Disease Management and Health Outcomes

, Volume 8, Issue 4, pp 211–221 | Cite as

Interventions for Families of Individuals with Schizophrenia

Maximising Outcomes for their Relatives
Review Article


Recent best practice guidelines recommend the provision of psychosocial family interventions for families of adults with schizophrenia. This article delineates the various family interventions and the empirical base of these interventions. These interventions include psychoeducation, family education, family consultation, and family support and advocacy groups. Although the provision of these interventions incur additional costs, they also have the potential for financial savings as a result of decreasing mental health service utilisation and improving outcomes for both the families and their ill relatives.

The article concludes with recommendations for providers and organisations to improve effective relationships with families of adults with schizophrenia. Providers and organisations need to understand the needs of families, become knowledgeable about interventions for families and direct families to appropriate resources if they are unable to provide the family intervention themselves.


  1. 1.
    National Institute of Mental Health. Caring for people with severe mental disorders: a national plan of research to improve services. Washington, DC: National Institute of Mental Health, 1991Google Scholar
  2. 2.
    Tessler R, Gamache G. Family experience with mental illness. Westport (CT): Auburn House, 2000Google Scholar
  3. 3.
    Wasow M. Professional and parental perspectives. In: Lefley HP, Wasow M, editors. Helping families cope with mental illness. Chur, Switzerland: Harwood Academic Publishers, 1994: 27–38Google Scholar
  4. 4.
    Thompson E, Doll W. The burden of families coping with the mentally ill: an invisible crisis. Fam Rel 1982; 31: 379–88CrossRefGoogle Scholar
  5. 5.
    Hoenig J, Hamilton M. The schizophrenic patient in the community and his effect on the household. Int J Psychiatry 1966; 12: 165–76CrossRefGoogle Scholar
  6. 6.
    Marsh D. Serious mental illness and the family: the practitioner’s guide. New York: John Wiley & Sons, Inc., 1998Google Scholar
  7. 7.
    Lefley H. Family caregiving in mental illness. Thousand Oaks (CA): Sage Publications, 1996Google Scholar
  8. 8.
    Hatfield A. Family education: theory and practice. In: Hatfield A, editor. Family interventions in mental illness. San Francisco, (CA): Jossey-Bass Publishers, 1994Google Scholar
  9. 9.
    Solomon P. Views of service delivery: an empirical assessment. In: Lefley H, Wasow M, editors. Helping families cope with mental illness. Chur, Switzerland: Harwood Academic Publishers, 1994: 259–74Google Scholar
  10. 10.
    Spaniol L, Jung H. Effective coping: a conceptual model. In: Hatfield A, Lefley H, editors. Families of the mentally ill: coping and adaptation. New York: Guilford Press, 1987Google Scholar
  11. 11.
    Spaniol L, Jung H. Issues and concerns of families that include a person with a severe mental illness. Boston (MA): Center for Psychiatric Rehabilitation, Boston University, 1983Google Scholar
  12. 12.
    Spaniol L, Zipple A. Families with a chronically mentally ill member: a review of the research findings. In: Bowker J, Rubin A, editors. Studies on chronic mental illness for social work researchers. Washington, DC: Council on Social Work Education, 1986: 52–82Google Scholar
  13. 13.
    American Psychiatric Association. Practice guidelines for the treatment of patients with schizophrenia. Am J Psychiatry 1997; 154 Suppl.: 1–63Google Scholar
  14. 14.
    McEvoy JP, Scherfler P, Frances A, editors. The expert consensus guidelines series: treatment of schizophrenia. J Clin Psychiatry 1999; 11 Suppl.: 8–80Google Scholar
