Bridging the Gap: Brief Family Psychoeducation in Forensic Mental Health

Voices to be heard: Understanding family perspectives in forensic care trajectories

INTRODUCTION

De-institutionalization of psychiatric care has greatly increased the role of family members in the recovery pathways of Persons labeled as Not Criminally Responsible (PNCR). However, the role of family members in supporting PNCR in forensic psychiatric care remains understudied. Scarce evidence indicates that PNCR have to deal with stigma and endure specific burdens (i.e., symptom-specific, financial, social, and emotional). Recovery-focused research showed that recovery in both persons with a severe mental illness and family members develop in parallel with each other and are characterized by similar helpful principles (e.g., hope and coping skills). As such, the recovery pathways of PNCR often goes hand in hand with the recovery pathway of their family members. During the family recovery process, family members often experience not being listened to or being empowered by professionals or not being involved in the decision-making process in the care trajectory of their relative. Therefore, the aim of this study is to capture how family members experience the care trajectories of their relatives, more specifically by looking at family recovery aspects and personal advocacy of family members.

METHODS

Semi-structured interviews were conducted with 21 family members of PNCR from 14 families. A thematic analysis confirms that family members suffer from stigma and worry significantly about the future of their relative.

RESULTS

Regarding the care trajectory of PNCR, family members experienced barriers in multiple domains while trying to support their relative: involvement in care and information sharing, visiting procedures, transitions between wards, and the psychiatric and judicial reporting by professionals. In addition, family members emphasized the importance of (social) support for themselves during the forensic psychiatric care trajectories and of a shared partnership.

DISCUSSION

These findings tie in with procedural justice theory as a precondition for family support and family recovery within forensic psychiatric care.

Family Recovery Interventions with Families of Mental Health Service Users: A Systematic Review of the Literature

INTRODUCTION

Recovery has become a catalyst for much organisational and cultural change within mental health services. Recovery involves the service user living the best life of their choice despite the presence of mental health challenges. In contrast, recovery of families remains under-developed with minimal attention given to the unique support families may require in their own recovery journeys. This paper aims to place focus on the topic through a systematic review of the literature into family recovery interventions in mental health; Method and Analysis: A PRISMA compliant systematic review was initiated. It included how the reviewers retrieved and selected studies for the systematic review. It outlined the inclusion/exclusion criteria and how these were further developed through the PICO framework. It also outlined how the reviewers assessed issues of bias and quality, as well as the process of data synthesis; Results: Three studies were included in this review. Each focusing on family recovery interventions across the lifespan: Kidstime to family toolkits to family psychoeducation. The benefits and challenges of each intervention to the family were synthesised along with a list of four family recovery enablers that are vital for the implementation of such family recovery interventions; Discussion/Implications for Practice: The results highlight the paucity of quality literature available for family recovery interventions. All three studies scored poorly in terms of quality, with one particular study (Nagi and Davies 2015) lacking quotations from participants to back up their claims. From this study, a number of actions need to be implemented, specifically around the enablers needed to allow for family recovery interventions to be fully implemented.

Incorporating Multicultural Couple and Family Therapy Into Incarcerated Settings

Incarceration rates have increased significantly since the 1990s, with more than two million adults in federal, state, and local facilities. More than half of the offenders report a history of mental health issues, highlighting the importance of offenders having access to effective therapeutic approaches, including individual, couples, and family counseling. Traditionally, the focus of mental health services has been individual treatment; however, family members are also significantly impacted by the offender's absence during incarceration. Incorporating family members into treatment can serve to improve relationships, leading to better outcomes at reentry and reductions in recidivism rates. Given the preponderance of persons of color in the incarcerated population, diversity issues in counseling must also be addressed. The purpose of the underlined article is to explore the implications of incorporating multicultural family therapy into incarcerated settings.

Taking parents seriously: The experiences of parents with a son or daughter in adult medium secure forensic mental health care

Adult forensic mental health services provide care and treatment to individuals with complex offending and mental health histories. However, little attention has been paid to the parents of those receiving care within them. This research explored the experiences of parents with an adult son or daughter with mental illness in a medium secure mental health unit. Transcripts from semi-structured interviews were analysed using interpretative phenomenological analysis. This led to the identification of three superordinate themes: 'Something's not right'-onset of mental distress; 'It's a terrible battle'-relating with professionals; and 'A very sad fact of life'-caring with no end in sight were identified which together contained nine subordinate themes. The onset of the mental distress was narrated as overwhelming, frightening, and confusing with experiences of violence. Services were seen as invalidating, and interactions with them characterized as a battle. Poor information and involvement were a common experience. Whilst diagnosis was a relief to some, the ongoing sense of loss and burden were clear. Staying connected and hopes for the future were also described. It is clear from this study that mental health services need to do more to engage and foster trust with parents from the outset and to offer support for this group. If secure services were to view parents as 'forensic carers', this may help improve respect and engagement between services and carers. Services and policymakers should strive to foster high-quality family involvement as part of developing social inclusion.

Engaging with Families Is a Challenge: Beliefs among Healthcare Professionals in Forensic Psychiatric Care

Being healthcare professionals in the complex field of forensic psychiatry care (FPC) seems particularly challenging. Historically, families have almost been invisible in FPC. The aim of this study was to uncover beliefs among healthcare professionals concerning families of patients admitted for FPC. Using a hermeneutical approach inspired by Gadamer's philosophy, group interviews with healthcare professionals in four Swedish forensic psychiatric clinics were analyzed. Analysis resulted in seven key beliefs. There were three beliefs about families: family belongingness is a resource for the patient; most families are broken and not possible to trust; and most families get in the way of the patient's care. Four beliefs concerned encounters with families: it is important to achieve a balance and control over the family; it is essential to set aside one's own values and morals; family-oriented work is an impossible mission; and family oriented work requires welcoming the families. Despite ethical dilemmas of working with families in FPC, healthcare professionals showed a willingness and desire to work in a more family-oriented manner. More knowledge, understanding, and caring tools are needed in order to meet the needs of the family as well as support the family's resources.