Abstract
Background: Parental mental illness is common, costly, can lead to children developing mental disorders and impaired lifetime outcomes, and places a substantial burden on caregiving partners. Family Talk (FT) is a widely implemented, 7-session, whole-family programme, with promising evidence of effectiveness in targeting the intergenerational transmission of mental illness. However, to date, very little qualitative research of family experiences of FT has been undertaken. The objectives of this study were to: (1) investigate the experiences of families attending FT; and (2) explore the key facilitators and barriers to engagement in mainstream mental health settings.Methods: This study was nested within a randomised controlled trial (RCT) of Family Talk [N = 86 families (139 parents, 221 children)] implemented in 15 adult, child and primary care mental health sites in Ireland. Semi-structured interviews were conducted with a purposive sample of 45 participants, including 23 parents with mental illness (PMI), 7 partners and 15 children/young people aged 9 to 18 years. Interview data were transcribed verbatim and analysed using constructivist grounded theory.Results: Over two thirds of families across sites reported substantial benefits from participation in FT, including reduced stigma, giving children and partners a voice, increased service-user confidence, and improved family communication/relationships. Key facilitators identified by families included: programme delivery by a competent, non-judgmental clinician; the whole-family approach; and family readiness to engage. Barriers to engagement included stigma, family crises/relapse, service constraints, impact of COVID-19, and a need for further child, family and follow-up sessions/supports.Conclusion: This study is the first qualitative analysis of family experiences of FT to be conducted within the context of an RCT and national programme to introduce family-focused practise for families with PMI. The findings illustrate that FT is beneficial across cultural/policy contexts, different mental disorders and can be implemented across adult and child mental health settings, including children with existing mental health challenges. Key barriers and facilitators to implementation were identified by families, all of which should help to inform the future implementation of FT, and other similar interventions, both in Ireland and elsewhere.
Highlights
It is estimated that 23% of all families have at least one parent who has, or had, a mental illness; this has been shown to increase the risk of children developing a mental disorder during their lifetime, whilst multiplying five-fold their utilisation of health and social services, and placing a substantial emotional, financial and parenting burden on caregiving partners [1,2,3]
Intervention Phase The findings suggest that Family Talk (FT) was challenging for many families despite the non-judgemental support provided by FT clinicians
This study is the first qualitative analysis of family experiences of FT conducted outside Sweden, the first situated within the context of an randomised controlled trial (RCT) of FT, and as part of the first nationwide endeavour to introduce family-focused practise/programmes (FFP) to adult and child mental health services in the Republic of Ireland (RoI)
Summary
It is estimated that 23% of all families have at least one parent who has, or had, a mental illness; this has been shown to increase the risk of children developing a mental disorder during their lifetime (range 41 to 77%), whilst multiplying five-fold their utilisation of health and social services, and placing a substantial emotional, financial and parenting burden on caregiving partners [1,2,3]. The transmission of risk from parents to children involves a complex interplay of genetic, prenatal, family and environmental/social influences and is significantly mediated by the impact of parental symptoms on parentchild interactions (e.g., insensitive and erratic attunement)(2) These vulnerable families are often not identified or supported by mental health professionals in the RoI, or in other jurisdictions, due to: a lack of policy/practise guidance; little or no collaboration between Adult Mental Health Services (AMHS) and Child and Adolescent Mental Health Services (CAMHS); an individualised, crisis-oriented approach to assessment/treatment; competency and confidentiality concerns amongst mental health professionals who may feel ill-equipped to undertake family work; and parental stigma/fear of social services and losing custody of their children [6, 7]. The objectives of this study were to: [1] investigate the experiences of families attending FT; and [2] explore the key facilitators and barriers to engagement in mainstream mental health settings
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