Family Psychoeducation for Serious Mental Illness PDF
Preview Family Psychoeducation for Serious Mental Illness
family psychoeducation for serious mental illness EVIDENCE-BASED PRACTICES SERIES series editors: David E. Biegel, Ph.D. Elizabeth M. Tracy, Ph.D. Mandel School of Applied Social Sciences, Case Western Reserve University Family Psychoeducation for Serious Mental Illness Harriet P. Lefl ey The Evidence-Based Practices Series is published in collaboration with the Mandel School of Applied Social Sciences at Case Western Reserve University. FAMILY PSYCHOEDUCATION FOR SERIOUS MENTAL ILLNESS Harriet P. Lefl ey 1 2009 1 Oxford University Press, Inc., publishes works that further Oxford University's objective of excellence in research, scholarship, and education. oxford new york Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto with offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Copyright © 2009 by Oxford University Press, Inc. Published by Oxford University Press, Inc. 198 Madison Avenue, New York, New York 10016 www.oup.com Oxford is a registered trademark of Oxford University Press All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. Library of Congress Cataloging-in-Publication Data Lefl ey, Harriet P. Family psychoeducation for serious mental illness / Harriet P. Lefl ey. p. cm.—(Evidence-based practices) Includes bibliographical references and index. ISBN 978-0-19-534049-5 1. Mental illness—Treatment. 2. Family psychotherapy. 3. Evidence-based psychiatry. I. Title. RC480.L435 2009 616.89'156--dc22 2008046056 1 3 5 7 9 8 6 4 2 Printed in the United States of America on acid-free paper This book is dedicated to consumers with serious mental illness, and to the families and friends who love them. This page intentionally left blank PREFACE W hen I was asked to contribute a book to a series on evidence-based practices in mental health treatment, I could only claim some degree of expertise in family psychoeducation for schizophrenia and other serious mental disorders. However, this is not my personal area of research. I must rely on the work of the greats in this fi eld, the pioneers whose work I have noted in the Acknowledgments section. A lthough my research has been in other areas of mental illness, family psycho- education and family education have been a major source of interest to me for at least a quarter of a century. This book focuses on family psychoeducation, which targets eff ects of family interventions on the persons with mental illness. However, I am including a substantial section on family education, which targets the needs of their families for coping skills. (Further distinctions between these two concepts will be carefully discussed in Chapter 2 . ) Mental illness has a huge impact on fami- lies, and alleviating psychological distress in caregivers is a legitimate c oncern for mental-health professionals. S everal important books have been written about various models of family psychoeducation and numerous overviews of the research can be found in the l iterature. To the best of my knowledge, most of these are cited here and hopefully integrated into a larger picture of what is actually going on in the fi eld today. To this end, I have also included descriptions of programs that are not readily available in scientifi c journals. This book covers a wide range of models, from randomized c ontrolled studies to ongoing brief educational courses, with and without evalu- ation data. The selection is based primarily on family psychoeducation programs with rigorous research designs and outcome data, those that exemplify evidence- based practice. However, briefer family education models are also included, con- tingent on available research fi ndings, but also on a program's longevity, updated VII VIII PREFACE manualization, and number of people served. I have tried to give as broad and inclusive a picture as possible of what is actually off ered to families of individuals with serious mental illness today, and apologize for any inadvertent omissions. F or practitioners wishing to implement evidence-based family psychoedu- cation, with full fi delity to the research model, the most valuable resource is the f amily psychoeducation toolkit developed primarily by Dr. William McFarlane and Dr. Lisa Dixon, under the auspices of the Substance Abuse and Mental Health Ser- vices Administration (SAMHSA). The toolkit is available online and in manual form (see Department of Health and Human Services, 2003, and www.samhsa.gov ). During the last quarter century, family psychoeducation has proved effi cacious in signifi cantly deterring relapse and re-hospitalization in patients with schizo- phrenia, bipolar disorder, and various other diagnostic categories, and in many cases enhancing families’ well-being. Although most of the research has focused on schizophrenia, this intervention has proved benefi cial across a range of severe psychiatric disorders. But evidence-based family psychoeducation has reached at best a few thousand families. National Alliance on Mental Illness's (NAMI) Family-to-Family has been taught to over 125,000 families. Some empirical data are now available for the eff ectiveness of this program, as well as for Journey of Hope. Because there have been numerous other attempts to provide family education, I decided to include a description of some of these other models, with whatever data have become available on their outcomes. These may be helpful to clinicians who wish to implement their own programs, but lack the resources a vailable in well-funded research projects. For the past quarter century I have also been engaged in leading a psychoedu- cational support group for families of people with severe mental illness at one of the largest psychiatric centers in the southeast. This is an open-ended group, a free service available to the public as well as to families of our patients. Families come and go according to need. Some come only during a crisis. Others have come consistently for ten or more years. Over the years thousands of families have told me their stories. W hen I speak about family experiences and family burden in the forthcoming pages, much of what I say will be derived from stress theory and from the copi- ous research on family burden. But research data provide a picture that is only as comprehensive as the questions asked and answered. Few of the instruments that measure stressful life events or family burden deal with patients’ access to hospi- talization, legal constraints, or other aspects of mental-health systems that impede timely treatment and cause frustration and grief to families. Nor do the research instruments mention the eff ects of incorrect theories and ineff ective treatments on the psychological well-being of families. Distancing behaviors and failure to communicate on the part of mental-health staff are serious aspects of family bur- den, but they are not found in the measurement scales. Many issues that arise in PREFACE IX support-group discussions regarding malfunctioning mental-health systems, which manifestly contribute to family disorder, are not found in the literature. So, some of the observations in this book will be based on my years of listening to families, as well as on citations from theory and research. In the main, I have tried to present a comprehensive picture of what is currently available to educate caregivers of people with serious mental illness, to distinguish the aims of family psychoeducation and family education, and to present an argu- ment for the usefulness of both. At the end, I speak of the potential for introducing family psychoeducation as standardized treatment in mental-health systems, and what we can expect for the future. C linicians and clinicians-in-training are well aware of the importance of social context for recovery from mental illness. In current mental-health systems, not only service providers, but other patients—consumers in recovery—are fulfi ll- ing a long-needed, tremendously important role in helping people recognize their strengths and lead satisfying lives. But for many consumers, families may be even more critical, because caring, knowledgeable family members are lifetime support systems. It is clear that they need information and understanding from the clini- cians who treat their loved ones. I hope this book fulfi lls its aim of educating men- tal-health professionals on the importance of educating families, friends, and all others concerned with the welfare of persons with serious mental illness.
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