Patients with severe mental disorders are best treated with family involvement

A new study contributes to new knowledge about what prevents and facilitates family involvement in the treatment of patients with severe mental disorders.

“We know that better treatment for severe mental disorders there is. Family involvement in the treatment of patients with severe mental illness is recommended throughout the Western world. Despite this, this is not always done, which has significant negative consequences for patients, relatives, the health care system and society,” says Christian Mickland Hanson.

She is a Ph.D. researcher at the Center for Medical Ethics, University of Oslo.

“Family involvement in psychiatry is often the result of vested interests. Sometimes families are involved, sometimes not. Vested interests cannot determine what treatment is offered to patients,” she says.

We need to know what prevents family participation

Myckland Hansson and his colleagues studied the factors that prevent and contribute family attraction The systematic involvement of the family is central to being able to provide proper treatment. One of the most important contributions of the study is to help close the gap between what we know works and what actually happens in clinics.

“To achieve better family engagement, we need to know what doesn’t work. A lot of research has focused on this before, but our main focus has been on what makes it work,” says Mickland Hanson.

The study is part of the Family Involvement During Serious Mental Health Challenge research project. The main goal of the project is to improve the participation of the patient’s family and the health care system, and thus improve the psychosocial health of patients and their relatives, as well as the quality of services.

Less likely to relapse with family involvement

Research shows that family involvement has a positive impact on patients and their families. For patients, it means less chance of relapse, better medicine, fewer hospitalizations and less burden on the health care system. Families can provide better care and support for patients.

“In the case of serious mental illness, society, the health care system, patients and their relatives are affected. That’s why we have to do everything we can to offer patients the best possible treatment,” says Mickland Hanson.

In the past, it was common to blame the patient’s illness on the family, she explains. Fortunately, today we know better. Family is critical to the patient’s recovery process.

“We depend on relatives. They have to contribute by helping and caring outside of health services. Otherwise, the health care system will not be sustainable. Relatives can be a great resource for clinicians and health services and know how patients work in different situations and contexts”.

It can be a huge burden on a family to have a family member who is struggling. It is important to start working together with families early in the treatment process to build trust and good dialogue between all involved. In this way, conflicts can be prevented, the patient’s resources can be optimized, and relatives can be supported.

“Relatives of people with mental health problems are often overlooked and sometimes neglected and rejected by health services. At the same time, with fewer bed posts and shorter follow-up times in psychiatry, it is imperative that they promote Why is family involvement so lacking when it is so important?’ Michaeland Hanson asks.

Factors preventing and facilitating family involvement

The study identified several factors at different levels that hinder family involvement in the treatment of patients with severe mental disorders.

The main factors were a lack of competence and experience of family involvement in treatment units, lack of awareness of measures that can be taken to involve families, negative attitudes towards family involvement, limited access to training and guidance, lack of priorities, routines and family involvement practices, lack of management support, and lack of resources in units.

“Proper family involvement must be built over time and on multiple levels simultaneously. It does not help with committed clinicians if the organization or treatment unit in which they work does not foster systematic family inclusion. This makes it difficult to achieve practical solutions for family involvement,” says Mickland Hanson.

Factors contributing to family involvement at the organizational level in health care units were: holistic approach in the department, clear roles and responsibilities for facilitating engagement, standardization of procedures, and simple tools and working knowledge of central factors that prevent engagement. This could be, for example, maintaining confidentiality and a situation where the patient refuses to involve his family.

For clinicians on the units, training and guidance on family involvement was important. This has led to increased competence and increased awareness and better attitudes towards family involvement in treatment units.

The researchers introduced measurements to facilitate better family involvement

In the study, family involvement was implemented based on national guidelines and guidelines for family involvement. The research team implemented measures to increase participation and support throughout the treatment unit. The key was to provide training to all staff on how to include families and help departments create viable procedures to offer a baseline level of family involvement for all patients.

Medical staff received training and guidance on psychological family education (PEF) from TIPS Sør-East. Here, doctors teach families to work together and develop communication skills, problem solving and gain insight into symptoms and stressors.

“The goal was to ensure that all employees had the same competencies, shared culture, goals and practices of family involvement. We achieved this by standardizing procedures at the organizational level, including managers, and working with each individual clinician,” says Mickland Hanson. .

The research team followed the treatment units for 18 months while they worked to implement the measures. Units appointed a Family Involvement Co-ordinator and an Improvement Team who were responsible for working to improve involvement.

Mickland Hanson explains that it was interesting to see the changes on both the group and individual levels.

“We’ve seen therapists often focus on lack of time and resources. Some have never worked with family involvement and don’t know what it means. Having personal experience of family involvement that works after training has been an important factor in advancement.”

Family involvement is important for families and patients

“Systematic family engagement is a complex intervention that requires effort, expertise and resources to implement, but we see health services being very successful when they do it. Participation is important for patients and relatives. It’s one of the most effective psychosis treatments we have,” says Michaeland Hanson.

She believes that PEF and more basic family involvement in the form of conversations with relatives and patients individually and together is something that all units treating patients with severe mental disorders can and should achieve.

“Systematic conversations about family involvement should be offered as a default approach, and it should start as early as possible in the treatment process,” she says.

The study was published in BMC Health Services Research.