A Family-Focused Intervention for Parental Mental Illness: A Practitioner Perspective

Background: Parental mental illness (PMI) is common and can lead to children developing mental disorders. Family Talk (FT) is a well-known and widely implemented intervention designed to reduce the risk of transgenerational psychopathology. However, given the research to practise “gap,” very little qualitative research, to date, has investigated practitioner experiences in implementing FT. This study aimed to explore the practitioner-perceived barriers and facilitators to the implementation and sustainability of FT within mainstream mental health settings.Methods: This qualitative study was nested within a randomised controlled trial (RCT) of Family Talk [N = 86 families (139 parents, 221 children)] within 15 adult (AMHS), child (CAMHS), primary care mental health, and child protection sites in Ireland. Semi-structured interviews and focus groups were undertaken with a purposive sample of clinicians (n = 31) and managers (n = 10), based on their experiences of implementing FT. Interview data were transcribed verbatim, analysed using constructivist grounded theory, and informed by Fixsen's implementation science framework.Results: Service providers highlighted a number of benefits for approximately two thirds of families across different diagnoses and mental health settings (AMHS/CAMHS/primary care). Sites varied in their capacity to embed FT, with key enablers identified as acquiring managerial and organisational support, building clinician skill, and establishing interagency collaboration. Implementation challenges included: recruitment difficulties, stresses in working with multiply-disadvantaged families, disruption in delivery due to the COVID-19 global pandemic, and sustainability concerns (e.g., perceived fit of FT with organisational remit/capacity, systemic and cultural barriers to change).Conclusion: This study is only the second qualitative study ever conducted to explore practitioner experiences in implementing FT, and the first conducted within the context of an RCT and national research programme to introduce family-focused practise (FFP) for families living with PMI. The findings illuminate the successes and complexities of implementing FFP in a country without a “think family” infrastructure, whilst highlighting a number of important generalisable lessons for the implementation of FT, and other similar interventions, elsewhere.

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Family Talk versus usual services in improving child and family psychosocial functioning in families with parental mental illness (PRIMERA—Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and children): study protocol for a randomised controlled trial

Trials ◽

10.1186/s13063-021-05199-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Mairead Furlong ◽

Sinead McGilloway ◽

Christine Mulligan ◽

Colm McGuinness ◽

Nuala Whelan

Keyword(s):

Mental Health ◽

Mental Illness ◽

Randomised Controlled Trial ◽

Psychosocial Functioning ◽

Controlled Trial ◽

Evidence Base ◽

Parental Mental Illness ◽

Research And Innovation ◽

Mental Health Settings ◽

Randomised Controlled

Abstract Background Parental mental illness is common and can lead to dependent children incurring a high risk of developing mental disorders, physical illness, and impaired educational and occupational outcomes. Family Talk is one of the better known interventions designed to prevent the intergenerational transmission of mental illness. However, its evidence base is small, with few robust independent randomised controlled trials, and no associated process or cost evaluations. The PRIMERA (Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and children) research programme involves a mixed method evaluation of Family Talk which is being delivered in mental health settings in Ireland to improve child and family psychosocial functioning in families with parental mental illness. Methods The study comprises a multi-centre, randomised controlled trial (RCT), with nested economic and process evaluations, to assess the clinical and cost-effectiveness and implementation mechanisms of Family Talk compared to usual services. The study is being conducted in 15 adult and child mental health settings in Ireland. Families with a parent with mental illness, and children aged 5–18 years (n = 144 families) will be randomised to either the 7-session Family Talk programme (n = 96) or to standard care (n = 48) using a 2:1 allocation ratio. The primary outcomes are child psychosocial functioning and family functioning. Secondary outcomes are as follows: understanding and experience of parental mental illness, parental mental health, child and parental resilience, partner wellbeing and service utilisation. Blind assessments will take place at pre-intervention and at 6- and 12-month follow-up. Discussion Given the prevalence and burden of intergenerational mental illness, it is imperative that prevention through evidence-based interventions becomes a public health priority. The current study will provide an important contribution to the international evidence base for Family Talk whilst also helping to identify key implementation lessons in the scaling up of Family Talk, and other similar interventions, within routine mental health settings. Trial registration ISRCTN Registry, ISRCTN13365858. Registered 5th February 2019.

