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Family psychoeducation

Definition

Family psychoeducation is a method based on clinical findings for training families to work together with mental health professionals as part of an overall clinical treatment plan for their family members. Family psychoeducation has been shown to improve patient outcomes for persons with schizophreniaand other major mental illnesses.

Purpose

The goal of family psychoeducation is to prevent patients with severe mental illnesses from relapsing, and to promote their re-entry into their home communities, with particular regard for their social and occupational functioning. To achieve that goal, family psychoeducation programs seek to provide families with the information they need about mental illness and the coping skills that will help them deal with their loved one's psychiatric disorder.

An associated goal of these programs is support for the patients' families. Families experience many burdens (financial, social, and psychological) in serving as long-term caregivers for their loved ones. Although the primary focus of family psychoeducation groups is improved patient outcomes, an essential intermediate goal is to promote the well-being of the family.

Description

There are several different models of family psychoeducation. Although they include many common elements, these different models include: single- and multiple-family groups; mixed groups that include family members and consumers (patients); groups of varying duration ranging from nine months to more than five years; and groups that focus on patients and families at different phases in the illness. Family psychoeducation programs have been studied extensively and refined by a number of researchers, including Drs. Ian Falloon, Gerald Hogarty, William McFarlane, and Lisa Dixon.

The evidence suggests that multi-family groups, which bring together several patients and their families, lead to better outcomes than single-family psychoeducation groups. The origins of multiple-family group therapygo back as far as 1960, when these groups were first assembled to solve ward-management problems in a psychiatric hospital. Lasting a minimum of nine months, the programs provided their participants with information about mental illness, its symptoms and treatment; medication and its side effects; how to communicate with a person with mental illness; and techniques for crisis interventionand mutual problem-solving.

Dixon recently outlined the characteristics of successful family psychoeducation programs. They include:

• The programs consider schizophrenia an illness like any other.
• They are led by mental health professionals.
• They are part of a total treatment plan that includes medication.
• Families are treated as partners rather than patients.
• The programs focus primarily on patient outcomes, secondarily on family outcomes.
• The programs differ from traditional family therapyin that they do not treat families as part of the problem; they see them as part of the solution.

It is also important that family educationprograms take into account the phase of the patient's illness; the life cycle of both the patient and the family; and the family's cultural context.

Results

A large body of evidence supports the use of family psychoeducation as a "best practice" for young adults with schizophrenia and their families. Because of this compelling evidence, researchers at the University of Maryland, as part of the Schizophrenia Patient Outcomes Research Team (PORT), identified family psychoeducation as an evidence-based practice that should be offered to all families. This and other research studies have shown reduced rates of relapse and lower rates of hospitalizationamong consumers and families involved in these programs. Other outcomes included increased rates of patient participation in vocational rehabilitationprograms and employment; decreased costs of care; and improved well-being of family members.

A meta-analysis of 16 individual studies found that family interventions of fewer than 10 sessions have no effect on the reduction of family burden. There are also several controlled studies that support the effectiveness of single-and multiple-family interventions for bipolar disorder, major depression, obsessive-compulsive disorder, anorexia nervosa, and borderline personality disorder. Studies of family psychoeducation have been conducted outside the United States in China, Norway, and the Netherlands; and with a Hispanic population in Los Angeles, California.

Unfortunately, putting family psychoeducation into effect in clinical settings has not kept pace with research. The PORT study found that only 31% of patients studied reported that their families received information about their illness. One recent strategy to expand these programs includes integrating family psychoeducation into assertive community treatment (ACT) programs.

See also Case management

Resources

BOOKS

Lefley, Harriet P. and Dale L. Johnson, eds. Family Interventions in Mental Illness: International Perspectives.Westport, CT: Praeger Publishers, 2002.

McFarlane, William R. "Families, Patients and Clinicians as Partners: Clinical Strategies and Research Outcomes in Single- and Multiple-Family Psychoeducation." In Helping Families Cope with Mental Illness.Switzerland: Harwood Academic Publishers, 1994.

PERIODICALS

Amenson, Christopher S. and Robert Paul Liberman. "Dissemination of Educational Classes for Families of Adults with Schizophrenia." Psychiatric Services52, no. 5 (2001): 589-592.

Dixon, Lisa, Curtis Adams and Alicia Lucksted. " Update on Family Psychoeducation for Schizophrenia." Schizophrenia Bulletin26, no. 1 (2000): 5-19.

Dixon, Lisa, McFarlane, William R., Lefley, Harriet, Lucksted, Alicia, Cohen, Michael, Falloon, Ian, Mueser, Kim, Miklowitz, David, Phyllis Solomon, and Sondheimer, Diane. "Evidence-Based Practices for Services to Families of People with Psychiatric Disabilities." Psychiatric Services52, no. 7 (July 2001): 903-910.

ORGANIZATIONS

National Alliance for the Mentally Ill (NAMI). Colonial Place Three, 2107 Wilson Blvd., Suite 300, Arlington, VA 22201-3042. (800) 950-NAMI (6264) or (703) 524-7600. Web site: <http://www.nami.org>.

National Mental Health Association (NMHA). 1021 Prince Street, Alexandria, VA 22314-2971. Phone: (800) 969-6642 or (703) 684-7722. Web site: <http://www.nmha.org>.

OTHER

National Institute of Mental Health. "Schizophrenia." (cited April 7, 2002). <http://www.nimh.nih.gov/publicat/schizoph.htm>.

Irene S. Levine, Ph.D.