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Rodell S, Parry S. Family members' experiences of seeking help for a young person with symptoms associated with the psychosis spectrum: A narrative review and synthesis. Clin Child Psychol Psychiatry 2024; 29:897-912. [PMID: 37188330 PMCID: PMC11188561 DOI: 10.1177/13591045231176701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Young people often rely on family carers to access support for their mental health. However, stigma can be a barrier to help seeking for young people and families. Little research has been undertaken with young people who experience highly stigmatised symptoms, such as psychosis spectrum symptoms, and even less research has been conducted with parents and carers, meaning barriers to help go unchallenged. Therefore, this narrative review aimed to explore stories of family experiences of seeking help for young people with symptoms associated with the psychosis spectrum. Sources searched were PsycINFO and PubMed. Reference lists of the selected papers were also cross-checked to ensure the search had not missed potential papers for inclusion. Searches returned 139 results, of which 12 were identified for inclusion. A narrative analytic approach was adopted to synthesise qualitative findings to provide a nuanced interpretation of help-seeking experiences. The narrative synthesis provided an opportunity to identify differences, similarities, and patterns across the studies to tell a cumulative emancipatory narrative of family experiences of seeking help for psychosis spectrum symptoms. Help-seeking experiences had a relational impact on families, with stress adding to conflict and anxieties inhibiting hopefulness, although families could emerge stronger and assertively with compassionate support.
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Affiliation(s)
- Sadie Rodell
- Doctorate of Clinical Psychology, Lancaster University, Lancaster, United Kingdom
| | - Sarah Parry
- Division of Health Research, Lancaster University, Lancaster, LA1 4YW, United Kingdom
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2
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Hem MH, Molewijk B, Weimand B, Pedersen R. Patients with severe mental illness and the ethical challenges related to confidentiality during family involvement: A scoping review. Front Public Health 2023; 10:960815. [PMID: 36711422 PMCID: PMC9877517 DOI: 10.3389/fpubh.2022.960815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
Background Despite evidence on the significant potential value of family involvement during the treatment of patients with severe mental illness, research has shown that family involvement is largely underused. The duty of confidentiality is reported to be a key barrier to family involvement. To develop more insight into this barrier, this scoping review focuses on the following question: What are the reported ethical challenges related to confidentiality when involving family in the treatment of patients with severe mental illness? Methods A systematic search into primary studies was conducted using the following databases: Medline (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), and Web of Science core collection (Clarivate). The PICO (Population, Intervention, Comparison, Outcome) scheme and qualitative content analysis were used to make the ethical challenges more explicit. Results Twelve studies-both qualitative and quantitative-were included. We identified the following main categories of ethical challenges: (1) the best interest of family members vs. confidentiality, (2) the patient's best interest vs. the right to confidentiality, (3) patient trust and alliance as a reason not to involve the relatives or not to share information, and (4) using confidentiality as a smokescreen. We also identified several subcategories and illustrative and concrete examples of ethical challenges. Conclusions Through a systematic examination, we discovered various types of ethical challenges related to confidentiality when involving the family in the treatment of patients with severe mental illness. However, research on these ethical challenges and the constituents of these challenges remains limited and often implicit. An ethical analysis will create knowledge which may facilitate a more balanced and nuanced approach to respecting the principle of confidentiality while also considering other moral principles. The duty of confidentiality does not always have to be a major barrier to family involvement; this insight and using this ethical analysis in the training of healthcare professionals may benefit the patient, the family, and the services.
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Affiliation(s)
- Marit Helene Hem
- Norwegian University of Science and Technology (NTNU) Social Research, Trondheim, Norway,Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Bert Molewijk
- Centre for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway,Department Ethics, Law and Humanities, Amsterdam University Medical Centre (UMC) and Vrije Universiteit, Amsterdam, Netherlands
| | - Bente Weimand
- University of South-Eastern Norway, Faculty of Health and Social Sciences, Drammen, Norway,Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Reidar Pedersen
- Centre for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway,*Correspondence: Reidar Pedersen ✉
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3
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The duty of confidentiality during family involvement: ethical challenges and possible solutions in the treatment of persons with psychotic disorders. BMC Psychiatry 2022; 22:812. [PMID: 36539741 PMCID: PMC9764492 DOI: 10.1186/s12888-022-04461-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Family involvement during severe mental illness is still poorly implemented, contrary to evidence-based recommendations. Confidentiality issues are among the most prominent barriers, with mental health professionals facing complex ethical, legal, and practical challenges. However, research focusing on this barrier is very sparse. Nested within a cluster-randomised trial to implement guidelines on family involvement for persons with psychotic disorders in community mental health centres, the aim of this sub-study was to explore ethical challenges related to the duty of confidentiality as experienced by mental health professionals, and to explore key measures that might contribute to improving the handling of such challenges. METHODS In total 75 participants participated in 21 semi-structured focus groups, including implementation team members at the initial and late phase of the intervention period and clinicians who were not on the implementation teams, at late phase of implementation. We used purposive sampling and manifest content analysis to explore participants' experiences and change processes. RESULTS Ethical challenges related to the duty of confidentiality included 1) Uncertainty in how to apply the legislation, 2) Patient autonomy versus a less strict interpretation of the duty of confidentiality, 3) Patient alliance and beneficence versus a less strict interpretation of the duty of confidentiality, 4) How to deal with uncertainty regarding what relatives know about the patients' illness, and 5) Relatives' interests versus the duty of confidentiality. Measures to facilitate better handling of the duty of confidentiality included 1) Training and practice in family involvement, and 2) Standardisation of family involvement practices. CONCLUSION When health professionals gained competence in and positive experiences with family involvement, this led to vital changes in how they interpreted and practiced the duty of confidentiality in their ethical reasoning and in clinical practice. Especially, the need to provide sufficient information to the patients about family involvement became evident during the study. To improve the handling of confidentiality issues, professionals should receive training in family involvement and confidentiality statutes followed by practice. Furthermore, family involvement should be standardised, and confidentiality guidelines should be implemented in the mental health services. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03869177. Registered 11.03.19.