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The Family Talk Programme in Ireland: A Qualitative Analysis of the Experiences of Families With Parental Mental Illness

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.783189 ◽

2021 ◽

Vol 12 ◽

Author(s):

Christine Mulligan ◽

Mairead Furlong ◽

Sharon McGarr ◽

Siobhan O'Connor ◽

Sinead McGilloway

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Disorders ◽

Qualitative Analysis ◽

Cultural Policy ◽

Controlled Trial ◽

Parental Mental Illness ◽

Family Experiences ◽

Family Approach ◽

Mental Health Settings

Background: Parental mental illness is common, costly, can lead to children developing mental disorders and impaired lifetime outcomes, and places a substantial burden on caregiving partners. Family Talk (FT) is a widely implemented, 7-session, whole-family programme, with promising evidence of effectiveness in targeting the intergenerational transmission of mental illness. However, to date, very little qualitative research of family experiences of FT has been undertaken. The objectives of this study were to: (1) investigate the experiences of families attending FT; and (2) explore the key facilitators and barriers to engagement in mainstream mental health settings.Methods: This study was nested within a randomised controlled trial (RCT) of Family Talk [N = 86 families (139 parents, 221 children)] implemented in 15 adult, child and primary care mental health sites in Ireland. Semi-structured interviews were conducted with a purposive sample of 45 participants, including 23 parents with mental illness (PMI), 7 partners and 15 children/young people aged 9 to 18 years. Interview data were transcribed verbatim and analysed using constructivist grounded theory.Results: Over two thirds of families across sites reported substantial benefits from participation in FT, including reduced stigma, giving children and partners a voice, increased service-user confidence, and improved family communication/relationships. Key facilitators identified by families included: programme delivery by a competent, non-judgmental clinician; the whole-family approach; and family readiness to engage. Barriers to engagement included stigma, family crises/relapse, service constraints, impact of COVID-19, and a need for further child, family and follow-up sessions/supports.Conclusion: This study is the first qualitative analysis of family experiences of FT to be conducted within the context of an RCT and national programme to introduce family-focused practise for families with PMI. The findings illustrate that FT is beneficial across cultural/policy contexts, different mental disorders and can be implemented across adult and child mental health settings, including children with existing mental health challenges. Key barriers and facilitators to implementation were identified by families, all of which should help to inform the future implementation of FT, and other similar interventions, both in Ireland and elsewhere.

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Family Talk Versus Usual Services In Improving Child And Family Psychosocial Functioning In Families With Parental Mental Illness (PRIMERA - Promoting Research And Innovation In Mental Health Services For Families And Children): Study Protocol For A Randomised Controlled Trial

10.21203/rs.3.rs-215175/v1 ◽

2021 ◽

Author(s):

Mairead Furlong ◽

Sinead McGilloway ◽

Christine Mulligan ◽

Colm McGuinness ◽

Nuala Whelan

Keyword(s):

Mental Health ◽

Mental Illness ◽

Randomised Controlled Trial ◽

Psychosocial Functioning ◽

Controlled Trial ◽

Evidence Base ◽

Service Utilisation ◽

Parental Mental Illness ◽

Mental Health Settings ◽

Randomised Controlled

Abstract Background: Parental mental illness is common and can lead to dependent children incurring a high risk of developing mental disorders, physical illness, and impaired educational and occupational outcomes. Family Talk is one of the better known interventions designed to prevent the intergenerational transmission of mental illness. However, its evidence base is small, with few robust independent randomised controlled trials, and no associated process or cost evaluations. The PRIMERA (Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and children) research programme involves a mixed methods evaluation of Family Talk which is being delivered in mental health settings in Ireland to improve child and family psychosocial functioning in families with parental mental illness.Methods: The study comprises a multi-centre, randomised controlled trial (RCT), with nested economic and process evaluations, to assess the clinical and cost effectiveness and implementation mechanisms of Family Talk compared to usual services. The study is being conducted in 15 adult and child mental health settings in Ireland. Families with a parent with mental illness, and children aged 5-18 years (n = 144 families) will be randomised to either the 7-session Family Talk programme (n = 96) or to standard care (n = 48) using a 2:1 allocation ratio. The primary outcomes are child psychosocial functioning and family functioning. Secondary outcomes are: understanding and experience of parental mental illness, parental mental health, child and parental resilience, partner wellbeing and service utilisation. Blind assessments will take place at pre-intervention, and at 6-, 12-month follow up.Discussion: Given the prevalence and burden of intergenerational mental illness, it is imperative that prevention through evidence-based interventions becomes a public health priority. The current study will provide an important contribution to the international evidence base for Family Talk whilst also helping to identify key implementation lessons in the scaling up of Family Talk, and other similar interventions, within routine mental health settings.Trial registration: ISRCTN Registry, ISRCTN13365858. Registered 5th February 2019. http://www.isrctn.com/ISRCTN13365858

