FPC Goals and Principles
This information was developed by members of the World Fellowship for Schizophrenia in conjunction with leading psychiatric researchers in work with families. The principles are based on positive research findings found when family members were included in treatment and care. Families caring for someone with major mental illness need to be included in their treatment and care. This document explains, for mental health professionals, the principles of and rationale for, work with families.
Goals for Work with Families:
- To achieve the best possible outcome for the individual with mental illness through collaborative treatment and management.
- To alleviate suffering among the members of the family by supporting them in their efforts to foster their loved one's recovery.
Principles of Family Work:
- To coordinate all elements of treatment and rehabilitation to ensure that everyone is working towards the same goals in a collaborative, supportive relationship Working together ensures that the goals for treatment and care are understood and agreed by the treatment team which includes the family. This will overcome the isolation that is experienced by both professionals and families.
- To pay attention to the social, as well as the clinical needs of the patient (consumer). It is insufficient to focus exclusively on medication management. Needs for appropriate accommodation, employment or alternative occupation, economic support, recreation and a supportive social network must be taken into account.
- To provide optimum medication management Clinicians should be alert to signs of over medication and to the unpleasant and disabling side effects of neuroleptics. There should be regular reviews of the medication with the patient and family. Education about medications plus regular assessment, particularly in relation to side effects, will encourage compliance.
- To listen to families and treat them as equal partners. Relatives have gained a great deal of experience in caring for their relative and professional carers can learn much from them. Their expertise should be acknowledged and valued. Clinicians should consult with family throughout the treatment and care program, to improve effectiveness, understanding and empathy. Speaking to families in their homes may help in initiating family contact.
- To explore family members expectations a) Of the treatment program Each family member may have different expectations. Because these may be unrealistic it is important to explain what the team hopes to achieve. b) For the patient After an episode of illness, particularly at the beginning, family members may expect the person to return rapidly to their previous level of functioning. The family will need to adjust their expectations and form new goals. Throughout the treatment process, family and patient expectations have to be regularly evaluated.
- To assess family's strengths and difficulties It is too easy to focus on the family's problems and ignore their strengths. Simply staying together constitutes a strength. A major strength is their intimate knowledge of the patient and what they have learned through a process of trial and error. Caring for someone with an mental illness exacts an emotional toll. Anxiety and depression are commonly found among family carers and should not be neglected. These symptoms reduce their capacity to support the patient.
- To help resolve family conflict by providing sensitive response to emotional stress Anger , anxiety and guilt expressed by family members should be dealt with in a sensitive way. Anger can usually be reframed as showing concern. Expressions of warmth are encouraged. Recreational activities should be promoted that are likely to lead to family members enjoying things together. When conflicts stemming from antagonistic relationships arise clinicians need to listen to the differing viewpoints impartially and seek resolution through compromise.
- To address feelings of loss Family members experience loss of hopes and expectations for their sick relative. They also feel that the person they know has been changed by the illness. Their grief needs to be acknowledged. They need help in coming to terms with both these kinds of loss.
- To provide relevant information for patient and family at appropriate times An introductory education program is an effective way of engaging families, but needs to be followed by continuing education throughout the period of treatment and care. Clinicians and families need to appreciate each patient's individual signs of relapse in order to bring about an early treatment intervention. Each family has its own concerns which need to be addressed. In addition clinicians should recommend that the family attend a support group.
- To provide an explicit Crisis Plan and professional response The family should have access to the treatment team when they know that their relative is in danger of relapse. A provisional plan, which includes relevant telephone numbers of key contacts and services, should be in place.
- To encourage clear communication among family members In some families, members find it difficult to communicate with each other. They have stopped listening. It is common for the person with the mental illness to be left out of discussions. Clinicians need to suggest simple ground rules for clear communication and support the family in their efforts to observe them.
- To provide training for the family in structured problem-solving techniques This cognitive-behavioural approach is of great value in helping families to tackle the main problems they face in caring for a person with mental illness. It is sensible to guide the family towards applying the techniques to a simple problem first so that they are likely to achieve success.
- To encourage the family to expand their social support networks Families tend to withdraw from their natural support networks through burden, shame and embarrassment about the illness. Initially they benefit from social interaction through relatives support groups, multi-family problem solving groups. It is important that the caring role does not absorb all their life and that a balance be maintained. Patients may be helped to increase their social activity by social skills training often with the assistance of siblings and friends.
- To be flexible in meeting the needs of the family Clinicians may decide to work with a single family or groups of families. Family members and/or the patient may need to be seen separately. The patient may need to discuss some concern privately when they do not concern the family.
- To provide the family with easy access to a professional in case of need if work with the family ceases It is essential to leave the family with a phone number and a named person who will deal with any future inquiries Sometimes a telephone discussion will suffice: at other times additional sessions maybe required to help the family to cope with a crisis or a change in their circumstances.
Note: Throughout this document the word "patient" is used. We recognize that in many parts of the world other words such as "user,""consumer," etc. are preferred.