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Allchin B, Albermann K, Blake-Holmes K, Gatsou L, Hine R, van Doesum K, Nicholson J. Sustaining efforts to improve family well-being with parents with mental ill health and substance (mis)use. Front Psychiatry 2024; 15:1376409. [PMID: 38596628 PMCID: PMC11003303 DOI: 10.3389/fpsyt.2024.1376409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Research conducted over the past 30 years has developed an extensive body of knowledge on families where parents experience mental ill health and/or substance (mis)use, and interventions that are effective in improving their outcomes. A more recent focus has also explored the importance and nuance of implementation. This perspective article reflects on the concept and practice of sustainability within this body of work and considers underlying assumptions in the field about the goal and direction of interventions that make clarity about sustainability difficult. We identify challenges for understanding sustainability, relating to how and who defines it, what is measured and the impact of context. We conclude by considering how we might be better able to plan and design for sustainability within this field.
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Affiliation(s)
- Becca Allchin
- Mental Health Program, Eastern Health, Melbourne, VIC, Australia
- School of Rural Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, VIC, Australia
| | - Kurt Albermann
- Social Pediatric Center, Cantonal Hospital, Winterthur, Switzerland
| | - Kate Blake-Holmes
- School of Social Work, Faculty of Social Sciences, University of East Anglia, Norwich, United Kingdom
| | - Lina Gatsou
- Institute of Health, Health Policy and Social Care Research, De Montfort University, Leicester, United Kingdom
- Child and Adolescent Mental Health Services, Leicestershire Partnership NHS (National Health Service) Trust, Leicester, United Kingdom
| | - Rochelle Hine
- Monash Rural Health, Monash University, Warragul, VIC, Australia
| | - Karin van Doesum
- Department of Clinical Psychology, Radboud University Nijmegen, Nijmegen, Netherlands
- Community Mental Health Service, Department Impluz Prevention, Dimence-groep, Deventer, Netherlands
| | - Joanne Nicholson
- The Heller School, Institute for Behavioral Health, Brandeis University, Waltham, MA, United States
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Ochoa S, Espinosa V, López-Carrilero R, Martinez I, Barrera ADH, Birulés I, Barajas A, Pélaez T, Díaz-Cutraro L, Coromina M, González-Rodríguez A, Verdaguer-Rodríguez M, Gutiérrez-Zotes A, Palma-Sevillano C, Montes C, Gallego J, Paya B, Casanovas F, Roldán M, Noval E, Varela Casals P, Salas-Sender M, Aznar A, Ayesa-Arriola R, Pousa E, Canal-Rivero M, Garrido-Torres N, Montserrat C, Muñoz-Lorenzo L, Crosas JM. Effectiveness of family metacognitive training in mothers with psychosis and their adolescent children: a multicenter study protocol. Front Psychol 2024; 15:1359693. [PMID: 38586292 PMCID: PMC10997187 DOI: 10.3389/fpsyg.2024.1359693] [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: 12/21/2023] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Background More than half of women with psychosis take care of their children despite the difficulties caused by the disease. Additionally, these kids have a higher risk of developing a mental health disorder. However, no interventions have been developed to meet these needs. Metacognitive Training (MCT) is a psychological intervention that has demonstrated its efficacy in improving cognitive insight, symptom management and social cognition in people with first-episode psychosis (FEP). Additionally, MCT has shown better results in women than men with FEP. This study aims to adapt and evaluate the efficacy of MCT-F in mothers and adolescent children in an online group context with the main purpose of improving family relationships, cognitive awareness and symptoms in women with psychosis and increase their children's knowledge of the disease and their functioning. As secondary objectives, it also aims to evaluate improvements in metacognition, social cognition, symptoms, protective factors and self-perception of stigma. Materials and methods A quasi-experimental design with participants acting as their own control will be carried out. Forty-eight mothers with psychosis and their adolescent children (between 12 and 20 years old) recruited from a total of 11 adult mental health care centers will receive MCT-F. Participants will be evaluated 11 weeks before the intervention (T1), at baseline (T2), and post-intervention (T3) with a cognitive insight scale, as a primary outcome. Measures of metacognitive and social cognition, symptoms, cognitive functioning, family and social functioning, protective factors (self-esteem, resilience, and coping strategies) and self-perceived stigma will be addressed as secondary outcomes. Assessment will also address trauma and attachment in mothers and, lastly, the feasibility and acceptability of MCT-F in both participant groups. Discussion This will be the first investigation of the efficacy, acceptability, and viability of the implementation of MCT-F. The results of this study may have clinical implications, contributing to improving mothers' with psychosis and adolescents' functioning and better understanding of the disease, in addition to the possible protective and preventive effect in adolescents, who are known to be at higher risk of developing severe mental disorders.Clinical trial registration:https://clinicaltrials.gov/, identifier [NCT05358457].
