Preferences for Family Involvement in Care Among Consumers With Serious Mental Illness
ABSTRACT OBJECTIVE: Despite robust evidence of efficacy, family services for individuals diagnosed as having serious mental illness are of limited availability and drastically underutilized. This underutilization may be due to a mismatch between consumer and family preferences and the services offered. This study is the first systematic report on preferences expressed by consumers with serious mental illness for family involvement. METHODS: The study enrolled 232 mental health consumers with serious mental illness who had contact with family but did not have any family regularly involved in their mental health care. Consumers were recruited from outpatient mental health clinics at three large medical centers in two Veterans Integrated Service Networks. Interviews elicited demographic characteristics, treatment preferences regarding family involvement, and perceived benefits and barriers to involvement. Chart diagnoses and measures of symptom severity, family functioning, and contact were collected. RESULTS: Seventy-eight percent (171 of 219) of the consumers wanted family members to be involved in their care, and many desired involvement through several methods. Consumers were concerned with the impact of involvement on both themselves and their family member. The consumer's degree of perceived benefit of family involvement significantly predicted the degree of desire for family involvement after analyses controlled for service need (family conflict, family-related quality of life, and symptom severity), enabling factors (family contact and family capacity), demographic variables (age, gender, race, living with family, and marital status), and barriers perceived by the consumer. CONCLUSIONS: The extent of overall support for family involvement in care coupled with the heterogeneity of preferred modes and concerns and anticipated benefits underscore the imperative to offer diverse family services and to elicit consumers' preferences regarding whether and how to involve their families.
- Australasian Psychiatry 06/2013; 21(3):213-215. DOI:10.1177/1039856213486217 · 0.56 Impact Factor
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ABSTRACT: OBJECTIVE The Recovery-Oriented Decisions for Relatives' Support (REORDER) intervention is an innovative, manualized protocol utilizing shared decision-making principles with persons who have serious mental illnesses to promote recovery and encourage consideration of family involvement in care. This study compared REORDER to enhanced treatment as usual in a randomized design. METHODS Participants included 226 veterans with serious mental illness whose relatives had low rates of contact with treatment staff. REORDER involved up to three consumer sessions followed by up to three relative educational sessions if the consumer and relative consented. Individuals were assessed at baseline and six months later. RESULTS Eighty-five percent of the 111 randomly assigned REORDER participants attended at least one REORDER consumer session; of those, 59% had at least one family session. REORDER participants had significantly reduced paranoid ideation and increased recovery at follow-up. CONCLUSIONS Participation in REORDER led to marked increases in family participation and improved consumer outcomes.Psychiatric services (Washington, D.C.) 11/2013; 65(1). DOI:10.1176/appi.ps.201300074 · 1.99 Impact Factor
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ABSTRACT: Objective: Many older persons with serious mental illness (SMI) suffer from high rates of comorbid medical conditions. Although families play a critical role in psychiatric illness management among adults with SMI, their contributions to improving health outcomes in this population has received little attention. This study explored family involvement in medical care for older adults with SMI. Methods: This mixed methods study involved analysis of quantitative data collected from older adults with SMI and cardiovascular risk (n = 28) participating in a pilot study of an intervention designed to improve patient-centered primary care augmented by qualitative interviews with their relatives (n = 13) to explore family involvement in medical care. Results: Approximately 89% of older adults with SMI reported family involvement in at least one aspect of their medical care (e.g., medication reminders, medical decision making). However, many family members reported that they were rarely involved in their relative's medical visits, and most did not perceive a need to be involved during routine care. Family members identified obesity as their relative's primary health concern and many wanted guidance from providers on effective strategies for supporting weight loss. Conclusions: Although many family members did not perceive a need to be involved in their relative's routine medical visits, they expressed interest in talking with providers about how to help their relative change unhealthy behaviors. Educating patients, families, and providers about the potential benefits of family involvement in medical care, including routine medical visits for persons with SMI and cardiovascular health risk may promote patient- and family-centered collaboration in this high-risk population.The International Journal of Psychiatry in Medicine 01/2014; 48(2):121-33. DOI:10.2190/PM.48.2.e · 0.81 Impact Factor