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Promoting physical health among people with enduring mental illness: a qualitative study of healthcare providers’ perspectives

BMJ Open ◽

10.1136/bmjopen-2020-044855 ◽

2021 ◽

Vol 11 (4) ◽

pp. e044855

Author(s):

Claire Collins ◽

Pearse Finegan ◽

Marie O'Shea ◽

James Larkin ◽

Ivana Pericin ◽

...

Keyword(s):

Mental Health ◽

Mental Illness ◽

Qualitative Study ◽

Physical Health ◽

Service Providers ◽

Healthcare Providers ◽

Structured Interviews ◽

Management Communication ◽

Health Service Providers ◽

Regular Contact

BackgroundPeople with enduring mental illness (EMI) have higher morbidity and mortality from chronic diseases than the general population, and this results in a signiﬁcantly reduced relative life expectancy—accounted for primarily by physical illness. This gap may be partly influenced by the reduced likelihood of access to and uptake of regular physical health screening.AimTo establish Irish service providers’ perspectives regarding the care of the physical health of people with EMI in an effort to inform future service developments aimed at improving the physical health of people with EMI.Design and settingQualitative study of healthcare providers—general practitioners (GPs) and members of the community mental health teams—in Ireland.ParticipantsGPs and mental health service providers.MethodsQualitative semi-structured interviews were conducted with 34 service providers. Thematic analysis was undertaken.ResultsParticipants considered that the physical health of people with EMI is not currently regularly addressed by the patient’s GP or the mental health team. Factors associated with this include patient compliance with attendance, time constraints in consultations to adequately support patient self-management, communication difficulties with the patient and between primary and secondary care, and lack of clarity as to whose responsibility it is to ensure physical health is monitored. In participants’ view, a barrier to improvement is the present funding approach.ConclusionThe evidence from this study has the potential to form the basis for innovation and change in service delivery for people with an EMI in Ireland and internationally, specifically in countries where it is not clear who has the overall responsibility to monitor the physical health of patients with EMI. This role requires time and regular contact, and both the organisation and the funding of the health system need to support it.

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Creating a ‘reverse’ integrated primary and mental healthcare clinic for those with serious mental illness

Primary Health Care Research & Development ◽

10.1017/s1463423615000523 ◽

2015 ◽

Vol 17 (05) ◽

pp. 421-427 ◽

Cited By ~ 5

Author(s):

Alexandros Maragakis ◽

Ragavan Siddharthan ◽

Jill RachBeisel ◽

Cassandra Snipes

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Illness ◽

Quality Of Care ◽

Serious Mental Illness ◽

Mental Healthcare ◽

Policy Reforms ◽

Mental Health Settings ◽

Primary Care Practitioners

Individuals with serious mental illness (SMI) are more likely to experience preventable medical health issues, such as diabetes, hyperlipidemia, obesity, and cardiovascular disease, than the general population. To further compound this issue, these individuals are less likely to seek preventative medical care. These factors result in higher usage of expensive emergency care, lower quality of care, and lower life expectancy. This manuscript presents literature that examines the health disparities this population experiences, and barriers to accessing primary care. Through the identification of these barriers, we recommend that the field of family medicine work in collaboration with the field of mental health to implement ‘reverse’ integrated care (RIC) systems, and provide primary care services in the mental health settings. By embedding primary care practitioners in mental health settings, where individuals with SMI are more likely to present for treatment, this population may receive treatment for somatic care by experts. This not only would improve the quality of care received by patients, but would also remove the burden of managing complex somatic care from providers trained in mental health. The rationale for this RIC system, as well as training and policy reforms, are discussed.

