The Family Talk Programme in Ireland: A Qualitative Analysis of the Experiences of Families With Parental Mental Illness

Abstract

Background: Parental mental illness is common, costly, can lead to children developing mental disorders and impaired lifetime outcomes, and places a substantial burden on caregiving partners. Family Talk (FT) is a widely implemented, 7-session, whole-family programme, with promising evidence of effectiveness in targeting the intergenerational transmission of mental illness. However, to date, very little qualitative research of family experiences of FT has been undertaken. The objectives of this study were to: (1) investigate the experiences of families attending FT; and (2) explore the key facilitators and barriers to engagement in mainstream mental health settings.Methods: This study was nested within a randomised controlled trial (RCT) of Family Talk [N = 86 families (139 parents, 221 children)] implemented in 15 adult, child and primary care mental health sites in Ireland. Semi-structured interviews were conducted with a purposive sample of 45 participants, including 23 parents with mental illness (PMI), 7 partners and 15 children/young people aged 9 to 18 years. Interview data were transcribed verbatim and analysed using constructivist grounded theory.Results: Over two thirds of families across sites reported substantial benefits from participation in FT, including reduced stigma, giving children and partners a voice, increased service-user confidence, and improved family communication/relationships. Key facilitators identified by families included: programme delivery by a competent, non-judgmental clinician; the whole-family approach; and family readiness to engage. Barriers to engagement included stigma, family crises/relapse, service constraints, impact of COVID-19, and a need for further child, family and follow-up sessions/supports.Conclusion: This study is the first qualitative analysis of family experiences of FT to be conducted within the context of an RCT and national programme to introduce family-focused practise for families with PMI. The findings illustrate that FT is beneficial across cultural/policy contexts, different mental disorders and can be implemented across adult and child mental health settings, including children with existing mental health challenges. Key barriers and facilitators to implementation were identified by families, all of which should help to inform the future implementation of FT, and other similar interventions, both in Ireland and elsewhere.

Parenting and Serious Mental Illness (SMI): A Systematic Review and Metasynthesis

“…Previous research has highlighted factors that inhibit parents from accessing support, including lack of policy and practice guidelines, lack of integration between adult and child services, crisis-orientated service provision, fears about child loss, and approaches that present a parenting ‘fix’ (Jones et al, 2016 ; Mulligan et al, 2020 , 2021 ; Tuck et al, 2022 ; van Esch & de Haan, 2017 ). The current review consolidates such findings and offers insights into how to target such barriers, by moving away from siloed and risk-focused approaches in which practitioners and policymakers are at the centre of decisions, and towards a system in which practitioners and other stakeholders scaffold compassionate, goal and strength based and collaborative support around parents, and the systems they live within.…”

Parents who experience psychosis: A qualitative exploration

“…The powerful role of an aversive practitioner‐led risk‐focus in impeding parents' ability to connect with service support, communities around them and a secure parenting identity enhances previous research that highlights that crisis‐orientated services can pose a barrier to parents accessing support (Jones et al, 2016; Mulligan et al, 2021). This finding suggests that services with a high‐threat focus can amplify problem‐based narratives both for parents, families and services.…”

Family Talk versus usual services in improving child and family psychosocial functioning in families with parental mental illness: a randomised controlled trial and cost analysis

“…Our qualitative analyses of family and practitioner experiences of FT indicated that the primary reasons for disengagement were mainly related to disillusionment due to delays/disruption caused by COVID-19, a family crisis, and a relapse in symptoms. Only two families highlighted parental stigma as a reason for disengagement ( 11 , 12 ).…”