The Meriden Family Work Programme is a training and organisational development programme, which has been promoting the development of family-sensitive mental health services since 1998.
It is an NHS programme which is hosted within Birmingham and Solihull Mental Health Foundation NHS Trust, although its remit has always been regional, and it now operates at a national and international level.
While the family is usually included in Child and Adolescent services and in Older Adults services, traditionally adult mental health services have focussed primarily on the individual. In the past, they have not offered a broad range of treatment modalities such as routine availability of ‘talking treatments’ including support for the family. The innovative Meriden Programme has been influential in modernising mental health services by shifting their focus to ensure that families and others in the person's social network receive care and support.
The programme is the largest of its kind worldwide with over 2600 therapists trained in family work and 137 trainers/supervisors in the West Midlands. Hundreds of professionals, family members and service users have benefited from its extensive array of specialist training packages, study days, internationally recognised conferences and well-accessed web site.
Originally funded from 1998 to 2004 through central West Midlands regional funding, Meriden worked closely with all the mental health provider trusts within the West Midlands region in a comprehensive programme of training and implementation. Subsequent funding for 2004 – 2007 was provided by several of those Trusts, demonstrating their commitment to ensuring that family work was available locally and embedded within the organisational infrastructures. From April 2007, the funding for the programme comes from a range of sources including West Midlands Mental Health and Primary Care NHS trusts and through other organisations, primarily NHS and Social Care, both within the West Midlands, and at a national and international level. As the reputation of the programme has grown, many other services wish to benefit from the experience and expertise built up in the programme since 1998.
Key priority areas for the programme include supporting the availability of family-sensitive services and evidence-based interventions; the needs of children of parents with mental health difficulties; family work in early intervention in Psychosis services; the needs of families from culturally diverse groups; family work in older adult services; the family’s experience of in-patient services and the development of therapeutic and training roles for service users and carers.
The overall aim of the programme is to train clinical staff, service users and carers in the skills needed to work with families, and to ensure that workers are able to implement these interventions following receipt of training through influencing management and creating a supportive host culture in the organisation.
The programme has had two main foci:
- A cascade system of training whereby therapists are trained as trainers and supervisors. These trainers provide in-service courses in their own localities to multi-disciplinary professional groups, service users and family members. This has ensured the widespread dissemination and sustainability of the programme and has been effective due to the ongoing support offered to the trainers and supervisors.
- On-going contact with managers and key individuals within services to identify barriers to the implementation of family work and solutions for overcoming these obstacles. The aim here is to bring about attitudinal and organisational change and ensure that family work becomes firmly embedded within services. Concrete structures have been put in place to ensure sustainability including recording and auditing systems, and ensuring that the provision of family work is written into clinicians’ job descriptions.
Since 1998, over 2600 therapists have been trained in the West Midlands and there are currently 137 active trainers within the West Midlands alone, representing professions from all of the different specialty areas. Carers and service users are actively involved in the programme in a number of capacities. Several have trained as therapists and some of these have trained as trainers. They act as consultants to the programme and play an active role in special interest groups.
In addition to continuing to train further therapists and trainers a number of key areas have been developed. These include:
- Development of family work in in-patient and acute services, and crisis/home treatment teams.
- Family interventions within Early Intervention in Psychosis services.
- Reaching hard to reach groups e.g. ensuring family work is accessible to culturally diverse groups; work with assertive outreach teams; work in forensic settings.
- Family interventions within Older Adult services.
- Child and Adolescent services (CAMHS) and the needs of children whose parents experience mental health difficulties.
- Links with higher education and curriculum development.
- Greater involvement of carers and service users both in training and delivery of family work.
- Carer Education and Support, (the Meriden "Caring for Carers" programme), with specific adaptations for use with Black and Minority (BME) carers and also Substance Misuse and Alcohol services.