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Affiliation(s)
- Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Victoria Espinosa
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Raquel López-Carrilero
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Irene Martinez
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | - Irene Birulés
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Facultat de Psicologia Departament de Cognició, Desenvolupament i Psicologia de l'Educació, Universistat de Barcelona, Barcelona, Spain
| | - Ana Barajas
- Departament de Psicologia, Facultat de Psicologia Clínica I de la Salut. Serra Húnter Programme, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Trinidad Pélaez
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - Luciana Díaz-Cutraro
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Department of Psychology, FPCEE Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Marta Coromina
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Alexandre González-Rodríguez
- Department of Mental Health, CIBERSAM, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, Terrassa, Spain
| | - Marina Verdaguer-Rodríguez
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain
| | - Alfonso Gutiérrez-Zotes
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Hospital Universitari Institut Pere Mata, Institut d’Investigació Sanitària Pere Virgili-CERCA, Universitat Rovira i Virgili, Reus, Spain
| | - Carolina Palma-Sevillano
- Department of Psychology, FPCEE Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- Hospital de Mataró, Consorci Sanitari del Maresme, Barcelona, Spain
| | - Cristian Montes
- Virgen del Rocío University Hospital, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Institute of Biomedicine of Seville (IBiS), First-episode Psychosis Research Network of Andalusia (Red PEPSur), University of Seville, Seville, Spain
| | | | - Beatriz Paya
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain
| | - Francesc Casanovas
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, Barcelona, Spain
| | - María Roldán
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, Barcelona, Spain
| | - Emma Noval
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain
| | | | | | - Ana Aznar
- Centre d’Higiene Mental Les Corts, Barcelona, Spain
| | - Rosa Ayesa-Arriola
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain
| | - Esther Pousa
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Manuel Canal-Rivero
- Virgen del Rocío University Hospital, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Institute of Biomedicine of Seville (IBiS), First-episode Psychosis Research Network of Andalusia (Red PEPSur), University of Seville, Seville, Spain
| | - Nathalia Garrido-Torres
- Virgen del Rocío University Hospital, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Institute of Biomedicine of Seville (IBiS), First-episode Psychosis Research Network of Andalusia (Red PEPSur), University of Seville, Seville, Spain
| | - Clara Montserrat
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Josep María Crosas
- Department of Mental Health, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Catalonia, Spain
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Espinosa V, Arin-González P, Jiménez-Lafuente A, Pardo N, López-Carrilero R, Birulés I, Barajas A, Pélaez T, Díaz-Cutraro L, Verdaguer-Rodríguez M, Gutiérrez-Zotes A, Palma-Sevillano C, Varela-Casals P, Salas-Sender M, Aznar A, Ayesa-Arriola R, Pousa E, Canal-Rivero M, Garrido-Torres N, Montserrat C, Muñoz-Lorenzo L, Crosas JM, Ochoa S. Family Metacognitive Training (MCT-F): Adapting MCT to Mothers with Psychosis and Their Adolescent Children. Behav Sci (Basel) 2024; 14:97. [PMID: 38392450 PMCID: PMC10885955 DOI: 10.3390/bs14020097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
Over half of women with psychosis are mothers. Research suggests that mothers with psychosis face unique challenges affecting both their mental health prognosis and their relationship with their children. Moreover, those children have a higher risk of developing a mental disorder. Notwithstanding, interventions specifically tailored to these families remain largely uncovered. Metacognitive Training (MCT) has demonstrated its efficacy in improving cognitive insight, symptom management, and social cognition in people with psychosis. However, there is no evidence of the efficacy of MCT in a family setting (MCT-F). This study describes the first adaptation of MCT for mothers with psychosis and their adolescent children in an online group setting. The phases (assessment, decision, adaptation, production, topical experts' integration) of the ADAPT-ITT model were systematically applied through a participatory approach (n = 22), including a first-person perspective and involving qualitative (e.g., topical expert literature review and consensus groups, interviews, thematic analyses) and quantitative methods. While MCT's core components were retained, participants guided adaptations both in content and delivery. The findings suggest the importance of community engagement and sharing decision-making processes to demonstrate the acceptability and feasibility of the adapted intervention. Employing a structured approach such as the ADAPT-ITT model ensures readiness of the new training for efficacy trials.