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Moyo N, Jones M, Kushemererwa D, Arefadib N, Jones A, Pantha S, Gray R. Service User and Carer Views and Expectations of Mental Health Nurses: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11001. [PMID: 36078717 PMCID: PMC9517907 DOI: 10.3390/ijerph191711001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/21/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
Service users' views and expectations of mental health nurses in a UK context were previously reviewed in 2008. The aim of this systematic review is to extend previous research by reviewing international research and work published after the original review. Five databases were searched for studies of any design, published since 2008, that addressed service user and carer views and expectations of mental health nurses. Two reviewers independently completed title and abstract, full-text screening and data extraction. A narrative synthesis was undertaken. We included 49 studies. Most included studies (n = 39, 80%) were qualitative. The importance of the therapeutic relationship and service users being supported in their personal recovery by mental health nurses were core themes identified across included studies. Service users frequently expressed concern about the quality of the therapeutic relationship and indicated that nurses lacked time to spend with them. Carers reported that their concerns were not taken seriously and were often excluded from the care of their relatives. Our critical appraisal identified important sources of bias in included studies. The findings of our review are broadly consistent with previous reviews however the importance of adopting a recovery approach has emerged as a new focus.
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Affiliation(s)
- Nompilo Moyo
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC 3000, Australia
| | - Martin Jones
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
- Department of Rural Health, University of South Australia, Whyalla Campus, Whyalla Norrie, SA 5608, Australia
- IIMPACT in Health, University of South Australia, Adelaide, SA 5000, Australia
| | - Diana Kushemererwa
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
| | - Noushin Arefadib
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
| | - Adrian Jones
- Faculty of Life Sciences, Wrexham Glyndwr University, Wrexham LL11 2AW, UK
| | - Sandesh Pantha
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
- Department of Rural Health, University of South Australia, Whyalla Campus, Whyalla Norrie, SA 5608, Australia
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5
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Abney AJ, Monash B, Trappey B, Olson APJ. A traumatic traveler. J Hosp Med 2022; 17:54-58. [PMID: 32195652 DOI: 10.12788/jhm.3379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/16/2019] [Accepted: 01/04/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Ancil J Abney
- Departments of Pediatrics and Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Bradley Monash
- Departments of Pediatrics and Medicine, University of California San Francisco, San Francisco, California
| | - Bernard Trappey
- Departments of Pediatrics and Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Andrew P J Olson
- Departments of Pediatrics and Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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Riffin C, Wolff JL, Butterworth J, Adelman RD, Pillemer KA. Challenges and approaches to involving family caregivers in primary care. PATIENT EDUCATION AND COUNSELING 2021; 104:1644-1651. [PMID: 33280966 PMCID: PMC8160020 DOI: 10.1016/j.pec.2020.11.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Older adults are commonly accompanied to routine medical visits. This study identifies challenges and explores approaches to managing patient-family interactions in primary care. METHODS Semi-structured interviews were conducted with primary care clinicians and staff (N = 30) as well as older adult patients and family caregivers (N = 40). Interviews were analyzed using content analysis. RESULTS Three major challenges to patient-family interactions were identified: navigating patient autonomy and family motivation to participate; adjudicating patient-family disagreements; and minimizing obtrusive behaviors by caregivers. Three approaches to managing patient-family interactions were identified. Collaborating involved non-judgmental listening, consensus-building, and validation of different perspectives. Dividing involved separating the patient and family member to elicit confidential information from one member of the dyad. Focusing involved re-directing the conversation to either the patient or family member while minimizing input from the other. Approaches varied by patients' cognitive status and overall health condition. In general, patients and caregivers expressed the most positive attitudes toward collaborating and patient-directed focusing approaches. CONCLUSION Primary care clinicians use varied approaches to managing their interactions with patient-family dyads. Patients and caregivers generally prefer those approaches that involve collaborative rather than individual discussions. PRACTICE IMPLICATIONS Findings suggest the potential for the development of communication-focused interventions to promote positive clinician-patient-family interactions.
