Exploring the delivery of family interventions to people facing recent-onset psychotic symptoms: the experience of navigating the family system

The experience of an episode of psychosis can be distressing and confusing. Families can encounter issues of grief and loss and may have difficulties navigating complicated healthcare structures. Family interventions (FIs) have been under-researched and have been difficult to implement in general clinical practice. Healthcare systems usually concentrate resources on acute and inpatient services. The delivery of evidence-based psychosocial treatments which support families are often overlooked. Part 1: A systematic review of the quantitative research literature on the effects of FIs on relapse and rehospitalisation in people with recent-onset psychosis was conducted. Searches of four bibliographic databases were completed and ten studies met the criteria for inclusion. FIs were either delivered as a discrete intervention or as part of a multi-element intervention. Findings highlighted that multi-element interventions were effective in reducing time spent in hospital. These treatment gains were robust and conferred long-term advantages. FIs delivered as a discrete intervention had mixed success in reducing the likelihood of readmission. However, there was some evidence that they reduced time in supported living environments as a whole. FIs have some success in reducing relapse and readmission for people with recent-onset psychosis. There have been difficulties in implementing FIs in routine clinical services. Existing research has focused on exploring family workers’ experiences with questionnaires. Further in-depth research is required to capture their experiences in rich detail. Part 2: The research study used Interpretative Phenomenological Analysis (IPA) to investigate the experience of delivering FIs to people with recent-onset psychosis and their families. Five care coordinators from early intervention psychosis (EIP) services were interviewed. Five superordinate themes were identified: A) External supports to delivering family work, B) Balancing the care coordinator and family worker roles, C) Barriers to engaging families, D) The internal world of the family worker and E) Family communication and relationships. The themes were considered in relation to the current understanding of FIs and the wider psychological literature. The findings highlight the need for establishing supportive and enabling conditions for FIs to thrive. Family workers face many clinical dilemmas and conflicts in the course of the work. It is important that high-quality clinical supervision is appropriately provisioned in order to help navigate these. Part 3: The researcher’s reflective account of the research journey. This incorporates the logistical processes, strengths and weaknesses of the study and personal learning as a critical appraisal.