What does "family involvement" in acute mental health care mean? A review of influential models

Introduction: Family/carer involvement is strongly recommended in clinical guidelines but often suffers from poor implementation. We approached this issue by exploring the fundamentals of why family involvement is conducted in... [ view full abstract ]

Introduction: Family/carer involvement is strongly recommended in clinical guidelines but often suffers from poor implementation. We approached this issue by exploring the fundamentals of why family involvement is conducted in the first place, including theoretical background, intervention components and the role of patients and families in the models.

Method: A multidisciplinary review team including academics, clinicians and individuals with lived experience of acute mental health services undertook a conceptual review. We identified key family involvement models (such as psychoeducation and Open Dialogue), assessed how they relate to their theoretical background and the components used to deliver them. We also explored how the delivery of the different family involvement models might be experienced by patients and families. Influential family involvement models were identified using a systematic search strategy. Information relating to the change theories and components of the models were extracted for a narrative synthesis and thematic analysis. Within our multidisciplinary meetings, we compared influential family involvement models and identified major commonalities and differences. 

Results: Findings indicated that despite large variation in the theoretical models underlying family involvement models, there were many commonalities in their components. A thematic analysis of the role of patients and families in the delivery of the models identified several potential issues for implementation.

Conclusions: We conclude that future clinical practice may benefit from more discussion about the change theories of family involvement models and how the different approaches might be experienced by patients and families.