A West Midlands
family therapy programme claims to have achieved remarkable results
in equipping families with the skills to reduce "relapse"
and hospital re-admittance rates for family members diagnosed with
a mental illness. Adam
James finds out how, and examines why - if the programme
is so good - it's not been rolled out to the rest of country
Strawford's tree-lined garden with its Buddha statue oozes calmness.
How far removed it is from the torment of her life seven years ago.
son Rob had been diagnosed with schizophrenia, precipitating a total
breakdown in family life. Overcome with paranoia and anxiety, Rob
spent most daylight hours locked in his bedroom. Distraught and
confused, Val and her husband no longer spoke to each other. Pent-up
anger was vented by smashing windows and doors.
had effectively lost my son and my friends drifted away," remembers
Val. "I lost my job and my husband was going to leave me -
we were not talking. We treated each other like animals. It was
51, says no professional explained the schizophrenia diagnosis to
her family, let alone offer advice. This was despite Rob at times
fearing his mother was a secret KGB agent. For one six week period
he did not eat, and had to be sectioned and force fed in hospital
to save his life.
was the predicament facing Martin Atchison, a project worker from
the Meriden West Midlands Family Programme, when he offered to intervene
four years ago.
1998 the programme has provided behavioural family therapy (BFT)
for 3,000 families, of which one member has a severe mental health
problem. Eighty per cent of the time it's a psychotic diagnosis,
such as schizophrenia.
intervention involves workers conducting assessments with family
members and then working with the whole family on problem-solving,
decision-making, power dynamics, goal-setting and communication
skills. The family member's psychiatric diagnosis is discussed and
methods of preventing "relapse" are taught.
therapy is extremely practical-based. Therapists might address -
sometimes through role playing - flash points of family contention,
or discuss how to ensure household bills are not ignored, how to
prevent one family member being excluded from household decisions,
how to express difficult feelings or understand why someone should
stay in bed all day.
about getting the message of trying to move everyone in the family
forward - and not just the person who is ill," explains Atchison.
a family will interpret all of one person's behaviour to the illness
- so a person will have, for example, no freedom to be angry. It
will always interpreted as them being unwell. But, maybe it's more
to due with the way that person is spoken to."
importance is placed on looking to the future, and family members
interacting positively with each other. "Many families find
this very powerful," says Atchison. "One family told me
that they had sat down after I'd left and realised they had not
said a positive thing to each other for three months."
project claims huge success. Its manager clinical psychologist Gráinne
Fadden says research demonstrates BFT reduces patient "relapse"
rates to less than 10%, compared to the 40% rate of patients on
the Strawford family's participation in the programme Rob has not
needed to be admitted to hospital. For Val, the skills and confidence
the project taught them kept Rob from permanent confinement in a
was the first time in four years that I had got to talk to someone
about Rob," says Val. "Within three months there were
improvements - Rob started having cups of tea with us and then joining
us for meals. BFT brought Rob back to us. It gave us a kick up the
backside and taught us the basic life skills of how to be nice with
each other, to sit and have a meal together, to have respect and
to solve problems together."
the Strawfords are a glowing endorsement of the Meriden programme
Atchison admits families "regularly" turn down offers
of assistance, often fearing they will be judged. Some service users
find the proposal too daunting.
family I have worked with has been sceptical at first," says
Martin. "Families often feel blamed - there is an awful lot
agrees. "As Rob's mother, I felt responsible for his illness.
I thought I whole can of worms would be opened. But it was not like
that. From the start Martin told us to forget what had happened,
and look to the future."
Meriden project is run by Birmingham and Solihull Mental Health
NHS Trust. In partnership with 12 neighbouring trusts, it has trained
1,900 psychiatrists, psychologists, nurses and other staff in BFT.
Last year, the Meriden project won an award from the National Institute
for Mental Health for its contribution to modernising mental health
the west Midlands remains the only region in the country with such
a dedicated family therapy service. Fadden finds this frustrating,
especially since it's now three years since National Institute for
Clinical Excellence (NICE) guidelines on schizophrenia concluded
that family interventions - such as BFT - should be available to
all families living with people diagnosed with schizophrenia.
says this lack of commitment to family therapy is largely because
the intervention lacks the massive commercial and marketing backing
of the pharmaceutical firms which psychiatric drugs benefit from.
would need a whole power and culture shift for this to change,"
now aged 27, did not have to wait so long. He feels his days of
destructive and acute paranoia are behind him and is looking forward
to starting voluntary work next month.
comforting to see everyone in the family getting on so much better,"
he says. "Everybody made the effort to live with me, and it
gave me the inspiration to carry on."
A shortened version of this article appeared in The
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