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Affiliation(s)
- Victoria Espinosa
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Etiopatogènia i Tractament dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
| | | | | | - Nerea Pardo
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Etiopatogènia i Tractament dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
| | - Raquel López-Carrilero
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Etiopatogènia i Tractament dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Irene Birulés
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Department of Social and Quantitative Psychology, Faculty of Psychology, University of Barcelona, 08035 Barcelona, Spain
| | - Ana Barajas
- Departament de Psicologia, Facultat de Psicologia Clínica I de la Salut. Serra Húnter Programme, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain
| | - Trinidad Pélaez
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Luciana Díaz-Cutraro
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Etiopatogènia i Tractament dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Psychology Department, FPCEE Blanquerna, Universitat Ramon Llull, 08022 Barcelona, Spain
| | - Marina Verdaguer-Rodríguez
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Etiopatogènia i Tractament dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain
| | - Alfonso Gutiérrez-Zotes
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili-CERCA, Universitat Rovira i Virgili, 43206 Reus, Spain
| | - Carolina Palma-Sevillano
- Psychology Department, FPCEE Blanquerna, Universitat Ramon Llull, 08022 Barcelona, Spain
- Hospital de Mataró, Consorci Sanitari del Maresme, 08301 Mataró, Spain
| | | | | | - Ana Aznar
- Centre d'Higiene Mental Les Corts, 08035 Barcelona, Spain
| | - Rosa Ayesa-Arriola
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, 39008 Santander, Spain
| | - Esther Pousa
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), 08041 Barcelona, Spain
| | - Manuel Canal-Rivero
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS), University of Seville, First-Episode Psychosis Research Network of Andalusia (Red PEPSur), 41013 Sevilla, Spain
| | - Nathalia Garrido-Torres
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS), University of Seville, First-Episode Psychosis Research Network of Andalusia (Red PEPSur), 41013 Sevilla, Spain
| | - Clara Montserrat
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, 08003 Barcelona, Spain
| | - Laura Muñoz-Lorenzo
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Josep Maria Crosas
- Department of Mental Health, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Etiopatogènia i Tractament dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
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Oakes L, Wolfenden L, Drake RJ, Calam R, Gregg L. Health and social care professionals' views and experiences of supporting parents with serious mental illness. Front Psychiatry 2023; 14:1284712. [PMID: 38161725 PMCID: PMC10756684 DOI: 10.3389/fpsyt.2023.1284712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction A significant number of individuals with a serious mental illness (SMI) such as schizophrenia or bipolar disorder are also parents of dependent children. Despite the risk of adverse psychological, behavioral, and social outcomes their needs often go unmet. To better understand the needs of parents with SMI and their children it is necessary to gain insight into the perspectives and experiences of the professionals in adult mental health and children's services who work with them, and who, ultimately, are best placed to meet those needs. Aims To explore the views and experiences of health and social care professionals working with parents with SMI to understand the needs of, and their role supporting, parents with SMI and their children. Methods Semi-structured interviews were conducted with seventeen professionals from six NHS and Local Authority settings in England, UK. Participants were included if they were employed in adult mental health or local authority children's services and had experience of working with parents with SMI. Sampling was purposive, including a wide range of professions in these settings. Interview data were analyzed using template analysis taking a critical realist perspective. Results Three top-level themes were generated: (1) Impact of parental SMI on the child, (2) Accessing support from services, (3) Role of professionals working with parents with SMI. Themes highlight diverse, wide-ranging effects of SMI on the child and a reluctance from parents to seek help due to stigma and fear. Available services are reported to be inaccessible and unacceptable to parents with SMI and practitioners experience conflict when balancing the needs of the parent and child. A whole-family approach facilitated by improved communication between services is advocated. Conclusion Participants believed that parents with SMI experience complex parenting challenges over and above other parents, describing a largely detrimental impact on the child. Support services were deemed inadequate, and participants stressed the need to develop specialist services tailored toward the needs of parents with SMI and their children. Although participants endorsed joined up working across health and social care settings to facilitate a whole family approach, they required greater service knowledge and training in parental SMI.
