Multi-Family Psycho-Education Group for Assertive Community
Treatment Clients and Families of Culturally Diverse
Background: A Pilot Study
Wendy Chow•Samuel Law•Lisa Andermann•
Jian Yang•Molyn Leszcz•Jiahui Wong•
Received: 9 January 2009/Accepted: 8 April 2010/Published online: 23 April 2010
? The Author(s) 2010. This article is published with open access at Springerlink.com
Family Psycho-education Group (MFPG) to an Assertive
Community Treatment Team developed to serve culturally
diverse clients who suffers from severe mental illness.
Participants included Chinese and Tamil clients and their
family members. Family members’ well-being, perceived
burden, and acceptance of clients were assessed before and
after the intervention. Focus group interviews with clini-
cians were conducted to qualitatively examine MFPG.
Family members’ acceptance increased after MFPG. Reg-
ular attendance was associated with reduction in perceived
family burden. Culturally competent delivery of MFPG
enhanced family members’ understanding of mental illness
and reduced stress levels and negative feelings towards
This study evaluates the incorporation of Multi-
treatment team ? Multi-family psycho-education ?
Severe and persistent mental illness
Cultural diversity ? Assertive community
Assertive Community Treatment (ACT) is a well-studied,
evidence-based, intensive and comprehensive treatment
that provides community psychiatric services for persons
who suffer from severe and persistent mental illness, such
as schizophrenia (Marshall and Lockwood 2000). Many
studies have shown that ACT services led to significant
reductions in relapse rates and symptoms, as well as
improvement in quality of life (Bond et al. 2004; McGrew
et al. 2002). The effectiveness of ACT specifically
designed for cultural diverse clients has also been dem-
onstrated (Yang et al. 2005).
Schizophrenia often impacts family relationships nega-
tively. Conversely, it has been shown that family burden
adversely affects clinical outcomes of clients (Perlick et al.
1992). Family functioning thus remains a key factor
influencing the treatment and recovery process. For
example, the Schizophrenia Patient Outcomes Research
Team (PORT) found that 83% of clients have families
living in close vicinity (Lehman and Steinwachs 1998;
Solomon et al. 1998), more than 80% have regular contacts
with their family members and 40–65% of clients live with
one or more family members. Families can be a vital
source of support and can contribute to improved quality of
life for clients with schizophrenia.
Indeed, family interventions are now considered to be
critical components in the treatment of schizophrenia. They
have been shown to improve communication between
W. Chow (&) ? S. Law ? L. Andermann
Assertive Community Treatment Team and Mental Health Court
Support Program, Community Mental Health Program,
Department of Psychiatry, Mount Sinai Hospital, Joseph and
Wolf Lebovic Health Complex and the University of Toronto,
260 Spadina Avenue, Suite 204, Toronto, ON M5T 2E4, Canada
Asian Initiative in Mental Health, Toronto Western Hospital,
399 Bathurst Street, East Wing, 9th Floor, Toronto,
ON M5T 2S8, Canada
M. Leszcz ? J. Sadavoy
Department of Psychiatry, Faculty of Medicine, University of
Toronto, Mount Sinai Hospital, Joseph and Wolf Lebovic Health
Complex, 600 University Avenue, Toronto, ON M5G 1X5,
Primary Care Program Design and Development Unit, Ministry
of Health and Long Term Care, 1075 Bay Street, 9th Floor,
Toronto, ON M5S 2B1, Canada
Community Ment Health J (2010) 46:364–371
family members and clients, reduce perceived family bur-
den, enhance linkages with the mental health system,
increase the rate of follow-up care and medication adher-
ence, reduce the risk of relapse by 15–25%, improve
remission of residual psychotic symptoms, encourage
employment and enhance social and family functioning
(Bustillo et al. 2001; Dixon et al. 2001; Lam and Dominic
1991; Lehman et al. 1995; McFarlane et al. 1995; Sherman
et al. 2005).
The McFarlane Multi-Family Psycho-education Group
(MFPG) is the leading approach used in North America for
families with persons who suffer from severe and persistent
mental illnesses (McFarlane et al. 1995). It is designed to
teach families coping and problem solving skills, increase
knowledge, and develop a support network. Compared to
single-family treatments, MFPG has been shown to be
especially effective in extending remission for clients who
are at high risk for relapse (McFarlane et al. 1995).