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Affiliation(s)
| | - Jennifer L Wolff
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Ronald D Adelman
- Department of Medicine, Weill Cornell Medicine, New York, USA; Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Department of Human Development, Cornell University, Ithaca, USA
| | - Karl A Pillemer
- Department of Human Development, Cornell University, Ithaca, USA
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7
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Romm KL, Nilsen L, Gjermundsen K, Holter M, Fjell A, Melle I, Repål A, Lobban F. Remote Care for Caregivers of People With Psychosis: Mixed Methods Pilot Study. JMIR Ment Health 2020; 7:e19497. [PMID: 32720905 PMCID: PMC7420633 DOI: 10.2196/19497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A reduced availability of resources has hampered the implementation of family work in psychosis. Web-based support programs have the potential to increase access to high-quality, standardized resources. This pilot study tested the Norwegian version of the Relatives Education and Coping Toolkit (REACT), a web-based United Kingdom National Health Service program in combination with phone-based support by trained family therapists. OBJECTIVE We investigated how the program was perceived by its users and identified the facilitators and barriers to its clinical implementation. METHODS Relatives of people with psychosis were offered access to REACT and to weekly family therapist support (with 1 of 2 trained family therapists) for 26 weeks. Level of distress and level of expressed emotion data were collected at baseline and after 26 weeks using the Family Questionnaire and the Relatives Stress Scale. Both family therapists and a subset of the relatives were interviewed about their experiences after completing the program. RESULTS During the program, relatives (n=19) had a median of 8 (range 4-11) consultations with the family therapists. Postintervention, there was a significant reduction in stress and in expressed emotions in the relatives of people with psychosis. Interviews with the relatives (n=7) and the family therapists (n=2) indicated the following themes as important-the intervention turned knowledge into action; the intervention strengthened the feeling of being involved and taken seriously by the health services; and management support and the ability for self-referral were important, while lack of reimbursement and clinician resistance to technology were barriers to implementation. CONCLUSIONS The service was found to offer a valued clinical benefit; however, strategies that aim to engage clinicians and increase organizational support toward new technology need to be developed.
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Affiliation(s)
- Kristin Lie Romm
- Institute of Clinical Medicine, Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Liv Nilsen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Marit Holter
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Toensberg, Norway
| | - Anne Fjell
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Arne Repål
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Toensberg, Norway
| | - Fiona Lobban
- Spectrum Centre, Division of Health Research, Lancaster University, Lancaster, United Kingdom
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8
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Johansson A, Anderzén-Carlsson A, Ewertzon M. Parents of adult children with long-term mental disorder: Their experiences of the mental health professionals' approach and feelings of alienation - A cross sectional study. Arch Psychiatr Nurs 2019; 33:129-137. [PMID: 31753218 DOI: 10.1016/j.apnu.2019.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 09/09/2019] [Accepted: 10/18/2019] [Indexed: 11/25/2022]
Abstract
The aim was to describe how parents of adult children suffering from long-term mental disorder experience the mental health professionals' approach and any feelings of alienation regarding the provision of care. A further aim was to investigate any differences according to the parents' gender or the child's age. 93 mothers and 37 fathers participated. A majority experienced the mental health professionals' approach toward them as being negative and they felt alienated from the professional care. Regardless of the age of the children, parents have a considerable need for a positive approach from the professionals that can enable them to choose how they should act and what they should do, in order to help and support their adult child.
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Affiliation(s)
- Anita Johansson
- Research and Development Centre, Skaraborg Hospital, SE-541 85 Skövde, Sweden.
| | - Agneta Anderzén-Carlsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE-702 81 Örebro, Sweden.
| | - Mats Ewertzon
- Ersta Sköndal Bräcke University College, Department of Health Care Sciences, P.O. Box 111 89, SE 100 61 Stockholm, Sweden.
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9
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Mui EYW, Chan SKW, Chan PY, Hui CLM, Chang WC, Lee EHM, Chen EYH. Systematic review (meta-aggregation) of qualitative studies on the experiences of family members caring for individuals with early psychosis. Int Rev Psychiatry 2019; 31:491-509. [PMID: 31547726 DOI: 10.1080/09540261.2019.1659236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite the importance of the role of caregivers of people with psychosis being widely recognized, comprehensive understanding of their experience is limited. A thorough understanding of the experience of caregivers over the journey of the illness, particularly during its early stages, is crucial. Qualitative studies published between 1 January 1949 and 31 January 2018 were obtained from seven databases based on PICo search strategy. Meta-aggregation methodology of the Joanna Briggs Institute (JBI) was adopted to aggregate existing qualitative findings about caregivers' experiences. Twenty-eight qualitative studies on 635 caregivers and family members were included in the review. Six inter-related categories-'stigma', 'help-seeking', 'service encounter', 'emotional challenges', 'on becoming a caregiver' and 'making sense of experience'-were aggregated from 129 themes from the sub-acute stage, the acute stage and the recovery or residual stage. Three statements about caregivers' experiences of their relative's first episode of psychosis were synthesized from the findings. Results highlighted the need of incorporating caregiver intervention into the existing services to support the emotional challenges, uncertainty, and stigma-related burden along the caregiving journey.
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Affiliation(s)
- Esther Yee Wai Mui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China
| | - Sherry K W Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong SAR , China
| | - Pik Ying Chan
- Department of Social Work and Social Administration, The University of Hong Kong , Hong Kong SAR , China
| | - Christy L M Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China
| | - Wing C Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong SAR , China
| | - Edwin H M Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China
| | - Eric Y H Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong SAR , China
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Poon AWC, Harvey C, Fuzzard S, O'Hanlon B. Implementing a family-inclusive practice model in youth mental health services in Australia. Early Interv Psychiatry 2019; 13:461-468. [PMID: 29052957 DOI: 10.1111/eip.12505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/25/2017] [Accepted: 08/20/2017] [Indexed: 11/28/2022]
Abstract
AIM A brief family-inclusive practice model, single session family consultation (SSFC), was introduced at 4 youth mental health service sites to determine the extent to which the model could be implemented in this context and its acceptability as a means of engaging families of young people. METHODS Within an action research paradigm, both quantitative and qualitative measures were used for this implementation project with the former reported here. There were 2 components: (1) evaluation of the experiences of young people and their families and (2) evaluation of the extent of implementation of SSFC. Quantitative data were analysed descriptively (item scores, range and any changes over time). RESULTS Twenty practitioners who were trained and supported in the use of SSFC participated in the 6-month implementation evaluation. In 6 months, 131 SSFC sessions were conducted across the 4 sites and the young people and their families were very satisfied with sessions (overall mean = 5.2, range = 0-6). Six months post-training, there were statistically significant improvements in the practitioners' confidence in providing family interventions (mean improvement = -0.47 (95% confidence interval (CI) = -0.91, -0.04), P = .035) and familiarity with approaches to working with families (mean improvement = -0.61 (95% CI = -1.13, -0.10, P = .023). Practitioners perceived significant improvement in organizational support for working with families. CONCLUSIONS SSFC was acceptable to clients and their families, was adopted by practitioners and was successfully implemented in the participating sites. This suggests that SSFC, when appropriately implemented, is useful to engage families in the treatment of young people facing mental health issues.