  15. 15.
    Dixon L, Lehman A. Family interventions for schizophrenia. Schizophr Bull 1995; 21(4): 631–43PubMedCrossRefGoogle Scholar
  16. 16.
    Dixon L, Goldman H, Hirad A. State policy and funding of services to families of adults with serious and persistent mental illness. Psychiatr Serv 1999; 50(4): 551–3PubMedGoogle Scholar
  17. 17.
    Comprehensive accreditation manual for hospitals, and the comprehensive manual for behavioral care. Chicago (IL): Joint Commission on Accreditation of Healthcare Organizations, 1997Google Scholar
  18. 18.
    Hatfield A. Families of adults with severe mental illness: New directions in research. Am J Orthopsychiatry 1997; 67: 254–60PubMedCrossRefGoogle Scholar
  19. 19.
    Solomon P. Moving from psychoeducation to family education for families of adults with serious mental illness. Psychiatr Serv 1996; 47: 1364–70PubMedGoogle Scholar
  20. 20.
    Brown G, Birley J, Wing J. Influence of family life on the course of schizophrenia disorders: a replication. Br J Psychiatry 1976; 121: 241–58CrossRefGoogle Scholar
  21. 21.
    Vaughn C, Leff J. The influence of family and social factors on the course of psychiatric illness. Br J Psychiatry 1976; 129: 125–37PubMedCrossRefGoogle Scholar
  22. 22.
    Vaughn C, Snyder K, Jones S, et al. Family factors on schizophrenia relapse. Arch Gen Psychiatry 1984; 41: 1169–77PubMedCrossRefGoogle Scholar
  23. 23.
    Dixon L, Adams C, Luckstead A. Update on family psychoeducation for schizophrenia. Schizophr Bull 2000; 26(1): 5–20PubMedCrossRefGoogle Scholar
  24. 24.
    Lukens E, Thorning H, Herman D. Family psychoeducation in schizophrenia: emerging themes and challenges. J Pract Psychol Behav Health 1999 Nov; 314–25Google Scholar
  25. 25.
    Penn D, Mueser K. Research update on the psychosocial treatment of schizophrenia. Am J Psychiatry 1996; 153(5): 607–17PubMedGoogle Scholar
  26. 26.
    Lam D. Psychosocial family intervention in schizophrenia: a review of empirical studies. Psychol Med 1991; 21: 423–41PubMedCrossRefGoogle Scholar
  27. 27.
    Luckstead A, Dixon L. Quality of care in services to family members of people with serious mental illness. Ment Health Serv Res 1999; 1(4): 223–30CrossRefGoogle Scholar
  28. 28.
    DeJesus MJ, Streiner D. An overview of family interventions and relapse on schizophrenia: a meta-analysis of research findings. Psychol Med 1994; 24: 565–78CrossRefGoogle Scholar
  29. 29.
    Dixon L, Lyles A, Scott J, et al. Services to families of adults with schizophrenia: from treatment recommendations to dissemination. Psychiatr Serv 1999; 50(2): 233–8PubMedGoogle Scholar
  30. 30.
    Ouidetle Gasque-Carter K, Curlee M. The educational needs of families of mentally ill adults: the South Carolina experience. Psychiatr Serv 1999; 50(4): 520–4Google Scholar
  31. 31.
    Bergmark T. Models of family support in Sweden: from mistreatment to understanding. In: Hatfield A, editor. Family interventions in mental illness. San Francisco (CA): Jossey-Bass Publishers, 1994: 71–7Google Scholar
  32. 32.
    Lefley H. Expressed emotion: conceptual, clinical, and social policy issues. Hosp Community Psychol 1992; 43: 591–8Google Scholar
  33. 33.
    Hatfield A, Spaniol L, Zipple A. Expressed emotion: a family perspective. Schizophr Bull 1982; 13: 221–6CrossRefGoogle Scholar
  34. 34.
    Bogart T, Solomon P. Collaboration procedures to share the treatment information among mental health care providers, consumers, and families. Psychiatr Serv 1999; 50: 1321–5PubMedGoogle Scholar
  35. 35.
    Strategy development: family interventions work — putting the research into practice. World Schizophrenia Fellowship; 1997 Sep 4–5; Christchurch, New ZealandGoogle Scholar
  36. 36.