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Affiliation(s)
- Lucy Oakes
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Lauren Wolfenden
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Richard J. Drake
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Rachel Calam
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Lynsey Gregg
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
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Seeman MV. Grappling with Issues of Motherhood for Women with Schizophrenia. Healthcare (Basel) 2023; 11:2882. [PMID: 37958026 PMCID: PMC10650198 DOI: 10.3390/healthcare11212882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Despite the fact that most persons with schizophrenia find steady employment difficult to sustain, many women with this diagnosis embrace and fulfill the most difficult task of all-motherhood. The aim of this paper is to specify the challenges of motherhood in this population and review the treatment strategies needed to keep mothers and children safe, protecting health and fostering growth. The review addresses concerns that had been brought to the author's earlier attention during her clinical involvement with an outpatient clinic for women with psychosis. It is, thus, a non-systematic, narrative review of topic areas subjectively assessed as essential to "good enough" mothering in the context of schizophrenia. Questions explored are the stigma against motherhood in this population, mothers' painful choices, issues of contraception, abortion, child custody, foster care and kin placement of children, the effects of antipsychotics, specific perinatal delusional syndromes, and, finally, the availability of parental support. This review is intended for clinicians. Recommendations are that care providers work collaboratively with mothers, take note of their strengths as well as their failings, offer a wide array of family services, monitor households closely for safety and for treatment adherence, appreciating the many challenges women with schizophrenia face daily.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A1, Canada
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Harries CI, Smith DM, Gregg L, Allott R, Wittkowski A. Parents who experience psychosis: A qualitative exploration. Psychol Psychother 2023; 96:590-607. [PMID: 36912129 DOI: 10.1111/papt.12458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/07/2023] [Accepted: 02/16/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVES Psychosis can present parents with complex parenting challenges and significant adverse outcomes for parents and their children have been reported. However, remarkably little is known about how parenting is experienced by these parents. Therefore, this qualitative study aimed to understand the lived experiences of parents with psychosis, including how parenting support was experienced. DESIGN AND METHODS Using interpretative phenomenological analysis (IPA), eight biological parents (five mothers and three fathers) with psychosis were recruited and interviewed from early intervention in psychosis services in the Northwest of England. RESULTS Three superordinate themes and seven subordinate themes were identified. Theme 1 'Living with the Struggle: Painfully Disconnected' captured a persistent parenting struggle that distanced parents from their children and support due to all-consuming experiences of psychosis, fear and risk-focused service support. Theme 2 'Desired and Vulnerable Position: Comfortably Connected' captured parental experiences of symptom relief through connection with their children, alongside parental need to be integrated with the systems around them. Theme 3 'Exposed: Parenting Under a Spotlight' represented parental experiences of inescapable observation and judgement from the systems around them. CONCLUSIONS Novel insights into the role of misaligned parent and service priorities in parental perceptions of powerlessness, shame and disconnection from their children, valued parenting identities, and system supports are presented. Systemic interventions that target stigma, provide system-wide psychoeducation and promote person-centred, compassionate and meaningful connections between parents and the systems they live within are needed to promote better parenting outcomes.