A culturally-modified version of MFPG has recently
been demonstrated to be effective in a group of non-Eng-
lish speaking, Vietnamese families living with schizo-
phrenia (Bradley et al. 2006). In this study, the authors
found significantly lower relapse rate and greater symptom
reduction in clients receiving MFPG intervention, com-
pared to a control group receiving standard case manage-
ment. Interestingly, the Vietnamese participants reported a
much higher level of family burden compared to a group of
English-speaking clients and families at the start of inter-
vention. This observation necessitates a closer examination
of family functioning in ethnic minority groups to identify
specific needs that should be addressed in MFPG
The cross-cultural literature suggests that Asian families
are different from mainstream culture in terms of their
perceived causes of mental illnesses, help-seeking behav-
iors and treatment preferences (Sadavoy et al. 2004), in
addition to differences in family structure and family
dynamics (Lee 1988). For example, studies have described
that delayed help-seeking behavior, particularly in cultur-
ally diverse groups such as Asian Americans with schizo-
phrenia, may lead to an increase in family burden, poor
treatment adherence, higher relapse rates, and lower utili-
zation of follow-up services (Chung and Lin 1994; Klein-
man 1980, 2004).
The pressures and stress of mental illness are high for
both clients and family members. In the Asian context, this
may be particularly remarkable. For example, most Asian
family activities are based around the extended family,
throughout the year. A family member who has mental
illness is invariably exposed to these family activities.
When faced with a member’s suffering and symptoms,
family members can often feel apprehensive, frustrated,
helpless, and guilty about the condition of the client. They
may also worry that psychiatric medications will bring
more harm than benefit for the member, and they may
express negative opinions about how the member is doing
and adversely affect the person’s self esteem, treatment
adherence, and attitude towards the illness. Issues of stigma
associated with mental illness often arise (Sirey et al.
2001). As well, the family member who suffers from
mental illness would highly value how he or she is per-
ceived by the rest of the family, as his or her social exis-
tence and support network is often contingent upon the
ability to function in family interactions; and this ability is
a critical measure of the member’s level of functioning and
recovery—both a source of value and stress. Overall, the
family context is important at multiple levels for many
Asian clients (Lin and Lin 1980).
The purpose of this study was to explore the acceptance
and effectiveness of a time-limited MFPG program using
the MFPG with ACT clients and family members from two
ethno-cultural minority groups; Chinese and Tamil. For the
first time, we also qualitatively examined the dynamics of
MFPG in a culturally diverse ACT context from the cli-
nicians’ perspective. We hypothesized that the MFPG
structure would be acceptable to families and clients of the
ACT team. MFPG would also significantly reduce per-
ceived burden and improve psychological and physical
well-being for family members. The descriptive aspect of
this study would enhance our current understanding of the
needs of culturally diverse clients who suffer from severe
mental illness and facilitate the design of culturally sensi-
This study was carried out by the Mount Sinai Hospital
Assertive Community Treatment Team (MSHACTT; Tor-
onto, Ontario, Canada), a unique program designed spe-
cifically for underserved clients from culturally diverse
backgrounds. The clinical effectiveness of this Team has
also been documented (Yang et al. 2005). The MSHACTT
provides culturally competent psychiatric treatment and
rehabilitation, especially, but not exclusively, to clients
from Asian communities. Forty-eight percent of the
MSHACTT clients are Chinese, and 20% are Tamil. The
rest (32%) are Vietnamese,
Korean, and African-
As an effort to reduce stigma and improve recruitment, a
psycho-social conference was held to introduce the project
to clients and families at a community restaurant. The team
Community Ment Health J (2010) 46:364–371365
researcher, three volunteer research assistants and the
MSHACT staff interviewed clients and their families for
the study. A large majority of clients and families agreed to
participate. Potential participants were given orientation
about the study purposes and procedures and signed a
consent form. The study was approved by the Mount Sinai
Hospital Research Ethics Board.
