each service user and associated family.Main outcome measuresRecruitment (number approached vs. number consented), attendance (number of sessions attended), attrition (number of dropouts at each time point), retention (proportion of participants who completed therapy sessions), and completeness of outcome measurement.ResultsOf 74 eligible service users, 31 (42%) consented to take part in the feasibility trial. The majority (n = 21, 67.7%) were recruited from community settings, seven (22.6%) were recruited from rehabilitation settings and three (9.7%) were recruited from acute wards. Twenty-four family units (92%) completed all 10 therapy sessions. The proportion who completed treatment was 77.42% (24/31). The mean number of sessions attended was 7.90 (standard deviation 3.96 sessions) out of 10. It proved feasible to collect a range of outcome data at baseline, post intervention and at the 3-month follow-up. The rating of sessions and the qualitative findings indicated that CaFI was acceptable to service users, families, FSMs and health-care professionals.LimitationsThe lack of a control group and the limited sample size mean that there is insufficient power to assess efficacy. The findings are not generalisable beyond this population.ConclusionsIt proved feasible to culturally adapt and test FI with a sample of African-Caribbean service users and their families. Our study yielded high rates of recruitment, attendance, retention and data completion. We delivered CaFI via FSMs in the absence of biological families. This novel aspect of the study has implications for other groups who do not have access to their biological families. We also demonstrated the feasibility of collecting a range of outcomes to inform future trials and confirmed CaFI’s acceptability to key stakeholders. These are important findings. If CaFI can be delivered to the group of service users with the most serious and persistent disparities in schizophrenia care, it has the potential to be modified for and delivered to other underserved groups.Future workA fully powered, multicentre trial, comparing CaFI with usual care, is planned.Trial registrationCurrent Controlled Trials ISRCTN94393315.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 32. See the NIHR Journals Library website for further project information.

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Families and Psychosis

Cited by 4 publications

References 125 publications

Family psychoeducation for people living with schizophrenia and their families

Family psychoeducation for people living with schizophrenia and their families

Families’ opinions about caring for patients with psychiatric disorders after involuntary hospitalization in Japan

Culturally adapted Family Intervention (CaFI) for African-Caribbean people diagnosed with schizophrenia and their families: a mixed-methods feasibility study of development, implementation and acceptability

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