    Grella C, Grusky O. Families of the severely mentally ill and satisfaction with services. Hosp Community Psychol 1989; 40: 831–5Google Scholar
  37. 37.
    Solomon P, Marcenko M. Families of adults with severe mental illness: their satisfaction with inpatient and outpatient treatments. Psychosoc Rehabil J 1992; 16: 121–34Google Scholar
  38. 38.
    Battaglino L. Family empowerment through self-help groups. In: Hatfield A, editor. Families of the mentally ill: meeting the challenges. San Francisco (CA): Jossey-Bass Publishers, 1987: 43–51Google Scholar
  39. 39.
    Burland J. Family-to-family: a trauma-and-recovery model of family education. In: Lefley H, editor. Families coping with mental illness: the cultural context. San Francisco (CA): Jossey-Bass Publishers, 1998: 33–41Google Scholar
  40. 40.
    Solomon P, Draine J, Mannion E, et al. The impact of individualized and group workshop family education interventions on ill relative outcomes. J Nerv Ment Dis 1996; 184: 252–4PubMedCrossRefGoogle Scholar
  41. 41.
    Bernheim K, Lehman A. Working with families of the mentally ill. New York: Norton, 1985Google Scholar
  42. 42.
    Bernheim K. Supportive family counseling. Schizophr Bull 1982; 8: 634–48PubMedCrossRefGoogle Scholar
  43. 43.
    Marsh D, Johnson D. The family experience of mental illness: implications for interventions. Prof Psychol Res Pract 1997; 28: 229–37CrossRefGoogle Scholar
  44. 44.
    Solomon P, Draine J, Mannion E, et al. Effectiveness of two models of brief family education: retaining gains of family members of adults with serious mental illness. Am J Orthopsychiatry 1997; 67: 177–86PubMedCrossRefGoogle Scholar
  45. 45.
    Solomon P, Draine J, Mannion E, et al. Impact of brief family psychoeducation on self-efficacy. Schizophr Bull 1996; 22(1): 41–50PubMedCrossRefGoogle Scholar
  46. 46.
    Mannion E, Draine J, Solomon P, et al. Applying research on family education about mental illness to development of a relatives’ group consultation model. Community Ment Health J 1997; 33(6): 555–74PubMedCrossRefGoogle Scholar
  47. 47.
    Budd R, Hughes I. What do relatives of people with Schizophrenia find helpful about family intervention? Schizophr Bull 1997; 23: 341–7PubMedCrossRefGoogle Scholar
  48. 48.
    Ascher-Svanum H, Lafuze J, Barrickman P, et al. Education needs of families of mentally ill adults. Psychiatr Serv 1997; 48: 1072–4PubMedGoogle Scholar
  49. 49.
    Mingyuan Z, Hegin Y, Chengde Y, et al. Effectiveness of psychoeducation of relatives of schizophrenic patients: a prospective cohort study in five cities of China. Int J Ment Health 1993; 22: 47–59Google Scholar
  50. 50.
    Xiang MG, Ran M, Li S. A controlled evaluation of psychoeducational family intervention in a rural Chinese community. Br J Psychiatry 1994; 165: 544–8PubMedCrossRefGoogle Scholar
  51. 51.
    Zhang M, Wang M, Li J, et al. Randomized-control trial of family interventions for 78 first-episode male schizophrenic patients: an 18-month study Suzhou, Jiangsu. Br J Psychiatry 1994; 465(24 Suppl.): 96–102Google Scholar
  52. 52.
    Solomon P. The cultural context of interventions for family members with a seriously mentally ill relative. In: Lefley H, editor. Families coping with mental illness: the cultural context. San Francisco (CA): Jossey-Bass Publishers, 1998Google Scholar
  53. 53.
    Pickett-Schenk S, Cook J, Laris A. Journey of Hope program outcomes. Commun Mental Health J 2000; 36: 413–24CrossRefGoogle Scholar
  54. 54.
    Citron M, Solomon P, Draine J. Self-help groups for families of persons with mental illness: perceived benefits of helpfulness. Community Ment Health J 1999; 35(1): 15–30PubMedCrossRefGoogle Scholar
  55. 55.
