Why involve families in acute mental healthcare? A collaborative conceptual review
Open accessAbstract
Objectives: Family involvement is strongly recommended in clinical guidelines but suffers from poor implementation. To explore this topic at a conceptual level, a multidisciplinary review team including academics, clinicians and individuals with lived experience undertook a review to explore the theoretical background of family involvement models in acute mental health treatment and how this relates to their delivery. Design: A conceptual review was undertaken, including a systematic search and narrative synthesis. Included family models were mapped onto the most commonly referenced underlying theories: the diathesis–stress model, systems theories and postmodern theories of mental health. Common components of the models were summarised and compared. Lastly, a thematic analysis was undertaken to explore the role of patients and families in the delivery of the approaches. Setting: General adult acute mental health treatment. Results: Six distinct family involvement models were identified: Calgary Family Assessment and Intervention Models, ERIC (Equipe Rapide d’Intervention de Crise), Family Psychoeducation Models, Family Systems Approach, Open Dialogue and the Somerset Model. Findings indicated that despite wide variation in the theoretical models underlying family involvement models, there were many commonalities in their components, such as a focus on communication, language use and joint decision-making. Thematic analysis of the role of patients and families identified several issues for implementation. This included potential harms that could emerge during delivery of the models, such as imposing linear ‘patient–carer’ relationships and the risk of perceived coercion. Conclusions: We conclude that future staff training may benefit from discussing the chosen family involvement model within the context of other theories of mental health. This may help to clarify the underlying purpose of family involvement and address the diverse needs and world views of patients, families and professionals in acute settings.
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The views and values of patients and families are often overlooked in service planning, leading to programs and services that do not address their needs and preferences.
“The views and values of patients and families are often overlooked in service planning, leading to programs and services that do not address their needs and preferences [39, 40].”
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- Authors
- Dirik, A., Sandhu, S., Giacco, D., Barrett, K., Bennison, G., Collinson, S., & Priebe, S.
- Affiliations
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
- Queen Mary University of London (GB)
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2017-09
- Volume
- 7
- Issue
- 9
- Pages
- e017680
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC5623469
- OpenAlex
- W2757731570
- Cited by
- 95
- References
- 85
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 15 · 2023: 9 · 2022: 21 · 2021: 12 · 2020: 10 · 2019: 10 · 2018: 2
- FWCI
- 0.92
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMJ Open (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by)
- Funders
- Research Trainees Coordinating Centre
- Topics
- Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
- Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- family involvement, acute psychiatric care, ERIC, family psychoeducation, family systems approach, open dialogue, diathesis-stress model, systems theory, shared decision-making, coercion, employee training, guideline implementation
- MeSH terms
- Acute Disease, Adult, Mental Disorders, Communication, Decision Making, Family, Humans, Professional-Family Relations, Research Design
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