Psych · Public and community psychiatry — carers and family-inclusive practice
Carers and family-inclusive practice
Also known as Family-inclusive practice · Carer-inclusive care · Family psychoeducation · Expressed emotion · Behavioural family therapy · Multifamily groups · Family-focused therapy · Carer burden · Triangle of Care · Informal caregivers mental health
Exam-exhaustive fellowship reference on carers and family-inclusive practice in psychiatry: expressed emotion and relapse, family psychoeducation, behavioural and multifamily models, FFT for bipolar, carer burden assessment, confidentiality versus partnership, early psychosis family work, implementation barriers, and RANZCP/NICE/APA regional frames. FRANZCP-primary, globally tagged.
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Red flags
- Using confidentiality as a blanket ban on all carer contact when risk is high or the patient has previously nominated involvement
- Blaming families for causing schizophrenia (misuse of expressed emotion as moral judgment)
- Discharging after crisis without communicating with nominated carers when consent or risk-based disclosure allows
- Ignoring carer distress, suicidal ideation, or patient-to-carer violence
- Mistaking a single information leaflet for structured family psychoeducation
- Failing to identify young carers, siblings, or culturally defined kinship carers
Meet the patient
A 19-year-old man is admitted with a first episode of psychosis. His mother drove four hours to be at the ward round. She has not slept for a week, she is frightened, and she has a list of questions. The night-shift nurse told her, kindly, that "we can't discuss his care — confidentiality". She is now sitting in the car park, crying, with no information and no plan for what happens when he comes home to her house.[2][9]
Every examiner's question is the same: what should the team have done, and what do you do now? The answer is family-inclusive practice — and the confidentiality line was wrong, in a way this topic will teach you to fix.[5][15]
References15ShowHide
- [1]Butzlaff RL, Hooley JM Expressed emotion and psychiatric relapse: a meta-analysis Arch Gen Psychiatry, 1998.PMID 9633674
- [2]Vaughn CE, Leff JP The influence of family and social factors on the course of psychiatric illness. A comparison of schizophrenic and depressed neurotic patients Br J Psychiatry, 1976.PMID 963348
- [3]McFarlane WR, Dixon L, Lukens E, Lucksted A Family psychoeducation and schizophrenia: a review of the literature J Marital Fam Ther, 2003.PMID 12728780
- [4]Pharoah F, Mari J, Rathbone J, Wong W Family intervention for schizophrenia Cochrane Database Syst Rev, 2010.PMID 21154340
- [5]Dixon L, McFarlane WR, Lefley H, et al. Evidence-based practices for services to families of people with psychiatric disabilities Psychiatr Serv, 2001.PMID 11433107
- [6]Yesufu-Udechuku A, Harrison B, Mayo-Wilson E, et al. Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis Br J Psychiatry, 2015.PMID 25833867
- [7]Pitschel-Walz G, Leucht S, Bäuml J, Kissling W, Engel RR The effect of family interventions on relapse and rehospitalization in schizophrenia--a meta-analysis Schizophr Bull, 2001.PMID 11215551
- [8]Zarit SH, Reever KE, Bach-Peterson J Relatives of the impaired elderly: correlates of feelings of burden Gerontologist, 1980.PMID 7203086
- [9]Bird V, Premkumar P, Kendall T, Whittington C, Mitchell J, Kuipers E Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: systematic review Br J Psychiatry, 2010.PMID 21037211
- [10]Rodolico A, Bighelli I, Avanzato C, et al. Family interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis Lancet Psychiatry, 2022.PMID 35093198
- [11]McFarlane WR Family Interventions for Schizophrenia and the Psychoses: A Review Fam Process, 2016.PMID 27411376
- [12]Miklowitz DJ, George EL, Richards JA, Simoneau TL, Suddath RL A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder Arch Gen Psychiatry, 2003.PMID 12963672
- [13]Falloon IR, Boyd JL, McGill CW, et al. Family management in the prevention of morbidity of schizophrenia. Clinical outcome of a two-year longitudinal study Arch Gen Psychiatry, 1985.PMID 2864032
- [14]Miklowitz DJ, Chung B Family-Focused Therapy for Bipolar Disorder: Reflections on 30 Years of Research Fam Process, 2016.PMID 27471058
- [15]Lucksted A, McFarlane W, Downing D, Dixon L Recent developments in family psychoeducation as an evidence-based practice J Marital Fam Ther, 2012.PMID 22283383