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Affiliation(s)
- Abner Weng Cheong Poon
- School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Carol Harvey
- Psychosocial Research Centre, Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia.,NorthWestern Mental Health, Coburg, Victoria, Australia
| | - Suzanne Fuzzard
- headspace Murray Bridge, Murray Bridge, South Australia, Australia
| | - Brendan O'Hanlon
- The Bouverie Centre, La Trobe University, Melbourne, Victoria, Australia
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11
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Luderowski A, Boden ZV. Love and incomprehensibility: The hermeneutic labour of caring for and understanding a loved one with psychosis. Health (London) 2019; 24:737-754. [PMID: 30935237 DOI: 10.1177/1363459319829189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Informal carers are increasingly involved in supporting people with severe and enduring mental health problems, and carers' perceptions impact the wellbeing of both parties. However, there is little research on how carers actually make sense of what their loved one is experiencing. Ten carers were interviewed about how they understood a loved one's psychosis. Data were analysed using a hermeneutic-phenomenological approach. Three themes described the carers' effortful quest to understand their loved one's experiences while maintaining their relational bonds. Carers described psychosis as incomprehensible, seeing their loved one as incompatible with the shared world. To overcome this, carers developed hermeneutic 'mooring points', making sense of their loved one's unusual experiences through novel accounts that drew on material or spiritual explanations. The findings suggest that informal carers resist biomedical narratives and develop idiosyncratic understandings of psychosis, in an attempt to maintain relational closeness. We suggest that this process is effortful - it is hermeneutic labour - done in the service of maintaining the caring relationship. Findings imply that services should better acknowledge the bond between carers and care-receivers, and that more relationally oriented approaches should be used to support carers of people experiencing severe mental health problems.
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12
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McCann TV, Lubman DI. Help-seeking barriers and facilitators for affected family members of a relative with alcohol and other drug misuse: A qualitative study. J Subst Abuse Treat 2018; 93:7-14. [DOI: 10.1016/j.jsat.2018.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 11/26/2022]
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13
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Clark E. Lessons from the past: Family involvement in patient admission and discharge, Beechworth Lunatic Asylum, 1900-1912. Int J Ment Health Nurs 2018; 27:320-328. [PMID: 28229546 DOI: 10.1111/inm.12323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 11/28/2022]
Abstract
In this study, document analysis is used to examine case books from the Beechworth Lunatic Asylum with the aim of determining the extent of family involvement in patients' admission and discharge. There were 420 male and 278 female patients admitted in the study period, with over half transferred from other Victorian asylums. Next of kin were identified for 64% of male and 84% of female patients. Families were involved in the admission of 52 (12%) male and 50 (18%) female patients, usually by bringing patients to the asylum or providing evidence of behavioural changes. Approximately 25% of patients were discharged (101 men and 62 women) and of these, families were involved in discharge for 26% of male and 71% of female patients, mainly by taking responsibility for them during trial discharge. Occasionally families refused to do this, or sought to have patients detained because of fears of violence. The relevance of the study to contemporary practice is explored, particularly the need for dialogue between clinicians and families who identify behavioural changes in family members, appropriate support for family carers, and timely provision of community care following discharge from inpatient facilities.
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Affiliation(s)
- Eileen Clark
- Clarks Clerks Research Services, Lavington, NSW, Australia
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14
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Miller DI. Inpatient Psychiatric Care: Families' Expectations and Perceptions of Support Received From Health Professionals. Perspect Psychiatr Care 2017; 53:350-356. [PMID: 27197547 DOI: 10.1111/ppc.12168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/28/2016] [Accepted: 03/29/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The purpose of this paper was to identify challenges of families caring for loved ones prior to inpatient psychiatric care, understand families' perceptions of support received from psychiatric health professionals, and identify ways for professionals to support families. CONCLUSIONS Families experienced many challenges prior to hospital admission. There was a large gap between families' expectations and perceptions of actual support received by psychiatric health professionals. PRACTICE IMPLICATIONS Nurses are well positioned to educate, advocate, and support overburdened families. Greater knowledge of families' challenges would enable nurses to anticipate and meet their needs.