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Personality disorder co-morbidity in primary care ‘Improving Access to Psychological Therapy’ (IAPT) services: a qualitative study exploring patient perspectives on treatment experience

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465820000594 ◽

2020 ◽

pp. 1-15

Author(s):

Gary Lamph ◽

John Baker ◽

Tommy Dickinson ◽

Karina Lovell

Keyword(s):

Mental Health ◽

Primary Care ◽

Personality Disorder ◽

Qualitative Study ◽

Patient Group ◽

Stepped Care ◽

Research Approach ◽

Structured Interviews ◽

Framework Analysis ◽

Co Morbidity

Abstract Background: High numbers of people present with common mental health disorders and co-morbid personality disorder traits in primary care ‘Improving Access to Psychological Therapies’ (IAPT) services in England and they receive sub-optimal treatments. No previous studies have explored the treatment experiences or needs of this patient population in England. Aims: This qualitative study explored the treatment experiences of patients (n = 22) with common mental health difficulties and co-morbid personality disorder as indicated by a score of 3 or more on the ‘Standardised Assessment of Personality – Abbreviated Scale’ (SAPAS) in receipt of primary care-based IAPT treatment. Method: A qualitative health research approach was used. Qualitative individual face-to-face semi-structured interviews were conducted. All interviews were audio recorded, data were transcribed verbatim and analysed using a framework analysis approach. Results: Findings revealed a need to adapt away from prescriptive cognitive behavioural therapy (CBT) treatment models towards more flexible, personalised and individualised treatment with this patient group. Time to emotionally offload, build a therapeutic relationship and link past experiences to presenting problems were highlighted as important. Conclusions: For the first time, the needs and treatment experiences of this patient group have been explored. This paper provides a unique patient experience insight that should be considered when exploring new approaches to working with and developing effective interventions via a stepped care approach.

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“Hear me out”: Experiences of mothers suffering from severe mental illness with health care providers – A qualitative perspective

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1835 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s899-s899 ◽

Cited By ~ 1

Author(s):

D. Banerjee ◽

G. Desai ◽

P.S. Chandra

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Illness ◽

Severe Mental Illness ◽

Health Care Providers ◽

Service Providers ◽

Care Providers ◽

Structured Interviews ◽

Seeking Help ◽

Competing Interest

BackgroundContrary to popular myth, majority of mentally ill women are mothers with increasing number of them seeking help. Little is known about their own experiences in this regard and the extent to which their needs are met.ObjectivesTo assess the barriers and facilitators in seeking help from mental health care providers in matters of pregnancy and parenting.MethodsThe study used qualitative design with social constructivist paradigm. A purposive sample of 30 mothers with severe mental illness was obtained. Data was collected through one-to-one in-depth semi-structured interviews. After verbatim transcription, inductive thematic analysis was used to explore transcripts.ResultsMost women considered motherhood “central” to their lives and almost all of them experienced the burden of the “dual role”. Main barriers in seeking help were stigma, treatment side effects, wrong information and time constraints. Whereas self-advocacy, early engagement, education of women and involvement of the family with service providers were the facilitating factors. The prime expectations of the mothers as identified were early and direct communication, patient audience and basic guidance in regards to child health and parenting issues.ConclusionWomen who are mothers and also users of mental health services face special challenges in managing the contradictory aspects of their dual identity. Hearing their voices are essential for service provision and ensuring adequate mental health needs. Early and direct intervention along with understanding and addressing critical areas are necessary for proper care of both the mother and child.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Family Planning for Women With Severe Mental Illness in Rural Ethiopia: A Qualitative Study

10.21203/rs.3.rs-73444/v1 ◽

2020 ◽

Author(s):

Tigist Zerihun ◽

Katherine Sorsdahl ◽

Charlotte Hanlon

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Illness ◽

Family Planning ◽

Mental Health Services ◽

Qualitative Study ◽

Health Services ◽

Reproductive Age ◽

Family Planning Services ◽

Care Services

Abstract Background: Family planning is a crucial issue for all women of reproductive age, but in women with severe mental illness (SMI) there may be particular challenges and concerns. As primary care-based mental health services are expanding in low- and middle-income countries (LMICs), there is an opportunity to improve family planning services for women with SMI. However, research exploring unmet family planning needs of women with SMI in such settings is scarce. Therefore, the present study explored the family planning experiences, unmet needs and preferences of women with SMI who reside in a predominantly rural area of Ethiopia Methods: A qualitative study design was used. Women with SMI who were participating in the ongoing population-based cohort study in Butajira were selected purposively on the basis of responses to a quantitative survey of current family planning utilization. In-depth interviews were conducted with 16 women with SMI who were of reproductive age. Audio files were transcribed in Amharic, translated into English and analyzed using the Framework Approach using Open Code qualitative data analysis software. Results: Participants reported pervasive effects of SMI upon the intimate relationships and sexual life of women. Although women with SMI felt that family planning was important, they had limited knowledge of family planning generally and a lack of understanding of the specific family planning needs relevant to having SMI. None of the women with SMI in the present study had received any recommendations to use family planning services while accessing mental health care services. The participants identified ways in which primary care-based mental health services could better meet their family planning needs. Conclusion: This study has provided in-depth perspectives from women with SMI about the broader context of their family planning experience, needs, barriers and how integrated primary care services could better meet their needs. Empowerment of women with SMI to access information and services needs to be an important focus of future efforts to improve the reproductive experiences of this vulnerable group.

