Abstract
BackgroundManaging early warning signs is an effective approach to preventing relapse in bipolar disorder. Involving relatives in relapse prevention has been shown to maximize the effectiveness of this approach. However, family-focused intervention research has typically used expert therapists, who are rarely available within routine clinical services. It remains unknown what issues exist when involving relatives in relapse prevention planning delivered by community mental health case managers. This study explored the value and barriers of involving relatives in relapse prevention from the perspectives of service users, relatives and care-coordinators.MethodsQualitative interview study nested within a randomized controlled trial of relapse prevention for individuals with bipolar disorder. The purposive sample of 52 participants comprised service users (n = 21), care coordinators (n = 21) and relatives (n = 10). Data were analyzed using a grounded theory approach.ResultsAll parties identified benefits of involving relatives in relapse prevention: improved understanding of bipolar disorder; relatives gaining a role in illness management; and improved relationships between each party. Nevertheless, relatives were often discouraged from becoming involved. Some staff perceived involving relatives increased the complexity of their own role and workload, and some service users valued the exclusivity of their relationship with their care-coordinator and prioritized taking individual responsibility for their illness over the benefits of involving their relatives. Barriers were heightened when family relationships were poor.ConclusionsWhilst involving relatives in relapse prevention has perceived value, it can increase the complexity of managing bipolar disorder for each party. In order to fully realize the benefits of involving relatives in relapse prevention, additional training and support for community care coordinators is needed.Trial registrationISRCTN41352631
Highlights
Managing early warning signs is an effective approach to preventing relapse in bipolar disorder
Among people with bipolar disorder, there is a perception that carers and families are often excluded from management decisions and ignored by health professionals to the distress of family members who remain uninformed about bipolar disorder [6]
This paper reports the findings of a qualitative study examining the views of service users, relatives and carecoordinators of the value and barriers of involving family members in relapse prevention
Summary
Managing early warning signs is an effective approach to preventing relapse in bipolar disorder. Family-focused intervention research has typically used expert therapists, who are rarely available within routine clinical services. It remains unknown what issues exist when involving relatives in relapse prevention planning delivered by community mental health case managers. In doing so individuals are forewarned of the recurrence of a relapse in time to seek early treatment and so minimize serious harm [2]. This approach is effective in improving function, increasing time to. Among people with bipolar disorder, there is a perception that carers and families are often excluded from management decisions and ignored by health professionals to the distress of family members who remain uninformed about bipolar disorder [6]
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