Two cohorts with a combined size of 14 ACTT clients
and 20 family members participated in the study. This
includes one cohort of Chinese ethnicity (7 clients and 11
family members) and one cohort of Tamil ethnicity (7 cli-
ents and 9 family members). Their demographic charac-
teristics are described in Table 1.
The McFarlane approach to MFG was adopted for its broad
evidence support and well-developed step-by-step instruc-
tion manual for professionals (McFarlane et al. 1991). Prior
to its implementation, the McFarlane team trained the
MSHACT Team in a two-day interactive role-play work-
shop. A preliminary survey was used to determine the time,
date and venue of the MFPG meetings. Since most Tamil
family members were new immigrants and needed trans-
portation assistance, group facilitators offered to pick them
up and drop them off before and after meetings. The Tamil
group meetings were held at a supportive housing boarding
home where most of the Tamil clients resided. In contrast,
the Chinese family members and clients preferred to have
meetings at the MSHACT office in Chinatown, Toronto.
Meetings occurred on weekends at noon, and lunch was
provided by the program in recognition of the symbolic
importance of eating together in the Asian culture. Group
members often brought dishes to share with others.
A 2-hour MFPG session was held once a month for
12 months. Each session was led by a supervisor supported
by two group facilitators who spoke the participants’ lan-
guage. These sessions were slightly modified to meet the
specific needs of ethno-cultural clients and family mem-
bers, addressing issues such as stigma and frustration over
the long-term pharmacological management (a session-by-
session outline is detailed in Appendix). For example, since
most Asian cultures prefer to use alternative medicine for
health maintenance over western medication for symptom
control, two sessions were dedicated to listening to con-
cerns, such as medication side effects and the continuous
use of medication even when clients appear to be func-
tioning normally again. More time was also spent talking
about the Canadian mental health system, such as the use
of emergency services, inpatient units and long-term care
facilities. In addition, during the first three sessions, group
facilitators focused on understanding the cultural normalcy
of their cohort. Montage and drawings were also used to
help participants express how family life might have
changed after the onset of mental illness.
Of the 14 clients and their respective family members, 6
(43%) completed the full 12 sessions, 2 (14%) completed
6–9 sessions, and 6 (43%) completed 2–3 sessions.
Quantitative Measure and Statistical Analyses
The Social Adjustment Schedule (SAS), Family Version
(Kreisman and Blumenthal 1985) was used. The SAS is a
reference scale designed to assess a variety of domains of
life satisfaction and perceived mental illness-related bur-
dens for family members. The SAS was translated into
Chinese by a bilingual Chinese researcher who had trans-
lated a variety of psychological instruments in published
studies. The Tamil version of the SAS was developed by a
Tamil professional translator. Trained volunteers con-
ducted structured interviews with family members 1 month
before and 3 months after the MFPG intervention. Paired t-
tests were then conducted to examine pre-and post-treat-
ment differences in 16 domains of the SAS scale.
To supplement the quantitative findings and learn more
about the dynamic process of MFPG, group facilitators
conducted a focus group following the final session of the
MFPG. Five ACT team staff members who had led the
MFPG intervention participated. During the hour-long
focus group, participants were asked open-ended questions
regarding their experience and their observations on the
Table 1 Demographics
Age(Mean ± SD) GenderLanguage
Ethnic language only (%)Ethnic language ? english (%)
ChineseClient (n = 7)38.6 ± 6.5 Female 29% (n = 2) 42 (n = 3)58 (n = 4)
Family member (n = 11)64.3 ± 11.6 Female 64% (n = 7) 73 (n = 8) 27 (n = 3)
Tamil Client (n = 7)37.6 ± 6.4 Female 14% (n = 1) 58 (n = 4)42 (n = 3)
Family member (n = 9)55.1 ± 17.9 Female 67% (n = 6) 56 (n = 5) 44 (n = 4)
Twelve clients (86%) were diagnosed with schizophrenia while 2 (14%) were diagnosed with schizoaffective disorder
366Community Ment Health J (2010) 46:364–371
impact of MFPG on patients and family members. Ques-
tions were followed by specific probes to clarify the
The focus group recordings and minutes were analyzed,
and a list of thematic categories was identified.
A questionnaire consisting of 36 specific items relating
to the themes discussed in the focus group was developed.