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Maori cultural adaptation of a brief mental health intervention in primary care

Journal of Primary Health Care ◽

10.1071/hc12231 ◽

2012 ◽

Vol 4 (3) ◽

pp. 231 ◽

Cited By ~ 8

Author(s):

Fiona Mathieson ◽

Kara Mihaere ◽

Sunny Collings ◽

Anthony Dowell ◽

James Stanley

Keyword(s):

Mental Health ◽

Primary Care ◽

Psychological Distress ◽

Controlled Trial ◽

Behavioural Therapy ◽

Self Management ◽

Structured Interviews ◽

Post Intervention ◽

Mental Health Patient ◽

Intervention Delivery

INTRODUCTION: There are no brief psychological mental health interventions designed specifically for Maori in a primary care setting. AIM: To adapt an existing cognitive behavioural therapybased, guided self-management intervention for near-threshold mental health syndromes in primary care, for Maori, and to examine its acceptability and effectiveness. METHODS: Semi-structured interviews with primary care clinicians and Maori patients were conducted to inform adaptations to the intervention. Clinicians were then trained in intervention delivery. Patients were recruited if they self-identified as Maori, were aged 1865 years, were experiencing stress or distress and scored =35 on the Kessler-10 (K10) measure of global psychological distress. Patient and clinician satisfaction was measured through a questionnaire and semi-structured interviews. Post-intervention, patients mental health status was measured at two weeks, six weeks and three months. RESULTS: Maori adaptations included increased emphasis on forming a relationship; spirituality; increased use of Maori language and changes to imagery in the self-management booklets. Nine of the 16 patients recruited into the study completed the intervention. Patients and clinicians rated the intervention favourably and provided positive feedback. Improvement was seen in patients K10 scores using intention-to-treat rated global psychological distress following intervention. DISCUSSION: This study found that it was not difficult to adapt an existing approach and resources, and they were well received by both providers and Maori patients. Further research is required with a larger sample utilising a randomised controlled trial, to establish whether this approach is effective. KEYWORDS: Primary health care; Maori mental health; patient satisfaction; brief intervention

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Veterans Health Administration staff experiences with suicidal ideation screening and risk assessment in the context of COVID-19

PLoS ONE ◽

10.1371/journal.pone.0261921 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261921

Author(s):

Summer Newell ◽

Lauren Denneson ◽

Annabelle Rynerson ◽

Sarah Rabin ◽

Victoria Elliott ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Suicidal Ideation ◽

Health Staff ◽

Veterans Health ◽

Health Administration ◽

Structured Interviews ◽

Mental Health Staff ◽

Populations At Risk ◽

Mental Health Settings

Universal screening for suicidal ideation in primary care and mental health settings has become a key prevention tool in many healthcare systems, including the Veterans Healthcare Administration (VHA). In response to the coronavirus pandemic, healthcare providers faced a number of challenges, including how to quickly adapt screening practices. The objective of this analyses was to learn staff perspectives on how the pandemic impacted suicide risk screening in primary care and mental health settings. Forty semi-structured interviews were conducted with primary care and mental health staff between April-September 2020 across 12 VHA facilities. A multi-disciplinary team employed a qualitative thematic analysis using a hybrid inductive/deductive approach. Staff reported multiple concerns for patients during the crisis, especially regarding vulnerable populations at risk for social isolation. Lack of clear protocols at some sites on how to serve patients screening positive for suicidal ideation created confusion for staff and led some sites to temporarily stop screening. Sites had varying degrees of adaptability to virtual based care, with the biggest challenge being completion of warm hand-offs to mental health specialists. Unanticipated opportunities that emerged during this time included increased ability of patients and staff to conduct virtual care, which is expected to continue benefit post-pandemic.

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