Abstract
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.
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References
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, 1991
Tessler R, Gamache G. Family experience with mental illness. Westport (CT): Auburn House, 2000
Wasow M. Professional and parental perspectives. In: Lefley HP, Wasow M, editors. Helping families cope with mental illness. Chur, Switzerland: Harwood Academic Publishers, 1994: 27–38
Thompson E, Doll W. The burden of families coping with the mentally ill: an invisible crisis. Fam Rel 1982; 31: 379–88
Hoenig J, Hamilton M. The schizophrenic patient in the community and his effect on the household. Int J Psychiatry 1966; 12: 165–76
Marsh D. Serious mental illness and the family: the practitioner’s guide. New York: John Wiley & Sons, Inc., 1998
Lefley H. Family caregiving in mental illness. Thousand Oaks (CA): Sage Publications, 1996
Hatfield A. Family education: theory and practice. In: Hatfield A, editor. Family interventions in mental illness. San Francisco, (CA): Jossey-Bass Publishers, 1994
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: 259–74
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, 1987
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, 1983
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: 52–82
American Psychiatric Association. Practice guidelines for the treatment of patients with schizophrenia. Am J Psychiatry 1997; 154 Suppl.: 1–63
McEvoy JP, Scherfler P, Frances A, editors. The expert consensus guidelines series: treatment of schizophrenia. J Clin Psychiatry 1999; 11 Suppl.: 8–80
Dixon L, Lehman A. Family interventions for schizophrenia. Schizophr Bull 1995; 21(4): 631–43
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): 551–3
Comprehensive accreditation manual for hospitals, and the comprehensive manual for behavioral care. Chicago (IL): Joint Commission on Accreditation of Healthcare Organizations, 1997
Hatfield A. Families of adults with severe mental illness: New directions in research. Am J Orthopsychiatry 1997; 67: 254–60
Solomon P. Moving from psychoeducation to family education for families of adults with serious mental illness. Psychiatr Serv 1996; 47: 1364–70
Brown G, Birley J, Wing J. Influence of family life on the course of schizophrenia disorders: a replication. Br J Psychiatry 1976; 121: 241–58
Vaughn C, Leff J. The influence of family and social factors on the course of psychiatric illness. Br J Psychiatry 1976; 129: 125–37
Vaughn C, Snyder K, Jones S, et al. Family factors on schizophrenia relapse. Arch Gen Psychiatry 1984; 41: 1169–77
Dixon L, Adams C, Luckstead A. Update on family psychoeducation for schizophrenia. Schizophr Bull 2000; 26(1): 5–20
Lukens E, Thorning H, Herman D. Family psychoeducation in schizophrenia: emerging themes and challenges. J Pract Psychol Behav Health 1999 Nov; 314–25
Penn D, Mueser K. Research update on the psychosocial treatment of schizophrenia. Am J Psychiatry 1996; 153(5): 607–17
Lam D. Psychosocial family intervention in schizophrenia: a review of empirical studies. Psychol Med 1991; 21: 423–41
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): 223–30
DeJesus MJ, Streiner D. An overview of family interventions and relapse on schizophrenia: a meta-analysis of research findings. Psychol Med 1994; 24: 565–78
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): 233–8
Ouidetle Gasque-Carter K, Curlee M. The educational needs of families of mentally ill adults: the South Carolina experience. Psychiatr Serv 1999; 50(4): 520–4
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: 71–7
Lefley H. Expressed emotion: conceptual, clinical, and social policy issues. Hosp Community Psychol 1992; 43: 591–8
Hatfield A, Spaniol L, Zipple A. Expressed emotion: a family perspective. Schizophr Bull 1982; 13: 221–6
Bogart T, Solomon P. Collaboration procedures to share the treatment information among mental health care providers, consumers, and families. Psychiatr Serv 1999; 50: 1321–5
Strategy development: family interventions work — putting the research into practice. World Schizophrenia Fellowship; 1997 Sep 4–5; Christchurch, New Zealand
Grella C, Grusky O. Families of the severely mentally ill and satisfaction with services. Hosp Community Psychol 1989; 40: 831–5
Solomon P, Marcenko M. Families of adults with severe mental illness: their satisfaction with inpatient and outpatient treatments. Psychosoc Rehabil J 1992; 16: 121–34
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: 43–51
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: 33–41
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: 252–4
Bernheim K, Lehman A. Working with families of the mentally ill. New York: Norton, 1985
Bernheim K. Supportive family counseling. Schizophr Bull 1982; 8: 634–48
Marsh D, Johnson D. The family experience of mental illness: implications for interventions. Prof Psychol Res Pract 1997; 28: 229–37
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: 177–86
Solomon P, Draine J, Mannion E, et al. Impact of brief family psychoeducation on self-efficacy. Schizophr Bull 1996; 22(1): 41–50
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): 555–74
Budd R, Hughes I. What do relatives of people with Schizophrenia find helpful about family intervention? Schizophr Bull 1997; 23: 341–7
Ascher-Svanum H, Lafuze J, Barrickman P, et al. Education needs of families of mentally ill adults. Psychiatr Serv 1997; 48: 1072–4
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: 47–59
Xiang MG, Ran M, Li S. A controlled evaluation of psychoeducational family intervention in a rural Chinese community. Br J Psychiatry 1994; 165: 544–8
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.): 96–102
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, 1998
Pickett-Schenk S, Cook J, Laris A. Journey of Hope program outcomes. Commun Mental Health J 2000; 36: 413–24
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): 15–30
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): 187–98
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: 143–60
Mannion E, Mueser K, Solomon P. Designing psychoeducational services for spouses of persons with serious mental illness. Community Ment Health J 1994; 30: 177–90
McFarlane W, Dushay R, Stastny P, et al. A comparison of two levels of Family-Aided Assertive Community Treatment. Psychiatr Serv 1996; 47(7): 744–50
Tarrier N, Lowson K, Barrowclough C. Some aspects of family interventions in schizophrenia — II Financial Considerations. Br J Psychiatry 1991; 159: 481–4
Biegel D, Li-yu S, Milligan S. Comparative analysis of family caregivers’ perceived relationship with mental health professionals. Psychiatr Serv; 46: 477–82
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: 203–36
Hatfield A, Fierstein R, Johnson D. Meeting the needs of families of the psychiatrically disabled. Psychosoc Rehabil J 1982; 6: 27–40
Holden D, Lewine R. How families evaluate mental health professionals, resources and effects of illness. Schizophr Bull 1982; 8(14): 626–33
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): 34–40
Francell C, Conn V, Gray D. Families’ perceptions of burden of care for chronic mentally ill relatives. Hosp Community Psychol 1988; 34: 296–300
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: 77–84
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: 40–50
Tessler R, Gamache G. Continuity of care, residence, and family burden in Ohio. Milbank Q 1994; 72: 149–69
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: 654–60
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): 370–7
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): 378–92
Wright E. The impact of organizational factors on mental health professionals’ involvement with families. Psychiatr Serv 1997; 48: 921–7
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Solomon, P. Interventions for Families of Individuals with Schizophrenia. Dis-Manage-Health-Outcomes 8, 211–221 (2000). https://doi.org/10.2165/00115677-200008040-00004
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DOI: https://doi.org/10.2165/00115677-200008040-00004