An Award-Winning Programme
The contribution made by the Meriden Programme to developing mental health services has been recognised in a number of ways. The programme was joint-winner of the National Institute for Mental Health in England (NIMHE) 2003 Positive Practice Award for ‘Modernising Mental Health Services’ and winner of the ‘Social Care Award’ (Midlands and East Region) in the Health and Social Care Awards by the Department of Health in 2005. In 2007, the Programme Director, Dr Gráinne Fadden was invited to Downing Street to meet the then Prime Minister, Mr Tony Blair in recognition of those delivering excellence in Public Services.
The model of family work adopted by the Meriden Programme is a psychoeducational approach known as Behavioural Family Therapy (BFT). This was developed by Professor Ian Falloon and colleagues. It is a practical, skills based intervention that usually takes 10 to 14 sessions to deliver. It provides information to the service user and their family about the service user’s mental health issues and treatment. The family also complete work on recognising early signs of relapse and develop a clear relapse plan. BFT promotes positive communication, problem solving skills and stress management within the family thus leading to stress reduction. The needs of all family members are addressed, and individual family members are encouraged to identify and work towards clear goals.
Who can BFT help?
Research has demonstrated that BFT is effective in reducing stress for service users and their families and in significantly reducing relapse rates and thus helping to promote recovery in those people suffering with severe and enduring mental health problems. The main focus of delivery has been around providing intervention to those families with a member with ‘psychosis’ or ‘manic depression’. The National Institute for Clinical Excellence Schizophrenia guidelines, originally published in 2002 recommend family interventions should be offered to 100% of individuals with schizophrenia who have experienced a recent relapse.
The revised and updated review of the guidelines (March 2009) confirm this and further recommend that families are offered intervention and engaged during the acute phase of illness, or as a method of promoting recovery for those with persisting symptoms. Standard six ‘Caring for Carers’ of the National Service Framework (1999), stipulates that all individuals who provide regular and substantive care for a person on CPA should have their own assessment and care plan that is implemented and reviewed regularly. The NICE Guidelines for bipolar disorder (2006) always emphasise the importance of family work.
The overall aims of BFT are increased understanding, stress reduction, and improved communication and problem-solving skills within the family. Although the research evidence base is strongest for those families experiencing psychosis or manic depression, the approach can be utilised effectively to help meet the needs of other families in contact with mental health services. In addition, there is growing support for using the approach with families experiencing stress in relation to long-term physical conditions.
Overview of the Therapy Process
The approach is not a ‘package’ where components are delivered to all families. Rather, it is an individualised approach where what is delivered to an individual family is based on the assessment of that particular family, and is tailored to their specific needs. Equally the pace and timescale of the support offered varies from family to family. In this collaborative approach, the therapist and family together determine what the agenda will be. Family work is generally offered in the family home unless the family have a preference for meeting elsewhere. This makes it easier for family members who are often in a stressful situation to be able to attend.
The elements of what is offered are drawn from those listed below:
- Meet with the family to discuss the benefits of the approach
- Agreement with the family that they are willing to try the approach
- Assessment of individual family members
- Assessment of families communication and problem solving skills
- Review of the assessment information on the families resources, problems and goals
- Meeting with the family to discuss/plan how to proceed and establishment of family meetings
- Information-sharing about the mental health issue and reaching a shared understanding
- Early warning signs and relapse prevention work – development of ‘staying well’ plans
- Helping the family to develop effective communication skills
- Supporting the development of the family’s Problem Solving skills
- Booster sessions
- Review and on-going support or closure
Families' Experiences of Behavioural Family Therapy
As part of the evaluation of the Meriden Programme, family members were interviewed about how they experienced Behavioural Family Therapy (Campbell, 2000). The following quotes illustrate the views they expressed:
- ‘I think us all being together helped. Because in a family somebody is always dashing off somewhere and at least over that period of time we were together discussing things’
- ‘I thought the goals were good – and the positive things. It gave you a chance to praise other people in the family which made us all feel a bit better.’
