Family Interventions in Psychosis: A Review of the Evidence and Barriers to Implementation

Abstract

Objective: Family interventions for schizophrenia are recommended psychological interventions worldwide. The National Institute for Care and Clinical Excellence (UK) and the Royal Australian and New Zealand College of Psychiatrists recommend family interventions as a first-line treatment and "treatment essential," respectively, at all stages of psychosis and with all aspects of care. However, the success of the integration of these interventions into routine clinical services has been problematic and remains a major challenge. Methods: We outline the national guidelines on family interventions for schizophrenia and review the evidence for this approach. Drawing on recent systematic reviews and through searching electronic databases for relevant articles, we review the barriers and facilitators associated with implementing family interventions into routine clinical services. Results: National guidelines continue to recommend psychological interventions for schizophrenia, reflecting the evidence base to support the provision of this approach across the psychosis spectrum. Reported estimates of implementation rates remain low and vary between 0% and 53%. Barriers to implementing family interventions exist at the service user, clinician, and organisational level. Factors that facilitate implementation of family interventions have been reported to a lesser extent. Conclusions: Implementation of family interventions for schizophrenia remains poor and is below recommended levels, with wide variation of implementation rates reported. This reflects inequality in the provision of family interventions for schizophrenia. Barriers at the service user, clinician, and organisational level have influenced the implementation of family interventions. A research agenda for improving consistent implementation of family interventions for schizophrenia is discussed.

Moderated online social therapy for carers of young people recovering from first-episode psychosis: study protocol for a randomised controlled trial

“…Despite an emerging evidence base for family interventions in early psychosis, and indeed a well-established evidence base for family interventions in chronic psychosis, the availability of these interventions in routine care is poor because of barriers at the level of services, clinician expertise, and the service user [71]. In addition, on entry into specialist first-episode services, carers often face an uncertain long-term prognosis for their relative and a process of recovery that extends well beyond the available 2-year period of care provided by state-supported specialist FEP care.…”

Not ‘Just a Talking Head’: Experiences of Australian Public Mental Health Clinicians Implementing a Dialogical Family Therapy Approach for Young People with Severe Mental Health Concerns

“…The implementation of evidence‐based practices in tertiary mental health settings has been associated with challenges such as engagement of staff and families, concerns regarding manualised approaches, and fidelity (Addis, Wade, & Hatgis, ; Albers, Mildon, Lyon, & Shlonsky, ; Berry & Haddock, ; Bucci, Berry, Barrowclough, & Haddock, ). These concerns have led to suggestions that scientific evidence for emerging innovation may not be enough to produce practice change (Urquhart et al., ).…”

“…A systematic review of implementation of family therapies for schizophrenia reported implementation rates of between 0% and 50% (Bucci et al., ). Kavanagh et al.…”

What the Problem May Be With Family Intervention … and With Dissemination More Generally: A Commentary

“…Bucci et al, 2016) may offer a partial answer if it is adequately resourced, and dedicated staffing would address the competing role demands experienced by case managers (Onwemere et al, 2016). Bucci et al, 2016) may offer a partial answer if it is adequately resourced, and dedicated staffing would address the competing role demands experienced by case managers (Onwemere et al, 2016).…”

“…A stepped-care approach is probably essential (Bucci et al, 2016): as Onwemere et al (2016) argue, many families may only be seeking information, or a brief, targeted intervention for a specific problem. A stepped-care approach is probably essential (Bucci et al, 2016): as Onwemere et al (2016) argue, many families may only be seeking information, or a brief, targeted intervention for a specific problem.…”