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Carers of persons with borderline personality disorder (BPD) experience high burden. Treatment guidelines advocate involving carers in comprehensive therapy approaches. This study is a randomized controlled trial of group psychoeducation, compared to waitlist. Group psychoeducation involved 6-8 carers per group and focused on improving relationship patterns between carers and relatives with BPD, psychoeducation about the disorder, peer support and self-care, and skills to reduce burden. Carers were randomized into intervention (N = 33) or waitlist (N = 35). After 10 weeks, those in the intervention reported improvements in dyadic adjustment with their relative, greater family empowerment, and reduced expressed emotion, sustained after 12 months. There were also improvements in carers' perceptions of being able to play a more active role, such as interacting with service providers. This study demonstrates that providing structured group programs for carers can be an effective way of extending interventions to a group experiencing high burden.

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The following article outlines the Safety First Model for working with high-risk young people in crisis. This hierarchical model prioritises emotional and physical safety by using multi-systemic and family-based interventions. A typical case example is used to illustrate the model and the structures and strategies employed at each level. The intervention model empowers families, facilitates their connections with other providers, and minimises the need for hospital admissions. The model also promotes collaborative and systemic practice in a child and adolescent mental health service.

Issues regarding the effectiveness of such a programme, its limitations, as well as the nature of examining and evaluating such work were discussed. Becoming more 'family friendly' is a realistic goal for adult mental health services.