- ‘It makes you think about other peoples feelings’
- ‘It gave us a chance to say things that we would not normally say’
- ‘It’s difficult to see where we would be today if we hadn’t had these meetings. I don’t know what would have happened’
- ‘I always found that it gave me a lift. Once they’d been (the therapists) it didn’t seem as bad …. And you sort of realise that they were understanding how you felt.
- ‘Very, very effective. On a scale of 0 to 10 I’d say 10 definitely’.
Campbell, A (2000) Families’ Experiences of Receiving Behavioural Family Therapy: A Phenomenological Study. MA Thesis. Dept of Social Policy and Social Work. School of Social Sciences. University of Birmingham.
Comments taken from stories written by people who have received BFT (Further details can be found within the “Carers Pages” on this site)
- ‘For the first time my role was clarified for my son’s well times and, more importantly, during times of relapse’.
- ‘We now recognise the early warning signs of relapse and act accordingly. This prevents my son going deeper into crisis’.
‘My son, myself and our family are proof that BFT can and does work. It not only gave my son his life back, it gave me my life back too. I am now able to do the things in life I want to do……..’.
The Meriden Programme takes its name from the village of Meriden which is a civil parish in the Solihull borough of the West Midlands in England, United Kingdom. The village claims to be at the very centre of England, and a 500-year-old (some sources say 200-year-old) sandstone pillar-shaped monument to that effect stands in the village green. This medieval village cross is a grade II listed artifact.
The village of Meriden is traditionally known as the “Heart of England”.
By calling the programme the Meriden Programme it reflects the view that families should be placed at the heart of mental health care. The other reason we thought the name was apt was because the programme is a cascade programme where the training and ideas that are central are disseminated out from the core to other parts of the West Midlands, to the rest of England and now to several other countries across the world.
Dr Grainne Fadden, Programme Director
Dr Gráinne Fadden is a Consultant Clinical Psychologist (Birmingham and Solihull Mental Health Foundation Trust), Honorary Senior Research Fellow at the University of Birmingham and Director of Meriden.
Dr Fadden has worked in the area of family work throughout her career; in clinical practice, research, training and more recently in relation to influencing organisational change to incorporate family work routinely into mental health services. She has also written extensively on the effects of mental health problems on families, the ways in which families can be supported, and on the training of mental health professionals to work with families, including books, book chapters and research articles.
Dr Fadden is a member of the CSIP National Psychosocial Interventions Implementation Group. She advises the Department of Health on issues relating to families and carers and also works closely with a range of national bodies, including the Royal College of Psychiatrists, regarding these issues.
Tel: 0121 301 2711
Chris Mansell - Deputy Director, Meriden Family Programme
Chris is the Deputy Programme Director. He is a Registered Mental Health Nurse and has clinical experience in both in-patient and community settings. He has been Head of Nursing in both Generic and Forensic Mental Health settings.
Chris trained in Behavioural Family Therapy (BFT) in 1998 and is also a Trainer and Supervisor. He has implemented the BFT model and has provided training and supervision in a variety of settings.
Chris is responsible for marketing the services of the Programme, product development and developing new business.
Tel.: 0121 301 2894
Martin Atchison, Deputy Programme Director
Martin is Deputy Programme Manager. His background is in Mental Health Nursing. After qualifying as a Mental Health Nurse he worked as an in-patient nurse for 2 years. He then started working in a Community Mental Health Team and subsequently managed this team for 5 years before starting work as a Clinical Specialist for the Meriden Programme in 2004. He has been involved in co-ordinating the Partners in Care campaign across the West Midlands and works alongside Carers in Partnership in a number of areas. Martin has worked on developing family work in Older Adult services and co-ordinates the special interest group.
Tel: 0121 301 2889
Paula Conneely, Clinical Specialist
Paula is an Occupational Therapist by profession and has worked in a variety of roles since qualifying in 1994, including Recovery and Assertive Outreach services. Paula trained in Behavioural Family Therapy in early 1998 and became a Trainer later in that year. Since that time she has been actively involved in working with families, as well as staff training, supervision and BFT service co-ordination.
