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Family Psychoeducational Programs for Schizophrenia not Widely Available Despite Support from Research

When it comes to treating mental health disorders, the participation of family members can be a huge help. Family psychoeducation (FPE) refers to a group of psychotherapeutic interventions which aim to treat disorders by emphasising the role of family members as partners in care. FPE programs have seen extensive success when applied to a variety of disorders, including schizophrenia.

But it can be quite stressful on family members. There remain concerns regarding supporting relatives and primary caregivers of those diagnosed with schizophrenia. Research has revealed that those who remain in frequent contact are at higher risk of developing anxiety, depression, and experiencing decreases in quality of life. The Trauma and Mental Health Report reached out to Brendan O’Hanlon, mental health program manager at La Trobe University in Melbourne, Australia, to discuss recurring concerns he has seen over the span of his 20 years in researching and coordinating FPE programs. O’Hanlon explains that relatives can often lack knowledge about the nature of schizophrenia, as well as information about skills they need to support family members through difficult symptoms, like delusional thinking or lack of volition. This tends to weigh on families and create a sense of inability to provide helpful support.

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Delusional thinking and lack of volition, symptoms commonly associated with schizophrenia can cause family members to feel frustrated and hostile towards their relative. Given that highly tense family environments have been shown to increase relapse and readmission rates for those with schizophrenia, FPE programs focus on improving family dynamics through education, training in communication, and problem-solving skills.

The most basic formats of FPE programs are Multiple-Family Group Therapy (MFGT) and Behavioural Family Therapy (BFT). Both program formats involve an assessment phase which is followed by family engagement, education, and training in skill development.

In the BFT format, diagnosed individuals and family members are assessed individually, followed by group meetings where family members are encouraged to address their concerns and are provided information about their relative’s condition. The goal of the BFT approach is to provide the family helpful problem-solving skills, which can help them navigate issues that arise.

MFGT functions similarly, but instead works with 5 to 6 families at a time. The families come together for clinician-facilitated group discussions where they share the challenges they have encountered with their relatives’ condition. The particular concerns of family members are used to shape the education provided to them as well as the specific problem-solving and communication skills that will be addressed. Working under the MFGT format, O’Hanlon noticed several benefits to having sessions with multiple families, including that “some clients went on to meet separately, developed educational and promotional materials for the model, and became quite engaged advocates.”

FPE programs are thoroughly-researched and extensively supported in clinical literature regarding their effectiveness in reducing relapse and readmission rates among patients with schizophrenia. The evidence suggests that these benefits typically start to come into effect after about 9 months of the intervention.

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Despite robust clinical support, FPE programs are not widely implemented. This may be due to the individualised medical model of care common to the North American mental health system, particularly in the treatment of schizophrenia. Some clinicians may be hesitant to administer mental health programs with a relational focus due to a lack of experience with them.

In addition, family members and their diagnosed relatives have expressed apprehension about entering into treatment together. Clients seeking treatment for schizophrenia may be estranged from their family members, or reluctant to enter into treatment due to a history of trauma within the family.

Recent changes in clinical recommendations point to a trend valuing the role of family in the treatment of mental illness, acknowledging that family members contribute significantly to the condition and well-being of their relatives. O’Hanlon notes that “the valuing of lived experience in co-design and co-production of therapeutic interventions will help bring families’ concerns to the forefront, and services won’t be able to brush them off in the way they’ve done historically.”

-Emma Puric, Contributing Writer

Image Credits:
Feature: Tima Miroschnichenko
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First: Wikimedia,
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Second: Camila Quintero Franco
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