Appendix 1: An overview of research

Partnering With Families Affected by Concurrent Disorders - Facilitators' Guide

In Appendix 1:

• Need for family services: Highlighting the evidence
• Approaches to working with families
• Family support and education
• References

Approaches to working with families

The Schizophrenia Patient Outcomes Research Team (PORT) recommended that all families who have contact with a relative with a mental health problem be offered a family psychosocial intervention. This intervention would span several months and include education about mental illness, family support, crisis intervention and problem solving (Lehman et al., 1998, Lehman et al., 2004). Other best-practice standards have also recommended that families participate in education and support programs.

• Clinical Practice Guidelines: Treatment of Schizophrenia (Canadian Psychiatric Association, 2005)
• Practice Guideline for the Treatment of Patients with Schizophrenia, 2nd edition (Lehman et al., 2004)
• Canadian Network for Mood and Anxiety Treatments (CANMAT) Guidelines for the Management of Patients with Bipolar Disorder: Consensus and Controversies (Yatham et al., 2005)

Service provider–led approaches that have been developed to address the needs of families include:

• multi-family group psychoeducation conducted by a mental health or addictions professional
• individual psychoeducation
• short-term multi-family education and support programs
• individual family consultation
• various forms of more traditional family therapy.

In addition, many families find support from peer-led information and support classes or groups, such as those provided by the Schizophrenia Society of Ontario (SSO), the Mood Disorders Association of Ontario (MDAO) and the National Alliance for the Mentally Ill (NAMI) (McFarlane, 2003).

The next section discusses the evidence base for the two group-based programs:

• multi-family psychoeducation
• short-term muliti-family education and support.

Multi-family group psychoeducation

Description

The primary goal of family psychoeducation groups is to improve outcomes for the ill family member (e.g., reduced time in and admission to hospitals, reduced relapse rates, improved overall level of functioning). In contrast to family therapy where the family is receiving treatment, family psychoeducation sees the family (and the consumer, where possible) as part of the treatment team (McFarlane et al., (2003b).

Family psychoeducation interventions seek to provide families with professional and peer support; information they need about mental health and/or substance use problems; and the coping skills they need to work with their loved one.

Most family psychoeducation programs:

• are led by health care professionals
• are offered as part of a treatment program for the consumer
• are diagnosis-specific
• extend over a period of nine to 36 months (Dixon et al., 2004).

Research

Research has shown that family psychoeducation programs lead to positive outcomes for consumers and families. See McFarlane et al. (2003a) for the specific studies that support each of the following:

Positive outcomes for consumers:

• Reduction in relapses.
• Reduction in hospitalization rates.
• Increase in consumer participation in vocational rehabilitation.
• Decrease in the cost of care.
• Increased consumer involvement in family life and social activities.
• Reduced psychiatric symptoms.
• Reduced relapse rates.
• Reduced consumer depression.
• Improved consumer energy and motivation.

Positive outcomes for families:

• Increased well-being of family members.
• Better health and fewer medical problems for all family members.
• Increased hopefulness.
• Development of effective emotional, behavioural and cognitive coping strategies.
• Increased perception of personal mastery and self-efficacy.

Family psychoeducation was originally developed as a component of treatment programs for people who had schizophrenia or other psychotic disorders (McFarlane et al., 2003a) and research now supports family psychoeducation as an evidence-based treatment for schizophrenia (Lukens & McFarlane, 2004).

Recently reports of studies of groups that focus on bipolar disorder, depression, eating disorders, borderline personality disorder and ADHD have appeared in the literature (Lukens & McFarlane, 2004, Murray-Swank & Dixon, 2004). A program for people with severe mental illness and substance use disorders and their families that combines single-family and multi-family group formats is being evaluated in a study supported by the National Institute of Mental Health (Mueser & Fox, 2002).

Barriers to implementation

Although the benefits of family psychoeducation have been documented, many family members do not have access to psychoeducation programs (Dixon et al., 2001). One of the most frequently cited explanations for the lack of programming is the time commitment for clinicians, family members and other resources for programs that run for at least nine months (Dixon et al., 2001).

When groups are available, drop-out rates for consumers and family members are substantial. Studies report rates ranging between 28 per cent and 70 per cent (Pollio et al., 2002).

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Partnering With Families Affected by Concurrent Disorders - Facilitators' Guide

• Overview
• Working with families
• Preparation
• Implementation
• Evaluation
• Session Outlines
  • Session 1: Introduction
  • Session 2: Substance use problems
  • Session 3: Mental health problems
  • Session 4: How concurrent disorders affect family life
  • Session 5: Self-care
  • Session 6: Stigma
  • Session 7: Navigating the treatment system
  • Session 8: Medication
  • Session 9: Relapse prevention
  • Session 10: Crisis and emergency
  • Session 11: Recovery
  • Session 12: Saying goodbye
• References
• Resources
• Appendix 1: An Overview of the Research
• Appendix 2: The Partnering With Families Affected by Concurrent Disorders Project

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