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Affiliation(s)
- Doris I Miller
- Doris I. Miller, MN, RN, is a Nursing Educator, Red River College, Winnipeg, Manitoba, Canada
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15
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McCann TV, Cotton SM, Lubman DI. Social problem solving in carers of young people with a first episode of psychosis: a randomized controlled trial. Early Interv Psychiatry 2017; 11:346-350. [PMID: 26592195 PMCID: PMC5573962 DOI: 10.1111/eip.12301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/22/2015] [Indexed: 11/30/2022]
Abstract
AIM Caring for young people with first-episode psychosis is difficult and demanding, and has detrimental effects on carers' well-being, with few evidence-based resources available to assist carers to deal with the problems they are confronted with in this situation. We aimed to examine if completion of a self-directed problem-solving bibliotherapy by first-time carers of young people with first-episode psychosis improved their social problem solving compared with carers who only received treatment as usual. METHODS A randomized controlled trial was carried out through two early intervention psychosis services in Melbourne, Australia. A sample of 124 carers were randomized to problem-solving bibliotherapy or treatment as usual. Participants were assessed at baseline, 6- and 16-week follow-up. RESULTS Intent-to-treat analyses were used and showed that recipients of bibliotherapy had greater social problem-solving abilities than those receiving treatment as usual, and these effects were maintained at both follow-up time points. CONCLUSIONS Our findings affirm that bibliotherapy, as a low-cost complement to treatment as usual for carers, had some effects in improving their problem-solving skills when addressing problems related to the care and support of young people with first-episode psychosis.
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Affiliation(s)
- Terence V McCann
- Centre for Chronic Disease, College of Health and Biomedicine (Discipline of Nursing), Victoria University, Melbourne, Victoria, Australia
| | - Sue M Cotton
- Orygen Youth Health Research Centre, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health and Monash University, Melbourne, Victoria, Australia
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16
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Ruggeri M, Lasalvia A, Santonastaso P, Pileggi F, Leuci E, Miceli M, Scarone S, Torresani S, Tosato S, De Santi K, Cristofalo D, Comacchio C, Tomassi S, Cremonese C, Fioritti A, Patelli G, Bonetto C. Family Burden, Emotional Distress and Service Satisfaction in First Episode Psychosis. Data from the GET UP Trial. Front Psychol 2017; 8:721. [PMID: 28559862 PMCID: PMC5432637 DOI: 10.3389/fpsyg.2017.00721] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/21/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Literature has documented the role of family in the outcome of chronic schizophrenia. In the light of this, family interventions (FIs) are becoming an integral component of treatment for psychosis. The First Episode of Psychosis (FEP) is the period when most of the changes in family atmosphere are observed; unfortunately, few studies on the relatives are available. Objective: To explore burden of care and emotional distress at baseline and at 9-month follow-up and the levels of service satisfaction at follow-up in the two groups of relatives (experimental treatment EXP vs. treatment as usual TAU) recruited in the cluster-randomized controlled GET UP PIANO trial. Methods: The experimental treatment was provided by routine public Community Mental Health Centers (Italian National Health Service) and consisted of Treatment as Usual plus evidence-based additional treatment (Cognitive Behavioral Therapy for psychosis for patients, Family Intervention for psychosis, and Case Management). TAU consisted of personalized outpatient psychopharmacological treatment, combined with non-specific supportive clinical management and informal support/educational sessions for families. The outcomes on relatives were assessed by the Involvement Evaluation Questionnaire (IEQ-EU), the General Health Questionnaire (GHQ-12), and the Verona Service Satisfaction Scale (VSSS-EU). Differences within and between groups were evaluated. Results: At baseline, 75 TAU and 185 EXP caregivers were assessed. In the experimental group 92% of relatives participated in at least 1 family session. At follow-up both groups experienced improvement in all IEQ and GHQ items, but caregivers belonging to the EXP arm experienced a significantly greater change in 10 IEQ items (mainly pertaining to the “Tension” dimension) and in GHQ items. Due to the low sample size, a significant effectiveness was only observed for 2 IEQ items and 1 GHQ-12 item. With respect to VSSS data at follow-up, caregivers in the EXP arm experienced significantly greater satisfaction in 8 items, almost all pertaining to the dimensions “Relatives' Involvement” and “Professionals' Skills and Behavior.” Conclusions: The Family intervention for psychosis delivered in the GET UP PIANO trial reduced family burden of illness and improved emotional distress and satisfaction with services. These results should encourage to promote FIs on caregivers of first-episode psychosis patients.
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Affiliation(s)
- Mirella Ruggeri
- UOC Psichiatria, Azienda Ospedaliera Universitaria IntegrataVerona, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVerona, Italy
| | - Antonio Lasalvia
- UOC Psichiatria, Azienda Ospedaliera Universitaria IntegrataVerona, Italy
| | - Paolo Santonastaso
- Department of Neurosciences, University of Padova and Azienda OspedalieraPadova, Italy
| | | | - Emanuela Leuci
- Department of Mental Health, Azienda USL ParmaParma, Italy
| | - Maurizio Miceli
- Department of Mental Health, Azienda USL FirenzeFirenze, Italy
| | - Silvio Scarone
- Department of Psychiatry, University of MilanoMilan, Italy
| | | | - Sarah Tosato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVerona, Italy
| | - Katia De Santi
- UOC Psichiatria, Azienda Ospedaliera Universitaria IntegrataVerona, Italy
| | - Doriana Cristofalo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVerona, Italy
| | - Carla Comacchio
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVerona, Italy
| | - Simona Tomassi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVerona, Italy
| | - Carla Cremonese
- Department of Neurosciences, University of Padova and Azienda OspedalieraPadova, Italy
| | - Angelo Fioritti
- Department of Mental Health, Azienda USL BolognaBologna, Italy
| | - Giovanni Patelli
- AO Ospedale Niguarda Ca' Granda Milano, MHD Programma2000Milan, Italy
| | - Chiara Bonetto
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVerona, Italy
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17
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Landeweer E, Molewijk B, Hem MH, Pedersen R. Worlds apart? A scoping review addressing different stakeholder perspectives on barriers to family involvement in the care for persons with severe mental illness. BMC Health Serv Res 2017; 17:349. [PMID: 28506296 PMCID: PMC5433083 DOI: 10.1186/s12913-017-2213-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 03/31/2017] [Indexed: 11/24/2022] Open