    Heller T, Roccoforte J, Hsieh K, et al. Benefits of support groups for families of adults with severe mental illness. Am J Orthopsychiatry 1997; 62(2): 187–98CrossRefGoogle Scholar
  56. 56.
    Norton S, Wandersman A, Goldman C. Perceived costs and benefits of membership in self-help groups: comparisons of members and non-members of the Alliance for the Mentally Ill. Community Ment Health J 1993; 29: 143–60PubMedCrossRefGoogle Scholar
  57. 57.
    Mannion E, Mueser K, Solomon P. Designing psychoeducational services for spouses of persons with serious mental illness. Community Ment Health J 1994; 30: 177–90PubMedCrossRefGoogle Scholar
  58. 58.
    McFarlane W, Dushay R, Stastny P, et al. A comparison of two levels of Family-Aided Assertive Community Treatment. Psychiatr Serv 1996; 47(7): 744–50PubMedGoogle Scholar
  59. 59.
    Tarrier N, Lowson K, Barrowclough C. Some aspects of family interventions in schizophrenia — II Financial Considerations. Br J Psychiatry 1991; 159: 481–4PubMedCrossRefGoogle Scholar
  60. 60.
    Biegel D, Li-yu S, Milligan S. Comparative analysis of family caregivers’ perceived relationship with mental health professionals. Psychiatr Serv; 46: 477–82Google Scholar
  61. 61.
    Fisher G, Benson P, Tessler R. Family response to mental illness: developments since deinstitutionalization. In: Greenley J. Mental disorder in social context. Greenwich (CT): JAI Press, Inc. 1990: 203–36Google Scholar
  62. 62.
    Hatfield A, Fierstein R, Johnson D. Meeting the needs of families of the psychiatrically disabled. Psychosoc Rehabil J 1982; 6: 27–40Google Scholar
  63. 63.
    Holden D, Lewine R. How families evaluate mental health professionals, resources and effects of illness. Schizophr Bull 1982; 8(14): 626–33PubMedCrossRefGoogle Scholar
  64. 64.
    Thomas C, Guy S, Ogiluie L. An evaluation of a practioner program designed to assist families of people with severe psychiatric disorders. Psychiatr Rehabil J 1999 Summer; 23(1): 34–40Google Scholar
  65. 65.
    Francell C, Conn V, Gray D. Families’ perceptions of burden of care for chronic mentally ill relatives. Hosp Community Psychol 1988; 34: 296–300Google Scholar
  66. 66.
    Spaniol L, Zipple A, Fitzgerald S. How professionals can share power with families: Practical approaches to working with families of the mentally ill. Psychosoc Rehabil J 1984; 8: 77–84Google Scholar
  67. 67.
    Greenberg J, Greenley J, Brown R. Do mental health services reduce distress in families of people with serious mental illness? Psychiatr Rehabil J 1997; 21: 40–50Google Scholar
  68. 68.
    Tessler R, Gamache G. Continuity of care, residence, and family burden in Ohio. Milbank Q 1994; 72: 149–69PubMedCrossRefGoogle Scholar
  69. 69.
    Smith J, Birchwood M. Relatives and patients as partners in the management of schizophrenia: the development of a service model. Br J Psychiatry 1990; 156: 654–60PubMedCrossRefGoogle Scholar
  70. 70.
    Coursey R, Curtis L, Marsh D, et al. Competencies for direct service staff members who work with adults with severe mental illness in outpatient public mental health managed care systems. Psychiatr Rehabil J 2000; 23(4): 370–7Google Scholar
  71. 71.
    Coursey R, Curtis L, Marsh D, et al. Competencies for direct service staff members who work with adults with severe mental illness: specific knowledge, attitudes, skills, and bibliography. Psychiatr Rehabil J 2000; 23(4): 378–92Google Scholar
  72. 72.
    Wright E. The impact of organizational factors on mental health professionals’ involvement with families. Psychiatr Serv 1997; 48: 921–7PubMedGoogle Scholar

Copyright information

© Adis International Limited 2000

Authors and Affiliations

  1. 1.School of Social WorkUniversity of PennsylvaniaPhiladelphiaUSA

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