Since joining the Meriden team in 2004, Paula has worked with fellow BFT workers to develop the Transcultural Family Work Forum, a special interest group which focuses on the application of family work with Black and Minority Ethnic families.
Tel: 0121 301 2710
Alison Lee, Clinical Specialist
Alison qualified as a Registered Mental Nurse (RMN) in 1995, beginning her career in Dudley initially working on in-patient wards and then being part of a community team.
Alison left the NHS for a short while to work as a Project Manager in the independent sector, returning to work for the NHS in Shropshire as manager of Assertive Outreach and Early Intervention Teams.
Alison trained in Behavioural Family Therapy in 1999 and has been a trainer/supervisor since 2004. Alison joined the Meriden team in 2008.
Tel: 0121 301 2892
Julia qualified as a Registered Mental Nurse (RMN) in 1987 and worked within a large hospital setting in Staffordshire until it closed in 1995.
She then moved into a community setting, working within adult mental health and older persons.
Julia moved to Birmingham to work in 2003 as a CPN and trained in Behavioural Family Therapy in 2004 and as Trainer/Supervisor in 2006. She now works full time for the Meriden Family Programme following a year’s secondment to the team.
Tel: 0121 301 2893
Peter Woodhams, Carer Consultant
Peter Woodhams is a carer of a son who has suffered from schizophrenia for over 10 years and whose family unit has benefited from behavioural family therapy. Since retiring from a role in industry Peter has become actively involved in working with mental health services. Peter was previously Chairman of the Meriden Family Programme Advisory Group, and is now employed part-time as Carer Consultant with the Programme since April 2008
Tel: 0121 678 2708
Sam Farooq, Business Manager/P.A to Dr Fadden
Sam has been working with the Meriden Programme since 2002. She originally started as Programme Administrator and PA to the Director, Grainne Fadden, but has since taken the role of Business Manager as well.
She has worked in the NHS for the last 9 years and was previously part of the organisation that was instrumental in the set-up of the Meriden Programme – Partnership for Developing Quality (PDQ).
Tel: 0121 301 2888
Maria Albanese, Team Administrator
Maria started working for the Meriden Programme as temporary Administrative Assistant in June 2007. Providing secretarial and administrative support for all members of the Meriden Programme team Previous to this Maria has also worked in previous roles for a local authority and other NHS organisations, gaining invaluable insight working with organisations that dealt with helping people and the family unit.
Prior to this and in complete contrast, the main part of Maria’s life was spent working for Architects and Surveyors in Leisure & Retail and within the construction industry.
Tel: 0121 301 2895
Nadine Berry, Team Administrator
Nadine has 11 years' experience in the print industry, where she planned the layout of pages in a variety of magazines. After working in this industry she studied counselling for 2 years at evening classes, then worked as a part time Administrator for Birmingham City Council in a day centre for women with mental health issues. Alongside this role, she completed a diploma in Person Centred Counselling. As part of her training she joined the counselling team at a day centre in South Birmingham, counselling service users with mental illness.
After attending the Meriden Family Programme's five day training course she felt very inspired by the work that the team does and is excited to now be a part of the team.
Tel: 0121 301 2896
Rubina Jhadray, Psychology Research Assistant
Rubina studied BSc Psychology at the University of Leicester and developed a keen interest in Clinical Psychology and the development and implementation of psychological interventions. Since obtaining her degree, Rubina has worked for the University of Leicester Counselling and Psychotherapy Research Clinic, Birmingham City Council and for South Staffordshire and Shropshire Foundation NHS Trust.
Rubina joined the Meriden Family Programme in January 2013 as a Psychology Research Assistant and is looking forward to furthering my knowledge about Behavioural Family Therapy and the implementation of family work within services.
Our postal address is:
The Meriden Family Work Programme
Tall Trees, The Uffculme Centre,
80, Queensbridge Road,
West Midlands B13 8QY