Group facilitators’ responses were transcribed and the
contents were analyzed according to their fit to the 36 items
and higher-order themes.
Part I. Quantitative Outcome: Family Members’
Firstly, the study has a participation rate of 57% families
a reasonable range, as compared to the literature: Sherman
et al. (2005), outlined that families’ participation in treat-
ment of serious mental illness in conventional outpatient
setting is a dismal 2–7%; Dyck et al. (2002) reported that
and Bradley et al. (2006) reported a combined refusal and
drop out rate of about 37% (participation rate of 63%).
The mean score of family members’ acceptance of their
client relatives was significantly increased (64.20 ± 13.90
vs. 76.30 ± 14.72, df = 13, P = 0.01). This acceptance is
even more pronounced in those who participated in more
than 50% of the sessions (n = 8, 61.38 ± 16.54 vs.
80.05 ± 17.02, df = 7, P = 0.01). We further did a rank
ordered correlation analysis and found that those who
attended more sessions had greater reduction in the area of
family burden (r = 0.5, P\0.05).
Although no significant changes were found in other
SAS variables, some positive trends were noted. These
changes included the family members’ perceived burden
of the client (17.92 ± 7.4 vs. 16.14 ± 6.2, df = 13,
P = 0.46), family members’ satisfaction with their own
physical health (2.69 ± 1.63 vs. 2.29 ± 1.63, df = 13,
P = 0.40), mental health (2.42 ± 1.21 vs. 2.00 ± 1.11,
df = 13, P = 0.37) and health in general (3.17 ± 1.87 vs.
2.7 1 ± 1.98, df = 13, P = 0.37).
Part II. Qualitative Study: Group Facilitators’
Several key themes emerged from the content analysis of
focus group transcripts. These themes are discussed in
Reduced Stigma and Shame, Isolation Among Family
Prior to the MFPG, family members felt a tremendous
stigma and sense of shame regarding their mentally ill rel-
atives. Family members worried that other people would
learn about their relatives’ mental illnesses, which may lead
to a loss in social support due to cultural stigma. Gradually,
family members avoided interactions with others in the
community and limited their social networks. Mental illness
became a taboo subject that they could not talk about or
share with anybody, even within the extended family. Since
all of the families were first generation immigrants, the
language barrier exacerbated their vulnerability to stigma
and discrimination. They lived with a high level of distress,
but received minimal social support. The families also
lacked access to information about their relatives’ illnesses,
treatment options, and support resources in the community.
The MFPG provided a safe venue where clients and
family members could meet and develop trust in each
other. They shared their unique experiences and percep-
tions without any fear of rejection.
ashamed and disappointed about her son who has mental
illness during the first few sessions. She said, ‘‘My hope is
gone and my son is finished. What else do you expect us to
do? How long can I hide the fact that he is not well?’’ After
the MFPG, she had a better understanding of the illness and
was able to speak more openly about her problems. She
shared about the violence at home and the client was
allowed to share his feelings of humiliation, hurt and anger
that resulted from family provocation. They were com-
fortable initiating discussions and seeking help when in
difficulty, rather than retreating to isolation which had been
the predominant behavioral pattern in the past.
A client’s mother was very sad,
Increase in Understanding of Client’s Condition
The family members gained a greater understanding of
clients’ mental illness through lectures given by our psy-
chiatrist, which helped to reduce disappointment and
frustration. Some families had particularly high expecta-
tions for clients to strive for academic and professional
excellence, which are common goals in the Asian culture.
However, chronic functional impairments can lead clients
to experience enormous shame, guilt, and fear, and can also
result in a tremendous sense of loss and hopelessness on
the part of the families. As family members learned that
clients’ low achievement was associated with mental ill-
ness rather than to undesirable personality traits, family
members’ attitude toward patients changed from blaming
and rejection to understanding, empathy and acceptance.
