Mental health professionals’ experiences of working with parents with psychosis and their families: a qualitative study

Abstract

Background Healthcare service users who are parents with psychosis form part of the caseload of most community mental health teams. Mental health professionals can experience uncertainty about how to work with and ask about the children of these parents, and often report difficulties when collaborating with other agencies. This study focused on professionals’ experiences of working with parents with psychosis and their families to gain an understanding of these parents’ needs from a service-level perspective, and to identify barriers that professionals may experience in meeting those needs. Methods Qualitative focus groups were conducted with four to eight mental health professionals per group. Data were analysed using reflexive thematic analysis. JR familiarised herself with the transcripts and then coded each salient unit within the text. Themes were then identified and discussed amongst all authors until there was agreement. Results We developed two overarching themes: 1) Diversity of need in parents with psychosis and 2) Role boundaries. The first explored mental health professionals’ perceived range of experiences that parents with psychosis and their families have, and the range of potential effects of parental psychosis on a child. The second theme described how some mental health professionals emphasised the importance of supporting service users in terms of their parenting status and others felt it was more critical to treat the person’s symptomatic expression. This theme also included issues with communication both with their service users and with other agencies. Conclusions Mental health professionals identified that the needs of parents with psychosis were diverse and reflected significant variation in the experiences of service users. Mental health professionals across different types of team (early intervention and community mental health) expressed contrasting viewpoints about how achievable it was to respond to a service user’s parenting status in an adult mental health setting. Future research should aim to determine where training is needed to enhance mental health professionals’ ability to work holistically with families in an adult mental health setting, and how to enhance collaboration with other agencies.

A Scoping Review of Interventions Designed to Support Parents With Mental Illness That Would Be Appropriate for Parents With Psychosis

“…These were Family Talk ( 68 ) and Triple P ( 93 ), both of which were unchanged from their usual delivery format. It may be the case that parents with psychosis would benefit from specific additions to parenting interventions, like safety planning for acute episodes ( 107 ), or a focus on regaining self-confidence during periods of stabilization ( 108 ).…”

“…Parents with psychosis and their families additionally struggle with parenting skills ( 6 , 14 , 117 ), self-confidence ( 109 ), and relapse of symptoms and subsequent hospitalization ( 117 ). Furthermore, these needs may be different during acute episodes of psychosis and periods of stability ( 108 , 117 ). Therefore, interventions that solely address parenting skills or aim to explain mental illness to the children of these parents are likely to be insufficient, and more holistic long-term interventions may be the most suitable to address the needs of this group of parents.…”

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

“…This subtheme illustrates that practitioner's beliefs about FFP impacted their practice. Practitioners, in principle, acknowledged the importance of considering wider family, including children, in their service-users' care (Grant et al, 2019;Grant & Reupert, 2016;Hjärthag et al, 2017;Leenman & Arblaster, 2020;Maddocks et al, 2010;O'Brien et al, 2011;Pfeiffenberger et al, 2016;Sjöblom et al, 2005;Skundberg-Kletthagen et al, 2020;Slack & Webber, 2008;Strand & Rudolfsson, 2018;Radley et al, 2021;Tchnernegovski et al, 2018a;Ward et al, 2017). It was described by some as a "basic attitude" (Sunde et al, 2021, p. 5) that had the ability to "break the cycle of intergenerational mental illness" (Tchernegovski et al, 2018a, p. 5) and support recovery efforts (Foster & Isobel, 2018;Sunde et al, 2021;Ward et al, 2017).…”

“…(Strand & Rudolfsson, 2018, p. 66) We all know that if you don't engage the family meaningfully, people's recoveries are limited. (Ward et al, 2017, p. 3) Despite reflections of FFP as important, most practitioners believed FFP was an additional duty and extension to their routine practice requiring more time and resources (Grant & Reupert, 2016;Krumm et al, 2019;Lauritzen and Reedtz, 2013;Leenman & Arblaster, 2020;Pfeiffenberger et al, 2016;Skundberg-Kletthagen et al, 2020;Strand & Rudolfsson, 2018;Sunde et al, 2021;Radley et al, 2021;Ward et al, 2017). FFP is not suitably resourced despite increased practice demands, which led to a need to prioritise elsewhere (Grant & Reupert, 2016;Lauritzen & Reedtz, 2013;Strand & Rudolfsson, 2018;Sunde et al, 2021).…”

The Needs and Experiences of Parents with Psychosis: A Qualitative Interview Study

“…However, acute psychotic symptoms are often brief, and a reduction in these is associated with improved quality of parenting care (Kahng et al, 2008). In fact, the quality of parenting provided by those who have experienced psychosis can often depend on the severity of the illness (Radley et al, 2021;Røhder et al, 2019). For example, a diagnosis of schizophrenia necessitates the presence of symptoms for at least six months (American Psychiatric Association, 2013), and has been associated with higher social services involvement and poorer staff-rated assessment of parenting amongst parents with a diagnosis of a psychotic disorder (Howard et al, 2004).…”