Family intervention after first-episode psychosis (MEQ)

(i) Expressed emotion. EE is a research construct describing the emotional climate of the family environment toward the ill person, classically including criticism, hostility, and emotional over-involvement (and warmth/positive remarks in fuller ratings).^[2][3] High EE robustly associates with higher relapse rates across schizophrenia and other disorders in meta-analysis — it is a moderator of course, not a parent-blaming aetiology of illness.^[1]

(ii) Structured family intervention. Goals: reduce relapse and carer burden; improve problem-solving and communication; support medication adherence without coercion theatre. Core elements typically include psychoeducation about illness and early warning signs, communication skills training, structured problem-solving, crisis planning, and reducing high-EE interaction patterns. Delivery may be single-family or multifamily group formats; Cochrane evidence supports family intervention for schizophrenia outcomes.^[5]

(iii) Engagement without blame. Validate carer fear and exhaustion; name the illness model (neurodevelopmental/stress-vulnerability); reframe criticism as worried attempts to help that can inadvertently increase stress; offer practical skills rather than moral critique; include both parents; protect the patient's confidentiality with a negotiated information-sharing plan.^[5][1]

(iv) Defer joint sessions when active intimate partner violence or child protection risk requires individual safety work first; severe paranoia about family that makes joint work countertherapeutic until engagement and risk stabilise; or when a family member is too unwell to participate safely.^[5]

(v) Outcomes beyond relapse. Examples: carer burden and depression; family problem-solving; service engagement; quality of life and social function; reduced hospital days.^[5][1]