Early Psychosis Intervention: A Culturally Adaptive Clinical Guide

21. Family Work in Early Psychosis

21 Family Work in Early Psychosis Christopher Loh Family Intervention Psychosis is a major psychiatric illness that has debilitating impact on patients and their families. Providing care for patients in their home environment can be physically and emotionally demanding for the families. Numerous studies have shown caregivers of patients with psychosis experience distress and burnout (Addington et al., 2003; Barrowclough, Tarrier, & Johnston, 1996; Chen et al., 2004). Evidence suggests that some families need considerable support to prevent further deterioration in family functioning, especially when the patient is admitted to hospital (Seng & Bentelspacher, 2001). Bowen (1978) describes the impact of serious emotional events as the “emotional shock wave”, which may have ripple effects in the family over time. The effects of the illness could resonate beyond the nuclear family too. The experience of working with the families in EPIP revealed the involvement of extended family members as well. In some instances, grandparents, uncles, aunties or in-laws played essential roles in the care of the identified patient, thus making it clear that contacts with families did not merely include parents, siblings, or spouses. Patients’ data collected in EPIP revealed that 92.1% of them stayed with their families, which included spouses, children, parents, siblings, and other relatives. Only 3.8% of the patients lived alone. Hence, any treatment plan must involve the family, nuclear or extended, so as to support the patients and reduce stress in the families. Individual Psychoeducation with Families Family psychoeducation is an essential component of the treatment process for psychosis and case managers play a crucial role in providing individual 248 Christopher Loh psychoeducation to patients and their families. In the case of the family, the psychoeducation can be provided with individuals or with the family as a group. Psychoeducation is done on a regular basis, especially during the initial (the first three months), mid (12th month) and end (22nd month) phases of treatment . For families of patients who require more than two years of EPIP service, psychoeducation is addressed again during discharge planning. Clearly, psychoeducation is not a one-off affair, as families need constant reminders and refreshment of their knowledge of psychosis. The frequency and intensity of psychoeducation depend largely on the needs of the families—family members may take more or less time to understand the information given during psychoeducation depending on their abilities to take in this knowledge. In our experience, there is a clear difference between the more educated families and the less educated ones in terms of their abilities to receive and understand psychoeducation. The level of understanding also depends on their acceptance of their loved one’s illness. In some instances, families may find it difficult to receive psychoeducation as they may attribute the symptoms of the patients to other causes. Some examples of the reasons given by families are that the patient’s “mind is too weak”, he or she just needs to “be more positive”, that he or she “thinks too much” or “is just stressed”. Many also attribute the illness to “offending spirits”. This has to do with the family’s cultural beliefs, which are elaborated in Chapter 15 “Cultural Issues in Early Psychosis Management”. In the course of this work, the team has come to know that the belief in spiritual invasion is somehow easier for parents to accept the bizarre behaviour displayed by their children as it externalizes the problem. Accepting that their children are suffering from a mental illness gives rise to guilt feelings as they blame themselves for not providing enough emotional support before the onset of the illness. Hence, the psychoeducation provided by case managers should be tailored to the needs of each family. Information imparted to the families is also paced carefully. Psychoeducation provided by case managers includes the nature of psychosis , its aetiology, medication and side-effects, modes of treatment, relapse prevention, stress management, and healthy lifestyle. Materials on these topics are passed to families in the process and families are also provided with the EPIP Resource Booklet for Caregivers, which consists information on when, where, and how to seek help during a crisis. In addition, psychoeducation on depression and/or anxiety disorders will be included if it is relevant to the Family Work in Early Psychosis 249 patient’s condition. Flipcharts and relapse signature cards are also used during the educational process. Home Visits A home visit is conducted by every case manager for all patients, especially...