Community Ment Health J (2010) 46:364–371 367
unhappy about his unwillingness to work and his habit of
getting up late in the morning. They attributed these to the
client’s laziness. They said, ‘‘He could function more
normally but it’s just him being lazy.’’ After the inter-
vention, they understood that the client’s behavior was due
to his negative symptoms and the side effects of medica-
tion. They felt less frustrated and gave more concern and
support for the client. They would ask, ‘‘What are we
supposed to do when he refused to get up?’’ After the
MFPG, they lived in better harmony with the client which
subsequently resulted in less conflict and improved medi-
A client’s mother and sister were
Support From Other Family Members Through MFPG;
Decrease in Helplessness and Hopelessness
The group usually had 15 min for warm up and snacks.
Most of them brought food to share with others. They were
able to relax and get to know each other through sharing
dishes and tips on how to prepare them. More importantly,
family members learned that they were not alone in fight-
ing clients’ mental illness. They felt relieved, supported
and became willing to contact each other outside of the
group sessions. They also learned how to normalize the
experience of mental illness as a medical condition rather
than a personal failure. Participants felt hopeful in an
atmosphere of acceptance, empathy, and understanding.
Having a channel to express their concerns within a safe
environment reduced their tension and burdens. Some of
them also volunteered to be involved with group coordi-
nation for the next set of family group meetings.
Improvement in Client-Family Relationships
There are several ways through which MFPG may enhance
the relationship between clients and family members:
i. The newfound knowledge of mental illness may have
helped clients and family members to readjust their
expectations of each other and becoming more tolerant
and accepting of each other.
for more than 10 years. Her father, who was over 80 years
of age, had attempted to contact and connect with her by
various means. She would yell at him whenever he visited
her. After the family intervention, she became more
receptive of his offers and visits. She even gave him $50
dollars on his birthday, and said, ‘‘The money is for you.’’
The father was in tears.
A client refused to contact her parents
ii. There is a consensus among group facilitators that
MFPG helped increase family members’ awareness of
their role in patients’ recovery process and relapse
prevention. For example, family members realized
how negative communication patterns could induce
anxiety in clients or even trigger the relapse of mental
illness. This motivated family members to learn how
to communicate better with clients.
Group facilitators agreed that training in communi-
cation and problem solving skills improved the
interactions between family members and clients.
Through MFPG, family members and clients learned
how to communicate with each other more effec-
tively. Participants also learned to apply negotiation
skills to practical problem solving situations.
was concerned about whether they were safe. He asked,
up with your calling and cursing. Please stop calling or else
I’ll be killed by your craziness.’’ After the family interven-
‘‘We are fine, nobody is going to hurt us. Just relax and may
be we’ll meet on the weekend for lunch.’’ The client was
reassured and looked forward to meeting with his parents.
A client always called his parents and
Another client had long standing financial problems and
smoked at home against his mother’s wishes. After inter-
vention, he made an agreement with his mother to reduce
the frequency of smoking and to smoke outside of the
apartment. He also allowed his mother to assist him in
managing his money by creating a joint account. The client
managed to withdraw money each week within his means.
Mutual Enhancement of MFPG and ACT
The dual role of the clinician as a group facilitator in
MFPG and as a primary team member in ACT places him/
her in the ideal position to ensure delivery of both services
in a timely manner. ACT enhanced MFPG because clini-
cians could use their weekly ACT visits to follow up on the
assignments from the previous MFPG session, provide
assistance and reward positive changes. Evolving issues
relevant to the MFPG intervention could also be addressed
in a more timely fashion because of ACT. On the other
hand, MFPG facilitated ACT practice via improved com-
munication, understanding and trust among clinicians, cli-
ents and family members. The knowledge acquired from
MFPG sessions also helped family members and clients to
work more collaboratively and effectively with ACT cli-
nicians. For example, family members increasingly helped
with monitoring and reporting medication adherence and
side effects. They also aided the ACT Team by reporting
early signs of relapse and assisting in crisis intervention.
368Community Ment Health J (2010) 46:364–371
Importance of Cultural and Linguistic Matching Between
Clients/Family Members and Clinicians
The sharing of common culture and language allows in-
depth discussion of values, health beliefs and the use of
alternative medicine. Both verbal and non-verbal commu-
nications were also enhanced because of similar ethnic
Unfortunately, it is difficult to find a psychiatrist who
speaks a minority language and educates families about
mental illness without an interpreter. In this study, members
from the Chinese MFPG found the educational sessions
conducted by a Chinese-speaking psychiatrist particularly
helpful and informative. In contrast, we had to use an inter-
preter for an English speaking psychiatrist in the Tamil
MFPG. Some subtle but important points might have been
lost in translation; in-depth discussions also appeared
Several other issues were also raised in the focus
Although some family members reported that they
found the MFPG sessions helpful, they reverted to their old
behaviors and attitudes when in stress. The lack of con-
sistent participation in all MPFG sessions might have also
limited the potential benefits of the program. Irregular
attendance could be related to clients’ illness and/or their
chronically strained relationship with family members.
