Finding the Balance: Family inclusive practice in adult community mental health

Abstract

Despite family involvement and participation being strongly recommended in mental health services policies and guidelines, the evidence suggests that this is not always implemented effectively. It is evident from the literature that there are high levels of dissatisfaction among carers regarding their involvement or exclusion within mental health services. It has been increasingly recognised that families, friends and relatives of people with mental health problems have often felt unheard, and overlooked. The aim of this study was to explore family inclusive practice in Adult Community Mental Health in a District Health Board. The focus for the study was on what adult community mental health nurses and clinical managers consider to be barriers and facilitators to family inclusive practice. A descriptive qualitative design was used to explore the community mental health nurses and clinical managers’ perspectives of family inclusive practice. Participants were sampled from the local adult community mental service and semi-structured interviews were used as the means of data collection. Transcripts were thematically analysed which produced three major themes: ‘Great Expectations: getting pulled in all directions’, ‘Engaging Family: the many layers’, and ‘Foundations and Pillars: service delivery plus’. The findings highlighted that navigating competing expectations and demands was an everyday challenge for participants. Among the barriers identified by participants were the lack of a shared understanding of what is expected in regard to family involvement, by society, family, clinicians and mental health services. The lack of time, confidence and skills impacted on effective family inclusive practice, along with a disconnect between the ‘ideal’ and the ‘reality’ of embedding organisational policies related to family inclusion. However, this study found strong leadership in particular through the function of the multi-disciplinary team (MDT) and clinicians actively attempting to overcome barriers by being flexible and finding solutions to meet the needs of family to be key facilitators. It also found that participants were philosophically committed to the concept of family inclusive practice, with many considering this was occurring more frequently than the literature suggested. To address the barriers and enhance the facilitators identified in this study a collaborative model of approach is proposed in order to provide a firm foundation and enable family inclusive practice to be fully embraced and become part of usual practice.