Abstract
Background Empirical evidence shows that family involvement (FI) can play a pivotal role in the coping and recovery of persons with severe mental illness (SMI). Nevertheless, various studies demonstrate that FI in mental healthcare services is often not (sufficiently) realized. In order to develop more insights, this scoping review gives an overview of how various stakeholders conceptualize, perceive and experience barriers to FI. Central questions are: 1) What are the main barriers to FI reported by the different key stakeholders (i.e. the persons with SMI, their families and the professionals, and 2) What are the differences and similarities between the various stakeholders’ perspectives on these barriers. Methods A systematic search into primary studies regarding FI was conducted in four databases: Medline/Pubmed, Cinahl, PsychInfo and Web of Knowledge with the use of a PICO scheme. Thematic analysis focused on stakeholder perspectives (i.e. which stakeholder group reports the barrier) and types of barriers (i.e. which types of barriers are addressed). Results Thirty three studies were included. The main barriers reported by the stakeholder groups reveal important similarities and differences between the stakeholder groups and were related to: 1) the person with SMI, 2) the family, 3) the professionals, 4) the organization of care and 5) the culture-paradigm. Discussion Our stakeholder approach elicits the different stakeholders’ concepts, presuppositions and experiences of barriers to FI, and gives fundamental insights on how to deal with barriers to FI. The stakeholders differing interpretations and perceptions of the barriers related to FI is closely related to the inherent complexity involved in FI in itself. In order to deal better with these barriers, openly discussing and reflecting upon each other’s normative understandings of barriers is needed. Conclusions Differences in perceptions of barriers to FI can itself be a barrier. To deal with barriers to FI, a dialogical approach on how the different stakeholders perceive and value FI and its barriers is required. Methods such as moral case deliberation or systematic ethics reflections can be useful. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2213-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elleke Landeweer
- Center for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, Oslo, NO, 0318, Norway.
| | - Bert Molewijk
- Center for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, Oslo, NO, 0318, Norway.,Department of Medical Humanities, VU University Medical Center, Amsterdam, The Netherlands
| | - Marit Helene Hem
- Center for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, Oslo, NO, 0318, Norway
| | - Reidar Pedersen
- Center for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, Oslo, NO, 0318, Norway
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18
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Andershed B, Ewertzon M, Johansson A. An isolated involvement in mental health care - experiences of parents of young adults. J Clin Nurs 2017; 26:1053-1065. [DOI: 10.1111/jocn.13560] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Birgitta Andershed
- Faculty of Health, Care and Nursing; Norwegian University of Science and Technology; Gjövik Norway
- Department of Palliative Research Centre; Ersta Sköndal University College; Stockholm Sweden
| | | | - Anita Johansson
- Research and Development Centre; Skaraborg Hospital; Skövde Sweden
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19
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Klages D, Usher K, Jackson D. 'Canaries in the mine'. Parents of adult children with schizophrenia: An integrative review of the literature. Int J Ment Health Nurs 2017; 26:5-19. [PMID: 27996189 DOI: 10.1111/inm.12290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2016] [Indexed: 11/28/2022]
Abstract
The purpose of this integrative review was to evaluate the current state of knowledge of parents who have adult children diagnosed with schizophrenia and their relationship with mental health professionals. Findings indicated that parents (primarily mothers) believed they intuitively knew when their adult children were becoming unwell and that they doggedly pursued connections with mental health care providers. Five themes were evident in the literature: trusting your instincts, feeling dismissed and devalued, making connections and making concessions, living with distress and sorrow, and becoming your own health-care provider. The implications of the findings on mental health nursing practice indicate that professional family relationships were not ideal, and that parents wanted to improve these relationships. Parents wanted health-care professionals to respond to their requests for help for both their children and for themselves, and wanted to be able to help the mental health team to help their adult children.
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Affiliation(s)
- Debra Klages
- School of Health, University of New England, Armidale, New South Wales, Australia
| | - Kim Usher
- School of Health, University of New England, Armidale, New South Wales, Australia
| | - Debra Jackson
- Faculty of Health & Life Sciences, Oxford Brookes University, Oxford, Oxfordshire, UK
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20
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Caqueo-Urízar A, Rus-Calafell M, Craig TKJ, Irarrazaval M, Urzúa A, Boyer L, Williams DR. Schizophrenia: Impact on Family Dynamics. Curr Psychiatry Rep 2017; 19:2. [PMID: 28097634 DOI: 10.1007/s11920-017-0756-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In many societies, family members are now the primary caregivers of mental health patients, taking on responsibilities traditionally under the purview of hospitals and medical professionals. The impact of this shift on the family is high, having both an emotional and economic toll. The aim of this paper is to review the main changes that occur in family dynamics for patients with schizophrenia. The article addresses three central themes: (i) changes in the family at the onset of the disorder, (ii) consequences for family members because of their caregiver role, and (iii) family interventions aimed at improving the complex dynamics within the family. After analyzing and discussing these themes, it is observed that despite advances in the field, the viability of taking care of a patient with schizophrenia by the family remains a challenge. Improving care will require commitments from the family, the mental health service system, and local and national governments for greater investments to improve the quality of life of society in general and individuals with schizophrenia in particular.
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Affiliation(s)
- Alejandra Caqueo-Urízar
- Escuela de Psicología y Filosofía, Universidad de Tarapacá, Avenida 18 de Septiembre 2222, Arica, Chile.
