Successful Single Family Engagement

Be friendly

Listen

Be curious about families’ actual experience

Don’t censor empathic responses to tragic

events

Use the “Sorry” strategy

Come to terms with not being the only one with

knowledge and skills

Be responsive to requests and give practical

help as asked

Successful Multi-Family Engagement

Tell them it works

Model non- pathologising and non-judging

Reassurance about being better or worse than

others

Stigma busting

Reassurance about confidentiality

Help in managing symptoms

“What do I have to offer”

“What can other families offer me”

Psychoeducation Workshop What we are aiming for?

• Families feel well informed about current

biological, psychological and social information

and options for individual and family well being

• Families have felt able to share their experiences

with others

• Both ill and non-ill family members are viewed as

skilled and knowledgable

• Families engage well with each other

Psychoeducational Workshop

You are the dinner event host.......for a group of

people who are anxious, have special needs and

who don’t know each other

Psychoeducation Workshop Process

• Keep it interactive and explorative

• Encourage everyone to be involved

• Use inclusive language (Take a “we” and “us”

stance not a “they” stance)

• Accommodate many knowledges rather than

trying to impose one framework or a “right way”

• Float hypotheses and dilemmas to generate

discussion

• Promote “bilingualism” (psychiatric lingo as well

as the lived experience)

Psychiatric BilingualismPrivate Experience

Sensitive to stimulus: “I can taste and hear everything” “I’m super-sensitive”

Confusion: “scrambled newspaper”

Feeling overwhelmed: “There’s too much going on”

Distracted: “I can’t read or concentrate” “my head is racing all the time”

Special experiences “stuck on something” “It feels like the world is depending on me” “I thought I was God”

Feeling unsafe & suspicious

Finding it hard to sleep/ “I can’t sit still”

Psychiatric Terms

Disturbed Arousal and

Attention

Thought Disorder

Disorganisation

Delusions

Hallucinations

Withdrawal

Paranoia

Loss of motivation

Bilingualism

Working in families’ own language

Favourite metaphors of mental illness from

clients, families .. or yourself

Thoughts on Engagement“Everyone was treated equally. Coming to group made ill people feel not

ill” (M- non-ill partner)

“It was helpful that other people were being so open and nobody was treating you like an idiot. It gave me confidence to open up” There was that safety from disapproval and criticism and just not being understood” (B-non-ill mother)

“The skills of the workers in helping people feel confident to speak is very important” (Pa-ill family member)

“The group was a healthy shift in focus because it wasn’t too serious. There’d be food on the table, tea and coffee. It wasn’t a lot of long faces around the table. So there was a sort of lightness about it instead of a dead seriousness that sometimes happens” (B-carer mother)

Psychoeducation Workshop Content

Causes of mental illness

Common illness experiences

The role of medication and non-medical treatments

Family impact/ trauma

Families' sharing their lived experience

The service system

Coping skills that families find useful

It comes down to Arousal Attention and Integration

The relationship between arousal and attention is sensitive..

We need to be aroused on a sensory level to pay attention to the world around us

In a psychotic state, people are over-aroused. This means they find it hard to pay attention and to process information properly.

Low attention and arousal can result in negative symptoms

Brain Changes

• Prefrontal cortex (underactive)

Problem-solving, planning, attention, initiative, motivation

• Limbic system (overactive)

Heightened arousal

Cingulate cortex (underactive)

Emotional lability and disconnection of thoughts/feelings

Causes: The Likely Culprits

Some genetic predisposition –activation of underlying codes

–may be more so for illness consisting of negative symptoms

Some trauma impact (Brian Koehler, John Read (9.3X Psychosis)

–sensitisation to stress (cortisol pathways)

– purposeful adaptations

–may be more prevalent for illness consisting of positive symptoms

Some interactional stress (Helm Stierlin) –strategy for resolution of intractable conflict (intra personal, family and /or social)

