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Family work – the evidence

There is a robust evidence base supporting the effectiveness of family work in improving the quality of life for both the people living with mental health difficulties and their families. The evidence has existed for more than 30 years. Research has demonstrated that family work reduces stress in the family and relapse and rehospitalisation rates for the individual for a number of different mental health problems. There are extensive research reviews of this area.

References: Recovery for Carers / Family Members (143.0 KiB)


The approaches that are effective focus on day-to-day issues with the whole family. Information sharing, knowing how to spot signs of relapse, increasing problem-solving and coping skills, and looking at new ways for family members to communicate, are the key components. Behavioural Family Therapy (BFT) is an example of these evidence-based approaches. Find out more information and a description of BFT here.

Working with families in this way is also cheaper for services in the longer term because relapse and rehospitalisation is reduced. For an analysis of the costs and benefits of family work in this context read the report – Investing in recovery: making the business case for effective interventions for people with schizophrenia and psychosis.

Investing In Recovery: making the business case for effective interventions for people with schizophrenia and psychosis (912.5 KiB)

The evidence base has been used in the development of several key policies and guidelines that focus on the delivery of mental health interventions for a range of mental health issues.

Using England as an example of how the evidence has been translated into policy, this page identifies some key documents that have been developed recommending interventions for people living with mental health problems. These have all recommended engaging with the family, and offering family work. 

The National Institute for Clinical Excellence England has produced guidance on four diagnoses with a recommendation for family interventions.

This guidance states that healthcare professionals should consider offering a focused family intervention to people with bipolar disorder in regular contact with their families, if a focus for the intervention can be agreed. The intervention should take place over 6–9 months, and cover psycho-education about the illness, ways to improve communication and problem solving.

 

This guidance states that services should offer family intervention to families of people with psychosis or schizophrenia who live with, or are in close contact with the service user. Family intervention should include the person with psychosis or schizophrenia if practical, be carried out for between 3 months and a year, include at least 10 planned sessions, take account of the whole family’s preference for either single-family intervention or multi-family group intervention, take account of the relationship between the main carer and the person with psychosis or schizophrenia,  have a specific supportive, educational or treatment function, and include negotiated problem solving or crisis management work.

 

This guidance states that family members, including siblings, should normally be included in the treatment of children and adolescents with eating disorders. Interventions may include sharing of information, advice on behavioural management and facilitating communication.

The therapeutic involvement of siblings and other family members should be considered in all cases because of the effects of anorexia nervosa on other family members.

 

Services should offer family intervention to all families of children and young people with psychosis or schizophrenia, particularly for preventing and reducing relapse. This can be started either during the acute phase or later, including in inpatient settings.

This guidance recommends that family intervention should include the child or young person with psychosis or schizophrenia if practical, be carried out for between 3 months and a year, include at least 10 planned sessions and take account of the whole family’s preference for either single-family intervention or multi-family group intervention. It should also take account of the relationship between the parent or carer and the child or young person with psychosis or schizophrenia, have a specific supportive, educational or treatment function, and include negotiated problem solving or crisis management work.

All of the NICE guidance can be accessed on their website

 

This report provides the most up-to-date economic evidence to support the business case for investment in effective, recovery-focused services. Drawing on a wide range of data, evidence for the cost-effectiveness of recovery-focused interventions is set out and contains a section focussing on family work.

Knapp, M., Andrew, A., McDaid, D., Iemmi, V., McCrone, P., Park, A., Parsonage, M., Boardman, J., & Shepherd, G. (2014) Investing in recovery: making the business case for effective interventions for people with schizophrenia and psychosis. Centre for Mental Health, The London School of Economics and Political Science, Rethink Mental Illness, London, UK.

 

Similarly, other countries such as the US have developed similar guidelines. In the US, the PORT guidelines (Schizophrenia Patient Outcomes Research Team) apply:

Dixon, L.B., Dickerson, F., Bellack, A.S., Bennett, M., Dickinson, D., Goldberg, R.W., Lehman, A., Tenhula, W.N., Calmes, C., Pasillas, R.M., Peer, J. & Kreyenbuhl, J. (2010) The 2009 Schizophrenia PORT Psychosocial Treatment Recommendations and Summary Statements. Schizophrenia Bulletin, 36 (1), 48-70.

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