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Affiliation(s)
- Claire I Harries
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Debbie M Smith
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Lynsey Gregg
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Rory Allott
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Anja Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
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Seeman MV. Schizophrenia in Women: Clinical Considerations. Psychiatr Clin North Am 2023; 46:475-486. [PMID: 37500245 DOI: 10.1016/j.psc.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Men and women, for biologic and sociocultural reasons, differ in the nature of their risks for schizophrenia and also in their care needs. Women with schizophrenia have several reproduction-associated risks and care needs that require special clinical consideration. They also have several specific risks related to antipsychotics and gender-associated needs not necessarily related to biology. These require clinicians' diagnostic acumen, treatment skills, cultural sensitivity, and advocacy know-how. Although this does not pertain to everyone, awareness on the part of clinicians is essential. This article addresses the current evidence for difference.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5P3L6, Canada.
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8
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Tuck M, Wittkowski A, Allott R, Gregg L. What about the children? Adult mental health practitioners' experiences and views of family-focused practice in Early Intervention Services. Psychol Psychother 2023; 96:697-715. [PMID: 37017306 DOI: 10.1111/papt.12464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND There is a significant risk of negative outcomes for families when a parent experiences serious mental illness. Family-focused practice (FFP) emphasises the "whole family" as the unit of care and has been found to improve outcomes for service users and their families. Despite its benefits, FFP is not routinely implemented in UK adult mental health services. This study explores adult mental health practitioners' experiences and views of FFP within Early Intervention Psychosis Services in the UK. METHODS Sixteen adult mental health practitioners employed in three Early Intervention Psychosis teams in the Northwest of England were interviewed. Interview data were analysed using thematic analysis. RESULTS Five core themes were generated: (1) A limited understanding of FFP, (2) Our practitioners, (3) Our approach, (4) Our families and (5) Our services. Practitioners' understanding of FFP was limited and typically excluded dependent children. Practitioners' age, professional and personal experience, and preconceptions of families influenced delivery, and in turn, the engagement approach they adopted impacted families' responsiveness. The diversity and dynamics of service user families such as age, socioeconomic status, culture and stigma impacted FFP. An operational context characterised by insufficient resources reduced FFP; however, organisational structures such as leadership, clinical supervision and multi-disciplinary teams facilitated FFP. CONCLUSIONS FFP is not yet embedded within Early Intervention Services. Practice recommendations include agreeing on a formal definition of FFP and its scope; the development of FFP policy; clarity in relation to staff responsibilities and identities; the adoption of a collaborative approach which encourages service user choice and for time to be ring-fenced to prioritise FFP. Future research should ascertain service user and family views on the facilitators and barriers to engaging with FFP in Early Intervention Services.
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Affiliation(s)
- Molly Tuck
- School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Anja Wittkowski
- School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rory Allott
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Lynsey Gregg
- School of Health Sciences, University of Manchester, Manchester, UK
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9
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Dunn A, Christiansen H, Elsby-Pearson C, Kramer J, Swinburn E, Platt B, Cartwright-Hatton S. Psychiatric in-patients who are parents: what interventions are tailored to their needs and how do they experience care? A systematic review and data synthesis. BJPsych Open 2023; 9:e111. [PMID: 37345520 PMCID: PMC10305023 DOI: 10.1192/bjo.2023.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Little is known about the experiences of parents who are in receipt of in-patient psychiatric care or about what interventions are employed to support them in their parenting role. AIMS The objective of the current study is to review two complementary areas of research: (a) research examining interventions developed to support the parent-child relationship within these settings; and (b) research focused on the experience of parents in in-patient settings. METHOD For studies reporting on parents' experience, qualitative accounts of past or present psychiatric in-patients (child aged 1-18 years) were included. For intervention studies, the intervention had to focus on supporting the parenting role and/or the parent-child dyad of parents (child aged 1-18 years) in current receipt of in-patient care. Four bibliographic databases (PubMed, SCOPOS, Web of Science and PsychINFO) were searched for relevant published and unpublished literature from 1 January 1980 to 26 July 2022. Intervention studies were appraised using the Mixed Methods Appraisal Tool. Qualitative papers were assessed using the Critical Appraisal Skills Programme tool. Data were extracted using tools designed for the study. Qualitative data were synthesised using thematic analysis. The protocol was registered with the International Prospective Register of Systematic Reviews (reference CRD42022309065). RESULTS Twenty-four papers (eight intervention studies and 16 studies examining parent experience) were included in the review. In-patient parents commonly reported hospital admission as having a negative impact on their parenting. Very few robust reports of interventions designed to support parents in receipt of psychiatric in-patient care were found. CONCLUSIONS Despite the identified need for support by parents who are receiving in-patient care, there is currently no intervention of this nature running in the UK health service.