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115-6018, USA.
| | - Mar Rus-Calafell
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Thomas K J Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matias Irarrazaval
- Departamento de Psiquiatría, Facultad de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
- Instituto Milenio para la Investigación en Depresión y Personalidad, Santiago, Chile
| | - Alfonso Urzúa
- Universidad Católica del Norte, Avda. Angamos 0610, Antofagasta, Chile
| | - Laurent Boyer
- Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, 13005, Marseille, France
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115-6018, USA
- Department of African and African American Studies, Harvard University, Cambridge, MA, USA
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21
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Becker KD, Buckingham SL, Rith-Najarian L, Kline ER. The Common Elements of treatment engagement for clinically high-risk youth and youth with first-episode psychosis. Early Interv Psychiatry 2016; 10:455-467. [PMID: 26486257 DOI: 10.1111/eip.12283] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/21/2015] [Indexed: 11/30/2022]
Abstract
AIM Without treatment, clinically high-risk (CHR) youth or youth with first-episode psychosis (FEP) have increased risk for significant complications from their illness; yet, treatment engagement among these youth is critically low. The purpose of this study was to examine engagement efforts with CHR/FEP youth to stimulate new ideas that might facilitate participation in services for this population. METHODS A literature review using distillation methods identified engagement practices reported in two bodies of literature. The first body of literature (i.e. 'CHR/FEP engagement') included 13 studies employing qualitative designs to explore consumer perspectives about treatment engagement practices in samples of CHR/FEP youth and their families. The second body of research (i.e. 'CHR/FEP RCTs') included 18 randomized controlled trials (RCTs) testing treatments for CHR/FEP youth and their families. Engagement practice frequencies were compared with the frequency of these practices within effective engagement interventions, as tested in 40 RCTs within the broader child and adolescent mental health literature (i.e. 'CAMH engagement'). RESULTS Treatment attrition and attendance were the most frequent engagement outcomes measured in the CHR/FEP RCTs. There were notable efforts described in the CHR/FEP RCTs towards engaging youth and families, yet CHR/FEP RCTs reportedly included only a small proportion of engagement practices described in either the CHR/FEP or CAMH engagement literatures. CONCLUSION Results suggest there might be practices available to complement current efforts at engaging CHR/FEP youth in treatment, and that increased attention to the measurement of engagement outcomes could provide important information regarding engagement in a population with low treatment engagement rates.
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Affiliation(s)
- Kimberly D Becker
- Division of Child & Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA.
| | - Sara L Buckingham
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Leslie Rith-Najarian
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Emily R Kline
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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22
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Cranwell K, Polacsek M, McCann TV. Improving mental health service users' with medical co-morbidity transition between tertiary medical hospital and primary care services: a qualitative study. BMC Health Serv Res 2016; 16:302. [PMID: 27456864 PMCID: PMC4960840 DOI: 10.1186/s12913-016-1567-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 07/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background Mental health service users have high rates of medical co-morbidity but frequently experience problems accessing and transitioning between tertiary medical and primary care services. The aim of this study was to identify ways to improve service users’ with medical co-morbidity care and experience during their transition between tertiary medical hospitals and primary care services. Method Experience-based co-design (EBCD) qualitative study incorporating a focus group discussion. The study took place in a large tertiary medical service, incorporating three medical hospitals, and primary care services, in Melbourne, Australia. A purposive sample of service users and their caregivers and tertiary medical and primary care clinicians participated in the focus group discussion, in August 2014. A semi-structured interview guide was used to inform data collection. A thematic analysis of the data was undertaken. Results Thirteen participants took part in the focus group interview, comprising 5 service users, 2 caregivers and 6 clinicians. Five themes were abstracted from the data, illustrating participants’ perspectives about factors that facilitated (clinicians’ expertise, engagement and accessibility enhancing transition) and presented as barriers (improving access pathways; enhancing communication and continuity of care; improving clinicians’ attitudes; and increasing caregiver participation) to service users’ progress through tertiary medical and primary care services. A sixth theme, enhancing service users’ transition, incorporated three strategies to enhance their transition through tertiary medical and primary care services. Conclusion EBCD is a useful approach to collaboratively develop strategies to improve service users’ with medical co-morbidity and their caregivers’ transition between tertiary medical and primary care services. A whole-of-service approach, incorporating policy development and implementation, change of practice philosophy, professional development education and support for clinicians, and acceptance of the need for caregiver participation, is required to improve service users’ transition.
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Affiliation(s)
- Kate Cranwell
- Community Services, Western Health, Melbourne, VIC, Australia
| | - Meg Polacsek
- Community Services, Western Health, Melbourne, VIC, Australia.,Centre for Chronic Disease, College of Health and Biomedicine, Discipline of Nursing, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia
| | - Terence V McCann
- Centre for Chronic Disease, College of Health and Biomedicine, Discipline of Nursing, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia.
