Abstract
BackgroundEmpirical evidence shows that family involvement (FI) can play a pivotal role in the coping and recovery of persons with severe mental illness (SMI). Nevertheless, various studies demonstrate that FI in mental healthcare services is often not (sufficiently) realized. In order to develop more insights, this scoping review gives an overview of how various stakeholders conceptualize, perceive and experience barriers to FI. Central questions are: 1) What are the main barriers to FI reported by the different key stakeholders (i.e. the persons with SMI, their families and the professionals, and 2) What are the differences and similarities between the various stakeholders’ perspectives on these barriers.MethodsA systematic search into primary studies regarding FI was conducted in four databases: Medline/Pubmed, Cinahl, PsychInfo and Web of Knowledge with the use of a PICO scheme. Thematic analysis focused on stakeholder perspectives (i.e. which stakeholder group reports the barrier) and types of barriers (i.e. which types of barriers are addressed).ResultsThirty three studies were included. The main barriers reported by the stakeholder groups reveal important similarities and differences between the stakeholder groups and were related to: 1) the person with SMI, 2) the family, 3) the professionals, 4) the organization of care and 5) the culture-paradigm.DiscussionOur stakeholder approach elicits the different stakeholders’ concepts, presuppositions and experiences of barriers to FI, and gives fundamental insights on how to deal with barriers to FI. The stakeholders differing interpretations and perceptions of the barriers related to FI is closely related to the inherent complexity involved in FI in itself. In order to deal better with these barriers, openly discussing and reflecting upon each other’s normative understandings of barriers is needed.ConclusionsDifferences in perceptions of barriers to FI can itself be a barrier. To deal with barriers to FI, a dialogical approach on how the different stakeholders perceive and value FI and its barriers is required. Methods such as moral case deliberation or systematic ethics reflections can be useful.
Highlights
Empirical evidence shows that family involvement (FI) can play a pivotal role in the coping and recovery of persons with severe mental illness (SMI)
Various studies have illustrated that family involvement (FI) in professional care and treatment can be beneficial for the person with severe mental illness (SMI) as well as for families
Ten studies encompassed more than one stakeholder perspective, of which seven involved all stakeholder groups [19, 21, 22, 24, 25, 28, 42], one included persons with SMI and the family perspective [23] and two involved the professional and family group [26, 37]
Summary
Empirical evidence shows that family involvement (FI) can play a pivotal role in the coping and recovery of persons with severe mental illness (SMI). Various studies have illustrated that family involvement (FI) in professional care and treatment can be beneficial for the person with severe mental illness (SMI) as well as for families (broadly defined). It can reduce the frequency of relapse and hospital admission as well as encourage compliance with medication and treatment endurance [2,3,4,5], and contribute to bettering the quality of life of family members [6, 7]. Numerous guidelines have been developed to facilitate collaboration with family in mental healthcare [11, 12]
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