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10
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Harries CI, Smith DM, Gregg L, Wittkowski A. Parenting and Serious Mental Illness (SMI): A Systematic Review and Metasynthesis. Clin Child Fam Psychol Rev 2023; 26:303-342. [PMID: 36807250 PMCID: PMC10123049 DOI: 10.1007/s10567-023-00427-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 02/21/2023]
Abstract
The consequences of Serious Mental Illness (SMI) on parent and child outcomes can be profound. Supporting parents to manage their caregiving roles alongside parental SMI successfully has been recognised as a public health priority. To meet this priority and develop effective and acceptable interventions, it is imperative that parents' experiences and support needs are understood. This systematic review aimed to synthesise qualitative research that explored parents' experiences and perceptions of the impact of SMI on their parenting and their corresponding support needs. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed. Five databases were searched for terms associated with SMI, parenting, and qualitative research. Twenty-nine studies involving 562 parents who experienced SMI met inclusion criteria, and the methodological quality of included studies was appraised using the Critical Appraisal Skills Programme. After findings were synthesised using thematic synthesis, six themes were identified: (1) The constrained parent, (2) parenting difficulties, (3) the strained child, (4) inescapable threat, (5) combatting threat, and (6) wrap-around support needs. Novel insights into the centrality of SMI-related parenting difficulties and threat perceptions across parent, family, healthcare, and wider social systems on strained parent-child and distanced parent-support relationships were highlighted. Systemic practice change initiatives via compassionate and inclusive system-wide support were recommended.
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Affiliation(s)
- C I Harries
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, 2Nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, M13 9NQ, UK
| | - D M Smith
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, 2Nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - L Gregg
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, 2Nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester, M13 9NQ, UK
| | - A Wittkowski
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, 2Nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
- Manchester Academic Health Science Centre, Manchester, M13 9NQ, UK.
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11
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Kageyama M, Koide K, Saita R, Iwasaki-Motegi R, Ichihashi K, Nemoto K, Sakae S, Yokoyama K. A randomized controlled study of an e-learning program (YURAIKU-PRO) for public health nurses to support parents with severe and persistent mental illness and their family members. BMC Nurs 2022; 21:342. [PMID: 36471361 PMCID: PMC9720938 DOI: 10.1186/s12912-022-01129-0] [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: 05/30/2022] [Accepted: 11/29/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Supporting parents with severe and persistent mental illness (SPMI) requires knowledge, skills, and a positive attitude toward parenthood. We developed a Japanese e-learning program for public health nurses (PHNs) to enable them to support parents with SPMI and their family members. This study aimed to evaluate the effectiveness of the program in improving the knowledge, skills, attitudes, and self-efficacy of PHNs in supporting them. METHODS A three-hour video-based e-learning program was developed. A randomized controlled trial was conducted with 176 PHNs responsible for maternal and child health in Japan. The outcome measures included the Sense of Coping Difficulty/Possibility Scale, skills to support people with SPMI, and achievement of program goals. Outcome data were collected at three time points during the study: baseline (T1), post-intervention (T2), and one month after T2 (T3) using self-administered electronic questionnaires. Outcome measures were assessed by comparing the two groups at the endpoint (T3) using t-tests and ANOVA. Effectiveness over time was assessed using a mixed model for repeated measures, with group and time interactions as fixed effects. RESULTS The study participants were randomly allocated to two groups:89 in the intervention group, and 87 in the control group. The total score and the scores in the two subscales of the Sense of Coping Difficulty/Possibility Scale in the intervention group at T3 were significantly higher than those in the control group, as shown by the t-test and ANOVA (all p<0.001). The Sense of Coping Difficulty subscale had a large effect size (Cohen's d=1.27). The analysis of the results of a mixed model for repeated measures showed that the group and time interactions on all outcome measures were not significantly different at T1 but were significantly different at T2 and T3. CONCLUSIONS The program was effective one month after its completion, particularly in reducing PHNs' difficulties in supporting parents with SPMI. TRIAL REGISTRATION UMIN000045765, November 1, 2021.