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23
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McCann TV, Bamberg J. Carers of older adults' satisfaction with public mental health service clinicians: a qualitative study. J Clin Nurs 2016; 25:1634-43. [DOI: 10.1111/jocn.13165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Terence V McCann
- Centre for Chronic Disease; College of Health and Biomedicine (Discipline of Nursing); Victoria University; Melbourne Victoria Australia
| | - John Bamberg
- Centre for Chronic Disease; College of Health and Biomedicine (Discipline of Nursing); Victoria University; Melbourne Victoria Australia
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24
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Cairns VA, Reid GS, Murray C. Family members' experience of seeking help for first-episode psychosis on behalf of a loved one: a meta-synthesis of qualitative research. Early Interv Psychiatry 2015; 9:185-99. [PMID: 24958353 DOI: 10.1111/eip.12157] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 04/29/2014] [Indexed: 11/28/2022]
Abstract
AIM Family members often play a vital role in seeking help for loved ones experiencing first-episode psychosis. Understanding this experience is crucial in facilitating the help-seeking process. Qualitative research offers valuable insight into the lived experience of family members who seek help on behalf of a loved one experiencing first-episode psychosis. METHOD The current research presents a systematic review of qualitative studies exploring the family member experience of seeking help for first-episode psychosis. RESULTS A meta-synthesis of 13 qualitative studies has revealed four themes relating to family members' experience of seeking help for first-episode psychosis. These include a sense of not knowing, the reaching of crisis point, the impact upon the family member and the mediating role of interactions with others. A further synthesis of translation captures the interaction of these themes within this experience. CONCLUSIONS The findings provide a novel insight into this experience, suggesting implications for clinical practice. These include a focus upon the facilitation of early positive interactions with family members and for first-episode psychosis to be presented to families in a normalizing manner. The need for future research that examines the experience of those who do not seek help from health services is discussed.
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25
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Ferrari M, Flora N, Anderson KK, Tuck A, Archie S, Kidd S, McKenzie K. The African, Caribbean and European (ACE) Pathways to Care study: a qualitative exploration of similarities and differences between African-origin, Caribbean-origin and European-origin groups in pathways to care for psychosis. BMJ Open 2015; 5:e006562. [PMID: 25588783 PMCID: PMC4298103 DOI: 10.1136/bmjopen-2014-006562] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This paper reports on a qualitative exploration of the reasons for differences in pathways to care and duration of untreated psychosis (DUP) in the African, Caribbean and European (ACE) Pathways to Care study from the perspective of respondents to the study and their families. SETTING Ontario, Canada. PARTICIPANTS Thirty-four participants in total. Twenty-five young people who had experienced a first episode of psychosis and nine family members. Participants were part of the ACE Pathways to Care study. DESIGN We implemented six focus groups. Furthermore, we implemented four in-depth interviews with two African-origin young women, one Caribbean-origin woman, and one European-origin woman with lived experience of psychosis. RESULTS Factors that influenced help-seeking delays across the three groups were: personal awareness of symptoms, family members' knowledge of psychotic symptoms and knowledge of mental health services. Youth and their family members described how stigma played a key role in pathways to care by stopping them from asking for help. The way in which stigma operated on the three groups' members, from feeling ashamed to feeling guilty for their mental illnesses, helped to explain differences in DUP between the groups. Guilt feelings emerged as a prominent theme among members from the African and Caribbean groups and it was not discussed in the European focus group. Delay in entering into first-episode psychosis programmes was also influenced by the stigma perceived by young people in healthcare settings. This had an impact on the therapeutic relationships, disclosure of symptoms and overall trust in the healthcare system. CONCLUSIONS The findings of this paper suggest that stigma, especially internalised stigma, may operate in different ways in European-origin, African-origin and Caribbean-origin groups. These findings could inform the development of more equitable services for people in early stages of psychosis.
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Affiliation(s)
- Manuela Ferrari
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Nina Flora
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Andrew Tuck
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Suzanne Archie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sean Kidd
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Kwame McKenzie
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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26
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McCann TV, Lubman DI. Qualitative process evaluation of a problem-solving guided self-help manual for family carers of young people with first-episode psychosis. BMC Psychiatry 2014; 14:168. [PMID: 24906392 PMCID: PMC4064108 DOI: 10.1186/1471-244x-14-168] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 06/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caring for a young person experiencing first-episode psychosis is challenging and can affect carers' well-being adversely. While some face-to-face approaches have achieved promising outcomes, they are costly and resource-intensive to provide, restricting their reach and penetration. Guided self-help in book-form (or bibliotherapy) is an alternative but untested approach in these circumstances. In this study, we aimed to evaluate carers' beliefs about the usefulness of problem-solving guided self-help manual for primary carers of young people with first-episode psychosis. METHODS A qualitative process evaluation nested in a randomised controlled trial, conducted across two early intervention psychosis services in Melbourne, Australia. 124 carers were randomised to problem-solving guided self-help intervention or treatment as usual. We also undertook a qualitative process evaluation, using individual interviews, with a random sample of 24 of the intervention group. A thematic analysis of the qualitative data was undertaken, which is the subject of this paper. Interviews were conducted between January 2009 and September 2010. RESULTS Three themes were abstracted from the data, reflecting carers' beliefs about the usefulness of the manual: promoting carers' well-being, increasing carers' understanding of and support for the young person with first-episode psychosis, and accessibility and delivery modes of the programme. CONCLUSION This process evaluation highlights that guided self-help is useful in informing and supporting carers of affected young people. While there is scope for broadening the delivery modes, the approach is easy to use and accessible, and can be used as a cost-effective adjunct to standard support provided to carers, by community mental health nurses and other clinicians. TRIAL REGISTRATION ACTRN12609000064202.
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Affiliation(s)
- Terence V McCann
- Centre for Chronic Disease Prevention and Management, Discipline of Mental Health Nursing and Aged Care, College of Health and Biomedicine, Victoria University, PO Box 1428, Melbourne 8001, VIC, Australia.
| | - Dan I Lubman
- Turning Point, Eastern Health and Monash University, Melbourne, Australia
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