Why involve families in acute mental healthcare? A collaborative conceptual review

Abstract

ObjectivesFamily involvement is strongly recommended in clinical guidelines but suffers from poor implementation. To explore this topic at a conceptual level, a multidisciplinary review team including academics, clinicians and individuals with lived experience undertook a review to explore the theoretical background of family involvement models in acute mental health treatment and how this relates to their delivery.DesignA conceptual review was undertaken, including a systematic search and narrative synthesis. Included family models were mapped onto the most commonly referenced underlying theories: the diathesis–stress model, systems theories and postmodern theories of mental health. Common components of the models were summarised and compared. Lastly, a thematic analysis was undertaken to explore the role of patients and families in the delivery of the approaches.SettingGeneral adult acute mental health treatment.ResultsSix distinct family involvement models were identified: Calgary Family Assessment and Intervention Models, ERIC (Equipe Rapide d’Intervention de Crise), Family Psychoeducation Models, Family Systems Approach, Open Dialogue and the Somerset Model. Findings indicated that despite wide variation in the theoretical models underlying family involvement models, there were many commonalities in their components, such as a focus on communication, language use and joint decision-making. Thematic analysis of the role of patients and families identified several issues for implementation. This included potential harms that could emerge during delivery of the models, such as imposing linear ‘patient–carer’ relationships and the risk of perceived coercion.ConclusionsWe conclude that future staff training may benefit from discussing the chosen family involvement model within the context of other theories of mental health. This may help to clarify the underlying purpose of family involvement and address the diverse needs and world views of patients, families and professionals in acute settings.

Nurses’ attitudes facing the family involvment in caring for people with mental disorder

“…However, it is necessary to invest in the training of these professionals since knowledge on the importance of families in care must be necessary from undergraduate school to clinical practice (12) . Also, nursing care to the family requires a theoretical and practical basis that supports it systematically, for example, from a systemic perspective.…”

“…A study highlights that the MH guidelines, when suggesting some type of family involvement, state that their inclusion can help to prevent relapses and reduce hospitalizations, despite not having clearly defined what establishes the involvement of families in care and the best method to combine them (12) . In Sweden, it was found that professionals support the involvement of families, but to invite them they were less favorable, and that working in a primary care center and having competence in dealing with families are predictive factors for positive attitudes (13) .…”

Qualitative investigation of relatives’ and service users’ experience of mental healthcare for suicidal behaviour in bipolar disorder

“…Relatives are often in a position to observe behavioural changes that may indicate increased or fluctuating risk, and where possible, should be kept informed of treatment/management plans. Closer involvement of family and friends may allow important information to be communicated more quickly, help build trust and supportive therapeutic relationships, and create more positive judgements of overall quality of care provided by mental health services 56…”

Collaborative Diabetes Management in China: A Digital Empowerment Perspective

“…While some researchers indicate patients to collaborate with doctors in drawing up selfmanagement plans and goals (such as [16] [17]). More researchers suggest to also incorporate immediate family members since they complement doctors to supervise and guide patents' self-management (such as [18] [19]). Therefore, this work focuses on the HDM program enabled by ICT tools, where patients, doctors, and relatives form "collaborative care" to overcome the difficulties of self-management.…”