Home is where the help is

Starting the conference strong, this correspondent’s first symposium was on Family and Severe Mental Disorders: A Clinical and Training Perspective, chaired by Professors Massimo Clerici and Tamas Kurimay.

Keeping it in family

Prof. Kurimay opened the discussions by talking about his experiences with a family-centred, systemic-network approach to psychiatry. In particular, he focused on the benefits, challenges, and potential approaches of more closely involving families in patient care.

In an age of dwindling healthcare budgets, Prof Kurimay highlighted the impact of using family as a resource, as they can:

• Collaborate with the Doctor
• Aid adherence to treatment
• Encourage proper diet
• Provide emotional support, hope and encouragement
• Ensure the patient continues to be involved in family life

From a psychiatrist’s point of view, training in family skills is important, as effective family interactions can also:

• Extend the Doctor’s influence
• Improve patient outcomes
• Reduce caregiver burnout
• Increase family resilience

The challenges of getting closer

However, despite the benefits of involving the family, there can still be resistance from psychiatrists due to the complicated, fragmented and time-consuming nature of family interactions.

Prof Kurimay and Prof Clerici both strongly supported the need for effective training for residents in skills relating to family management and family-orientated psychiatric practice. They noted that training in these skills is actually recommended by the guidelines, but in practice, implementation of this training is falling short.

The Italian job

The final presentation in the session was from Doctor Daniele Carretta, a resident in a northern Italian mental healthcare trust, which (in the opinion of this correspondent) brought an interesting ‘ground-level’ view of the practical application of a family-orientated approach.

Family is a particularly emotive topic in Italy, where families are the main source of caregiving for patients suffering from mental illness. The importance of family ties is still a strong cultural motivator, with mothers remaining the primary coordinator of family life.

Dr Caretta described how his Trust had modified the Ian Falloon cognitive-behavioural psychoeducational model that they had previously been using to now include family discussions and support groups.

Almost all families initially strongly expressed interest in these meetings, but there was a high level of dropout over the course of the programme, with less than one in five families continuing to attend to the final meeting. However, Prof Kurimay noted that even if families only end up attending one meeting, this can still be of genuine benefit both to them and the patient.

Starting strong

After a symposium with strong practical outlook, I was left with a clear impression of the importance of involving families in the treatment process. However, effective training, clear communication of the timelines and work involved, and realistic expectations are all vital to ensure that the psychiatrist and the family can have a rewarding and mutual beneficial relationship that helps both the patient and all those that are there to support them.