Some family members worried that their community
would get to know that they have mentally ill rela-
tives through gossip from other MFPG family members. In
this regard, an emphasis on confidentiality and more ethno-
attached to mental illness in the minority communities.
Another issue related to the diverse participants’
socioeconomic spectrum is the varying levels of education,
income and knowledge of mental illnesses among family
members. The types of symptoms, course of illness, and
level of functioning also differed from one client to
another. The challenge for group facilitators was thus to
help family members address common issues, such as
fighting stigma, developing trust and increasing self-con-
fidence. One way to make MFPG more beneficial to clients
and families is perhaps to tailor the format and content of
the sessions to meet specific needs of subgroups. For
example, the MFPG program may be followed by a series
of special talks in small groups addressing common
Our pilot study has shown that MFPG was effective with
culturally diverse populations in reducing family burden.
While other studies indicated significant benefits of family
psycho-education in improving client outcomes, our study
adversely affects clinical outcomes of major mental dis-
orders (Perlick et al. 1992). Interventions that reduce such a
burden could result in better client outcome, such as lower
hospitalization rates (Falloon and Pederson 1985).
Our qualitative study revealed dynamic changes that
occurred throughout MFPG. First, MFPG provided real life
narratives supporting the benefits of MFPG in reducing
family members’ perceived burden and improving their
overall well-being. It also emphasized the importance of an
ethno-cultural specific context for the success of MFPG,
which allowed participants to share experience and support
each other in their own language during and after sessions.
Second, we found decreased hostility and conflicts, and
better understanding, among family members and clients.
Communication skills training further helped family
members handle disagreements in productive ways. Third,
increased knowledge about mental illness impacted posi-
tively on participants’ beliefs about health maintenance,
medication and side effects. Family members learned to
observe for signs and symptoms of relapse and seek help
appropriately and in a timely fashion. Both clients and
family members also developed great trust towards staff,
which facilitated communication
A number of barriers made MFPG especially challeng-
ing for a culturally diverse population. These included
deep-rooted beliefs about health maintenance, stigma of
mental illness and a prevailing culture to ‘‘save face’’. The
fear of discrimination must be adequately addressed prior
to introducing MFPG. MFPG also requires a significant
commitment from participants and staff. To accommodate
the work schedules of family members, facilitators have to
be prepared to work on weekends. The moderate partici-
pation rate (57% completion), while is comparable to the
literature, may benefit from further effort. In this study, we
provided transportation assistance, food, and flexible
schedules to optimize attendance. Other strategies to
attempt may include: providing a small token monetary
appreciation, weekly scheduled reminders, larger propor-
tion of time dedicated to specific interests of the family
members (i.e. some departure from the MFPG protocol),
and certificate of attendance at end of the program, etc.
This study showed the level of family burden is high and
responded to MFPG. In turn, having the MFPG program to
be more psychologically in tune with the burden suffered
by the families, and finding ways to be practically sup-
portive from the beginning may further help with the par-
ticipation and satisfaction rates.
This pilot study is also unique in that it explores further
the ideas of implementing MFPG in an ACT setting—as
and the treatment
Community Ment Health J (2010) 46:364–371369
put forward earlier by McFarlane et al. (1992), and
McFarlane (1997)—that specifically serves ethnic minority
populations. There is a dearth of such dual implementation
in the literature, for no rational reasons, given how well
proven and established both MFPG and ACT are. Potential
barriers may still be, even for an ACT team, the extra
resources required for MFPG, the relative long duration for
its implementation, the time and energy required to
mobilize family members, and the (often misguided and
inflexibly held) need to preserve clients’ confidentiality
from family members, etc. One recent study from ACT
research in Japan found family involvement critical in its
success (Tamaki et al. 2008), and this pilot study’s out-
come helps to further establish this positive view, and may
advocate for ACT protocol to specifically implement
Furthermore, this pilot study described one of the first
MFPG programs for Chinese and Tamil clients and their
family members—ethnic cultures that are well known to
have strong family involvement. A randomized controlled
trial will be warranted to investigate the true effectiveness
of incorporating MFPG to ACT for ethno-specific minority
clients. Baseline and follow-up surveys with clients and
family members are also needed to identify other facilita-
tors and barriers influencing intervention outcomes.
