Working with Families

Partnering With Families Affected by Concurrent Disorders - Facilitators' Guide

On this page:

• Families and the substance use and mental health system
• Important principles for health care professionals working with families

Great movement has been made in the past decade in Canada toward integrated and collaborative treatment of addiction and mental health problems. This has been based on a growing awareness that integrated approaches produce better outcomes for consumers. The evidence also strongly suggests that social support is unequalled in its importance in producing effective long-term outcomes.

Complementing this has been a growing movement of family members who, while they know full well the problems related to concurrent disorders in family members, have felt that they were not included in finding effective solutions for these problems. They have become more mobilized and assertive about their need and right to understand, participate in and contribute to their loved ones’ treatment.

Working with members of consumers’ social networks can help them progress toward personal goals and prevent and reduce the severity of slips and relapses, regarding both substance use and symptoms of mental health problems. The significant advances made by consumers, families and professionals, working together, gives us hope that we can continue to improve the long-term outlook for people with concurrent disorders.

Families and the substance use and mental health system

Too often family members are not welcomed or included in the process of working with someone with mental health and substance use problems. Family members’ stories about their experiences with the system often provide strong illustration of this fact. When the mental health system offers family members acceptance and support, it’s an important step in helping them feel empowered to be more assertive about their needs.

At the same time that family members need to feel more empowered, treatment services need to be more inviting and open to family involvement. This starts with professionals openly exploring their attitudes, values and beliefs about family members, the ways current routines and procedures usually presume family members aren't to be included, and the policies and practices that need to be in place to ensure that the experience of family members is more positive. Family members have seen the difficult journey that has resulted in a loved one coming into care. Working to involve family members in ongoing, active support for consumers in recovery is a wise investment of resources, as is the provision of support to family members, even when the family member they are concerned about is not in care.

The consumer’s consent is a necessary condition for involving family members in the direct care of someone with substance use and/or mental health problems. But lack of consent does not preclude providing education and support to family members. The evidence strongly suggests that education and support has a positive impact on consumer outcomes as well as on the well-being of the family member.

Important principles for health care professionals working with families

The primary goals in working with families of persons with co-occurring mental health and substance abuse problems include the following:

• Providing support and respect for families.
• Listening to families’ concerns and involving them as equal partners in the planning and delivery of treatment wherever possible.
• Acknowledging, valuing and respecting family members’ special kind of expertise.
• Offering a variety of evidence-based interventions for families. This includes professional and peer support and education about concurrent disorders.
• Providing opportunities for family members to increase their feelings of personal mastery and self-efficacy.
• Acknowledging that family members also move through their own journey of recovery and that this journey into, through and out of illness often parallels that of the consumer.
• Addressing family members’ experiences of grief and loss.
• Exploring family members’ expectations of the treatment program and expectations for the consumer.
• Assessing the family’s ability (strengths and limitations) to support the consumer.
• Providing ways for the family to build resilience in the presence of emotional pain, conflicts, difficult emotions, extreme stress and caregiver compassion fatigue.
• Encouraging family members to expand their social support networks—for example, to participate in family support organizations such as The Schizophrenia Society of Ontario or the Mood Disorders of Ontario; help the family gain access to support from other families affected by concurrent disorders.
• Helping resolve family conflict by responding sensitively to emotional distress.
• Providing relevant information for the consumer and his or her family at appropriate times.
• Emphasizing the importance of family member self-care.
• Providing an explicit crisis plan and professional response.
• Helping the family develop problem-solving skills.
• Facilitating access to another professional in the event that the current

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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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