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Affiliation(s)
- Masako Kageyama
- grid.136593.b0000 0004 0373 3971Osaka University Institute of Advanced Co-Creation Studies, 1-7 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Keiko Koide
- grid.136593.b0000 0004 0373 3971Department of Health Promotion Science, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Ryotaro Saita
- grid.412398.50000 0004 0403 4283Department of Medical Innovation, Osaka University Hospital, 2-2 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Riho Iwasaki-Motegi
- grid.415776.60000 0001 2037 6433Section of Public Health Nursing Research Department of Health Promotion, National Institute of Public Health, 2-3-6 Minami Wako, Saitama, 351-0197 Japan
| | - Kayo Ichihashi
- grid.412708.80000 0004 1764 7572Department of Neuropsychiatry, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655 Japan
| | - Kiyotaka Nemoto
- grid.20515.330000 0001 2369 4728Department of Psychiatry, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai Tsukuba, Ibaraki, 305-8575 Japan
| | - Setsuko Sakae
- grid.444005.10000 0001 2112 2435Department of Social Design, Faculty of Sociology, St. Andrew’s University, 1-1 Manabino, Izumi, Osaka 594-1198 Japan
| | - Keiko Yokoyama
- grid.469307.f0000 0004 0619 0749Department of Nursing, Faculty of Nursing, Yokohama Soei University, 1Miho-cho, Yokohama City, Kanagawa, 226-0015 Japan
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12
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Dubreucq M, Lysaker PH, Dubreucq J. A qualitative exploration of stakeholders' perspectives on the experiences, challenges, and needs of persons with serious mental illness as they consider finding a partner or becoming parent. Front Psychiatry 2022; 13:1066309. [PMID: 36713897 PMCID: PMC9874152 DOI: 10.3389/fpsyt.2022.1066309] [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: 10/10/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND While many persons with serious mental illness (SMI) consider intimate relationships and becoming parent as central parts of their lives deeply affecting wellbeing and recovery, others anticipate facing multiple challenges in these life domains. This qualitative study sought to explore the perspectives of persons with SMI and mental health providers (MHPs) with diverse backgrounds and practices on the experiences, challenges, needs and expectations of persons with SMI as they consider finding a partner or becoming parent. METHODS For this qualitative study, we conducted five focus groups between March and December 2020 for a total number of 22 participants (nine persons with SMI and thirteen MHPs) recruited from a center for psychiatric rehabilitation and a community mental health center in France. We used the inductive six-step process by Braun and Clarke for the thematic analysis. RESULTS Participants reported some challenges related to intimate relationships, stigma/self-stigma, disclosure and decision-making about start a family. Their expectations included: (i) psychoeducation about decision-making about finding a partner and starting a family; (ii) support in making empowered decisions about finding a partner, starting a family or disclosure to a prospective partner or their child; (iii) peer-support interventions; (iv) enhancing coping strategies; (v) integrated service provision including home treatment interventions, training to recovery-oriented practices and access to dedicated resources for providers. CONCLUSION In short, intimate relationships and desire to start a family for persons with SMI should be more considered in psychiatric rehabilitation and additional support and interventions should therefore be provided.
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Affiliation(s)
- Marine Dubreucq
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France.,Fondation FondaMental, Créteil, France.,GCSMS Rehacoor 42, Saint Etienne, France.,INSERM U1290, Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, Lyon, France
| | - Paul H Lysaker
- Roudebush VA Medical Center, Research Department, Indianapolis, IN, United States.,Department of Clinical Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Julien Dubreucq
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France.,Fondation FondaMental, Créteil, France.,Centre de Neurosciences Cognitive, UMR 5229, CNRS, Université Claude Bernard Lyon 1, Lyon, France.,Réseau Handicap Psychique, Grenoble, France.,Service de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Saint Etienne, Saint Etienne, France
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