Outline of 12-Session MFPG Model
Session 1: Introductions, principles, goals, common
emotions among consumers and family members.
Learning about the normative stages of emotional
reactions to the trauma of mental illness and under-
standing illness symptoms as a ‘‘double-edged sword.’’
Addressing issues of impact of stigma of mental illness
on client and family members. Perspectives and expe-
rience of obtaining mental health services when facing
language and cultural barriers.
Session 2: Overview: schizophrenia, learning how to
get through ‘‘Critical Periods’’ in mental illness, how a
diagnosis is made and characteristic features of psy-
chotic illnesses. What to do in the event of a crisis.
Session 3: Learning from each other. An opportunity
for each person to share his/her family’s personal story.
Session 4: Education session by our ACTT psychia-
trists. Basics about the brain: functions of key brain
areas; research on functional and structural brain
abnormalities in the major mental illnesses; chemical
messengers in the brain; genetic research. Eliciting
alternative impression of nature of illness, explanatory
models, and how modern views and traditional views
can inform each other and recognize differences.
Session 5: Problem solving skills workshop. Learning
how to define a problem; brainstorm, and choose
possible solutions. Focus on setting limits. Exploring
problem solving approaches and rationale for such.
Examine the fit of such skills to the explanatory model
above. Discuss limitations and expand on skill sets.
Session 6: Medication review, including side effects
and adherence issues, as well as learning how medica-
tions work and early warning signs of relapse. Explor-
ing the role of traditional healing, herbal medication,
and recognizing some potential benefit and advantages
and/or conflicts between multiple treatment modalities.
Session 7: Empathy workshop: a look at mental illness
from the consumer’s viewpoint. Understanding the
subjective experience of coping with a brain disorder;
problems in maintaining self-esteem and positive
identity; gaining empathy for the psychological strug-
gle to protect ones integrity in mental illness. Exploring
the western notion of empathy and the societal
expectations from family and professional workers.
Explore the notion of empathic care vs. paternalistic
care and more directive approach in Asian societies.
Session 8: Communication skills workshop: learning
effective ways to communicate with each other.
Learning how illness interferes with the capacity to
communicate: learning how to be clear; how to respond
when a topic is loaded; talking to the person behind the
symptoms of mental illness.
Session 9: Self-Care: Learning about family burden and
sharing, and handling negative feelings of anger,
entrapment, guilt and grief; balance in one’s life.
Examining the pre-migration role of family vs. post
migrational role shifts (if any), and realistic goal
setting. From the Mount Sinai ACT Health Concept
Survey in 2002, it was shown that more than 50% of the
clients and family members considered mental illness
to be caused by various stressors. Discussion on how
they can reduce stress through daily living skills.
Session 10: Rehabilitation and recovery; Learning from
each other how our clients are recovering from mental
Session 11: Fighting stigma; Advocacy, learning the
mental health system in Canada and how to express
their needs. The Asian concept of family is based on
extended family. and these core units include uncles,
aunts, cousins and their children. Discussions on how to
handle and fight with the stigma within themselves and
outside the family as well.
Session 12: Next steps, closing; celebrating the expe-
rience by recognizing their growth, support, friendship
and their learning, and planning for the next phase of
Family Education Group.
370 Community Ment Health J (2010) 46:364–371
Acknowledgments Download full-text
Hospital Assertive Community Treatment Team for directing and
facilitating the family psycho-education groups. We also thank Har-
old Chui for his editorial assistance, and Li Chu, Angel Qiu, and
Juanita Nathan for their administrative assistance.
The authors thank the staff of Mount Sinai
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