SAMHSA-1

Family Psychoeducation

FAMILY PSYCHOEDUCATION BACKGROUND
Family members and other persons involved in the lives and care of adults who have serious mental illnesses often provide emotional support, case management, financial assistance, advocacy, and housing to their mentally ill loved ones. Although serving in this capacity can be rewarding, it may be very difficult. Family members often have limited access to the resources and information they need. Research conducted over the past decade has shown that patients’ outcomes improve when the needs of family members for information, clinical guidance, and support are met.

Several models have evolved to address the needs of families of persons with mental illness: individual consultation and family psychoeducation conducted by a behavioral health professional, various forms of more traditional family therapy, and a range of professionally led short-term family education programs, sometimes referred to as therapeutic education.

Also available are family-led information and support classes or groups, such as those provided by the National Alliance for the Mentally Ill (NAMI). Family psychoeducation has a deep enough research and dissemination base to be considered an evidence based practice. However, the term “psychoeducation” can be misleading: family psychoeducation includes many therapeutic elements, often uses a consultative framework, and shares characteristics with other types of family interventions.

A variety of family psychoeducation programs have been developed by behavioral health care professionals over the past two decades . These programs have been offered as part of an overall clinical treatment plan for individuals who have mental illness. They last nine months to five years, are usually diagnosis specific, and focus primarily on consumer outcomes, although the well-being of the family is an essential intermediate outcome. Family psychoeducation models differ in their format-for example, multiple-family, single-family, or mixed sessions-the duration of treatment, consumer participation, location-for example, clinic based, home, family practice, or other community settings-and the degree of emphasis on didactic, cognitive-behavioral, and systemic techniques.

WHO BENEFITS FROM FAMILY PSYCHOEDUCATION? 
Family psychoeducation has been shown to be effective for all families who have contact with a relative who has mental illness.

In addition, family psychoeducation is effective for consumers with mental illness and other problems, especially consumers who have been hospitalized. Consumers with a variety of diagnosis have benefited from family psychoeducation:

  • Schizophrenia
  • Schizoaffective disorder
  • Bipolar illness
  • Major depression
  • Borderline personality disorder

Anyone who is helping and/or supporting a consumer in his or her recovery – parents, other relatives, close friends, or neighbors – may be included in family psychoeducation. The consumer and family do not have to live in the same house or apartment.

ESSENTIAL ELEMENTS 
Treatment models that have been supported by evidence of effectiveness have required clinicians to adhere to fifteen principles in working with families of persons who have mental illness:

  • Coordinate all elements of treatment and rehabilitation to ensure that everyone is working toward the same goals in a collaborative, supportive relationship.
  • Pay attention to both the social and the clinical needs of the consumer.
  • Provide optimum medication management.
  • Listen to families’ concerns and involve them as equal partners in the planning and delivery of treatment.
  • Explore family members’ expectations of the treatment program and expectations for the consumer.
  • Assess the strengths and limitations of the family’s ability to support the consumer.
  • Help resolve family conflict by responding sensitively to emotional distress.
  • Address feelings of loss.
  • Provide relevant information for the consumer and his or her family at appropriate times.
  • Provide an explicit crisis plan and professional response.
  • Help improve communication among family members.
  • Provide training for the family in structured problem-solving techniques.
  • Encourage family members to expand their social support networks-for example, to participate in family support organizations such as NAMI.
  • Be flexible in meeting the needs of the family.
  • Provide the family with easy access to another professional in the event that the current work with the family ceases.

In addition, the following elements are essential to providing consumer and family benefits:

  • The intervention should span at least nine months
  • The intervention should include education about mental illness, family support, crisis intervention, and problem solving
  • Families should participate in education and support programs
  • Family members should be engaged in the treatment and rehabilitation of consumers who are mentally ill
  • The information should be accompanied by skills training, ongoing guidance about management of mental illness, and emotional support for family members

OTHER IMPORTANT FEATURES 
Psychoeducation can be provided in single-family and multi-family groups. For multi-family groups, practitioners invite five to six consumers and their families to participate in a psychoeducation group for at least six months. Additional meeting time promotes improved outcomes. Meetings are held every other week. The format is structured and pragmatic to assist people with developing skills for handling problems posed by mental illness. Over time practitioners, family members, and consumers form a partnership as they work toward recovery. Consumers and their supporters may decide to meet as a single family rather than in the multi-family group format.

Family psychoeducation involves:

  • joining (developing an alliance)
  • on-going education about the illness
  • problem-solving
  • creating social supports
  • developing coping skills

Family psychoeducation sessions focus on:

  • exploring precipitants of previous acute episodes of illness
  • review of prodromal signs and symptoms
  • reactions of the family in supporting family members with an illness
  • coping strategies and strengths that have been successful
  • social supports in the community
  • grief and mourning in relation to the illness and the development of a treatment plan

OUTCOMES
Research on family psychoeducation programs has demonstrated that this service leads to a number of positive outcomes when compared to standard individual services:

  • Reduction in relapses
  • Reduction in hospitalization rates
  • Increase in well-being of family members
  • Increase in consumer participation in vocational rehabilitation
  • Decrease in the cost of care
  • Increased consumer involvement in family life and social activities
  • Better health and fewer medical problems for all family members
  • Reduced psychiatric symptoms
  • Reduced need for medication
  • Reduced consumer depression, more energy, and motivation