Developing a family intervention service for serious mental illness: Clinical observations and experiences

Pervasive alienation: on seeing the invisible, meeting the inaccessible and engaging 'lost to contact' clients with major mental illness

Increasing integration of services for adults with severe mental health problems has highlighted the challenges to services posed by clients who are difficult to engage. There is a dearth of studies on direct work with individuals who are reclusive and difficult to contact, in contrast with the bulk of literature where the patient and network are present and available. This paper describes the work of a busy CMHT with such clients; barriers to collaborative work are explored and some of the team's strategies to overcome these barriers are delineated. Long, slow and persistent contact is observed to be a core feature of the work. The paper goes on to examine the fit between the realities of ongoing work with such clients and the available therapeutic and service discourses.

Religious coping and psychological wellbeing in carers of relatives with schizophrenia

OBJECTIVE

To examine the use of religious coping and its relation to psychological wellbeing in carers of relatives with schizophrenia.

METHOD

Sixty carers of patients with an ICD-10 diagnosis of schizophrenia, were assessed on strength of religious belief, perceived burden, religious and other coping strategies and psychological wellbeing.

RESULTS

Coping strategies of denial and problem solving, strength of religious belief and perceived burden were significant predictors of wellbeing.

CONCLUSION

Strength of religious belief plays an important role in helping family members to cope with the stress of caring for a mentally ill relative. In addition to psychoeducation and problem solving coping, the role of religious coping in enhancing wellbeing of carers needs to be considered in family intervention programmes.

Randomised controlled effectiveness trial of a needs-based psychosocial intervention service for carers of people with schizophrenia

BACKGROUND

Family interventions are effective in reducing relapse in patients with schizophrenia, but there is little work demonstrating the effectiveness of the interventions in routine service settings.

AIMS

To test the effectiveness of a needs-based family intervention service for patients recruited as out-patients and their carers, including those of low expressed emotion status.

METHOD

Carers of out-patient schizophrenia sufferers selected only on illness history factors were randomly allocated to receive either family support alone or in combination with systematic psychosocial interventions based on an assessment of need. Delivery of family interventions attempted to involve the clinical team.

RESULTS

Relapse outcomes were superior for family-treated patients at six-month follow-up, although most of the clinical and symptom patient variables assessed remained stable, as did measures of carer burden.

CONCLUSIONS

The study demonstrated the effectiveness of family interventions in routine service settings. Problems with staff, patient and carer engagement and participation were identified.

The relationship between coping style and burden in the carers of relatives with schizophrenia

The development of a questionnaire to measure the coping style of people caring for a relative with schizophrenia is described. Data on the psychometric properties of this questionnaire are reported for a sample of 91 carers. It is shown that coping style is associated with carer burden and psychological distress. In particular, the coping styles 'collusion', 'criticism/coercion', 'overprotectiveness', 'emotional over-involvement' and 'resignation' were found to be associated with higher levels of carer burden, and the coping style 'warmth' was found to be associated with lower levels of carer burden.