Families and Mental Disorders: From Burden to Empowerment
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PE is focussed on providing patients and families with information about early signs of relapse and effects of medication.
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Research indicates that families tend to not find the information too complicated to understand. CBT is aimed at increasing optimism. Some programmes with the most robust evidence for efficacy are outlined below. Provision of new information — presentations are given and families are provided with newsletters, pamphlets, lists of resources and websites, and may borrow books and videos relatives tend to find videos the most informative and presentations more informative than the literature. Increased knowledge about schizophrenia 26 Increased satisfaction with health care services 6 Increased use of coping behaviours 6 Increased optimism 6 Reduced anxiety, stress and distress 6 Improved patient medication adherence 38 Reduced patient relapse and admission rates 25 , 38 Reduced family burden 13 , 25 , 29 No change in levels of EE or EOI.
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A week skill-building course taught by family members who receive specific training to lead and facilitate sessions for family members. Improvements in knowledge and both emotional and problem-focussed coping 7 Improved problem-solving and reduced distress and subjective burden 25 , 38 Improved family coping 38 Improved overall functioning of the patient including self-maintenance, social functioning and community living skills and decreased number and durations of hospitalisations.
To instil hope by focussing on recovery 20 , 34 To provide education and information 20 , 34 To implement strategies to reduce stress and distress 20 , 34 To enhance existing coping strategies 20 , 34 To foster effective communication 20 , 34 To promote independence 20 , 34 To develop a staying well plan 20 , 34 To reduce HEE 33 To prevent psychotic relapse.
An increase in the understanding of the illnesses 38 Decreased family tension and stress 20 , 34 Decreased burden 20 , 34 Decreased EOI 33 Decreased rates of relapse and hospitalisation 3 , 38 Improved medication adherence. Barriers to implementing these interventions in practice are time, funding and the availability of supervision.
Most existing mental health care facilities have resources to supply educational interventions. Brief educational intervention in the setting of a consultation can greatly reduce subjective burden in family members of mentally ill patients. For example, in families where there is more than one caregiver, they should take turns in caring for the patient and should make full use of their time away from the patient by maximising time for hobbies and leisure.
Families of patients with schizophrenia experience high levels of burden and receive very little information about the illness, how to cope with their mentally ill relative or related matters such as EE. They are subsequently rendered largely ill-equipped to deal with these challenges and problems. By providing more information and resources, and implementing programmes designed to address these problems, families of patients with schizophrenia can experience higher levels of support and empowerment and lower levels of burden.
Furthermore, families need to be psycho-educated about the negative effects of patient criticism and intrusive behaviours which increase levels of HEE and EOI, both of which are detrimental to patients and increase relapse rates. The author declares that he has no financial or personal relationships which may have inappropriately influenced him in writing this article.
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