–purposeful positioning

Stress Vulnerability Model

Variable individual stress thresholds

Biological and psychological vulnerability

Multiple stressors or triggers (primary & seocondary)

Family Communication Stress (EE)

High Expressed Emotion = Intensity, negativity and complexity (Leff & Vaughan)

e.g.• Critical comments• Over-involvement• Lack of warmth• Crowding• Excessive pressure to perform• Interactions with conflict• Multiple sources of input

or... Changes to family perceptions of ill person that lead to changed communication (Barrowclough)

Content: Available Treatment

Physical issues (Sleep, drugs, vitamins, natural remedies)

Medical treatment/ CTOs

Non-medical ways of dealing with primary impact (thinking skills, managing symptoms, managing arousal/ triggers)

Dealing with secondary impact (social skills, personal development, employment)

Content: Family Impact

Discarded ideas of families as causing mental illness (be up front about this)

How families deal with trauma impact

Changes to life cycles/family roles

Challenges to communication and conflict resolution

Coping skills

Options: Single Family work, Debriefing and Multi-family group work

Inner West MFG Evidence

Ill family members in the MFG had significantly less relapse than those who were in case management only

12% of MFG group vs 36% of CM group immediately after the group

25% of MFG vs 63% of CM group after 18 months

Significant reduction in psychiatric symptoms for families in MFG

Ill family members in the MFG were more involved in employment-related activities

Content: The service system

Outline the roles of the various teams including emergency options, case management and ISPs

Identify non-government psychiatric support services, centrelink and CRS services

Describe individual and family therapy services

Describe client and carer advocacy services mental illness fellowship, SANE, ARAFEMI

Content: Coping Skills• Revise expectations, temporarily

– be realistic– determine your own yardstick

• Keep the emotional environment low key– enthusiasm is normal; tone it down– disagreement is normal; tone it down

• Give people space– Time out is important for everyone– It is okay to offer. Its okay to refuse.

• Be clear about limits– Create reasonable rules for living together.– Rules and limits can help create a low key predictable home environment

Content: Coping Skills• Ignore the unimportant stuff

– No one can change everything at once.

• Keep communication simple– Discuss what you have to say to each other calmly, clearly and positively

• Be clear about the best use of medication– Let the doctor know about side effects or concerns– Keep track of medication usage

• Develop a normal family routine– Keep many family routines independent of the person with the illness

• Pick up early warning signs– take time to study and identify particular warning signs– discuss them at times of low tension– initiate contact with mental health workers

Ongoing Group: Format• socialising 10• go round (past two weeks) 20• defining a focus for work 10

• simple problem• narrative problem• solution focussed exceptions

• generate ideas (no holds barred) 10• toss around up and down side 20 • locate workable solutions 5• generate a plan with the family 5• socialising 10

Picking the problem

• Don’t ignore medication, safety or drug issues!

• Simplify• Narrow• Concentrate on behavior• Focus on relapse risk• Avoid crisis issues too complex or risky for

the group setting

Brainstorming

• All members can contribute

• All suggestions are welcome

• No suggestion is analyzed or critiqued during

brainstorming

• Suggestions are limited to 10 - 12 ideas

• The person with the identified problem chooses 1 -

2 suggestions to try

Taking Action

• An action plan is developed for the chosen suggestion(s)

• Tasks are identified and assigned• Consensus is achieved prior to leaving the

meeting• The plan is reviewed at the next meeting to

determine success or the need for further problem-solving

Working on ProblemsIt was great to have that creativity from the group by exploring it on

the whiteboard and then getting a photocopy on different issues and different suggestions (E- ill family member)

“It was a space where we could actually have mental health issues talked about. My dad and I had never spoken about it (E- ill family member)

“Being with people in the same boat means you are compelled to find solutions” (A-ill family member)

One older member talked about the importance of forgiving each other so their change in behaviour was not always as great as

their way of thinking” (A-facilitator)