Successful Single Family Engagement

1
Successful Single Family Engagement

• Be friendly
• Listen
• Be curious about families actual experience
• Dont censor empathic responses to tragic events
• Use the Sorry strategy
• Come to terms with not being the only one with
  knowledge and skills
• Be responsive to requests and give practical help
  as asked

2
Successful Multi-Family Engagement

• Tell them it works
• Model non- pathologising and non-judging
• Reassurance about being better or worse than
  others
• Stigma busting
• Reassurance about confidentiality
• Help in managing symptoms
• What do I have to offer
• What can other families offer me

3
Psychoeducation Workshop What we are aiming for?

• Families feel well informed about current
  biological, psychological and social information
  and options for individual and family well being
• Families have felt able to share their
  experiences with others
• Both ill and non-ill family members are viewed as
  skilled and knowledgable
• Families engage well with each other

4
Psychoeducational Workshop

• You are the dinner event host.......for a group
  of people who are anxious, have special needs and
  who dont know each other

5
Psychoeducation Workshop Process

• Keep it interactive and explorative
• Encourage everyone to be involved
• Use inclusive language (Take a we and us
  stance not a they stance)
• Accommodate many knowledges rather than trying to
  impose one framework or a right way
• Float hypotheses and dilemmas to generate
  discussion
• Promote bilingualism (psychiatric lingo as well
  as the lived experience)

6
Psychiatric Bilingualism

• Private Experience
• Sensitive to stimulus I can taste and hear
  everything Im super-sensitive
• Confusion scrambled newspaper
• Feeling overwhelmed Theres too much going on
• Distracted I cant read or concentrate my
  head is racing all the time
• Special experiences stuck on something It
  feels like the world is depending on me I
  thought I was God
• Feeling unsafe suspicious
• Finding it hard to sleep/ I cant sit still

• Psychiatric Terms
• Disturbed Arousal and Attention
• Thought Disorder
• Disorganisation
• Delusions
• Hallucinations
• Withdrawal
• Paranoia
• Loss of motivation

7
Bilingualism

• Working in families own language
• Favourite metaphors of mental illness from
  clients, families .. or yourself

8
Thoughts on Engagement

• Everyone was treated equally. Coming to group
  made ill people feel not ill (M- non-ill
  partner)
• It was helpful that other people were being so
  open and nobody was treating you like an idiot.
  It gave me confidence to open up There was that
  safety from disapproval and criticism and just
  not being understood (B-non-ill mother)
• The skills of the workers in helping people feel
  confident to speak is very important (Pa-ill
  family member)
• The group was a healthy shift in focus because
  it wasnt too serious. Thered be food on the
  table, tea and coffee. It wasnt a lot of long
  faces around the table. So there was a sort of
  lightness about it instead of a dead seriousness
  that sometimes happens (B-carer mother)

9
Psychoeducation Workshop Content

• Causes of mental illness
• Common illness experiences
• The role of medication and non-medical treatments
• Family impact/ trauma
• Families' sharing their lived experience
• The service system
• Coping skills that families find useful

10
It comes down to Arousal Attention and Integration

• The relationship between arousal and attention is
  sensitive..
• We need to be aroused on a sensory level to pay
  attention to the world around us
• In a psychotic state, people are over-aroused.
  This means they find it hard to pay attention and
  to process information properly.
• Low attention and arousal can result in negative
  symptoms

11
Brain Changes

• Prefrontal cortex (underactive)
• Problem-solving, planning, attention, initiative,
  motivation
• Limbic system (overactive)
• Heightened arousal
• Cingulate cortex (underactive)
• Emotional lability and disconnection of
  thoughts/feelings

12
Causes The Likely Culprits

• Some genetic predisposition
• activation of underlying codes
• may be more so for illness consisting of negative
  symptoms
• Some trauma impact (Brian Koehler, John Read
• (9.3X Psychosis)
• sensitisation to stress (cortisol pathways)
• purposeful adaptations
• may be more prevalent for illness consisting of
  positive symptoms
• Some interactional stress (Helm Stierlin)
• strategy for resolution of intractable conflict
  (intra personal, family and /or social)
• purposeful positioning

13
Stress Vulnerability Model

• Variable individual stress thresholds
• Biological and psychological vulnerability
• Multiple stressors or triggers (primary
  seocondary)

14
Family Communication Stress (EE)

• High Expressed Emotion Intensity, negativity
  and complexity (Leff Vaughan)
• e.g.
• Critical comments
• Over-involvement
• Lack of warmth
• Crowding
• Excessive pressure to perform
• Interactions with conflict
• Multiple sources of input
• or... Changes to family perceptions of ill person
  that lead to changed communication (Barrowclough)

15
Content Available Treatment

• Physical issues (Sleep, drugs, vitamins, natural
  remedies)
• Medical treatment/ CTOs
• Non-medical ways of dealing with primary impact
  (thinking skills, managing symptoms, managing
  arousal/ triggers)
• Dealing with secondary impact (social skills,
  personal development, employment)

16
Content Family Impact

• Discarded ideas of families as causing mental
  illness (be up front about this)
• How families deal with trauma impact
• Changes to life cycles/family roles
• Challenges to communication and conflict
  resolution
• Coping skills
• Options Single Family work, Debriefing and
  Multi-family group work

17
Inner West MFG Evidence

• Ill family members in the MFG had significantly
  less relapse than those who were in case
  management only
• 12 of MFG group vs 36 of CM group immediately
  after the group
• 25 of MFG vs 63 of CM group after 18 months
• Significant reduction in psychiatric symptoms for
  families in MFG
• Ill family members in the MFG were more involved
  in employment-related activities

18
Content The service system

• Outline the roles of the various teams including
  emergency options, case management and ISPs
• Identify non-government psychiatric support
  services, centrelink and CRS services
• Describe individual and family therapy services
• Describe client and carer advocacy services
  mental illness fellowship, SANE, ARAFEMI

19
Content Coping Skills

• Revise expectations, temporarily
• be realistic
• determine your own yardstick
• Keep the emotional environment low key
• enthusiasm is normal tone it down
• disagreement is normal tone it down
• Give people space
• Time out is important for everyone
• It is okay to offer. Its okay to refuse.
• Be clear about limits
• Create reasonable rules for living together.
• Rules and limits can help create a low key
  predictable home environment

20
Content Coping Skills

• Ignore the unimportant stuff
• No one can change everything at once.
• Keep communication simple
• Discuss what you have to say to each other
  calmly, clearly and positively
• Be clear about the best use of medication
• Let the doctor know about side effects or
  concerns
• Keep track of medication usage
• Develop a normal family routine
• Keep many family routines independent of the
  person with the illness
• Pick up early warning signs
• take time to study and identify particular
  warning signs
• discuss them at times of low tension
• initiate contact with mental health workers

21
Ongoing Group Format

• socialising 10
• go round (past two weeks) 20
• defining a focus for work 10
• simple problem
• narrative problem
• solution focussed exceptions
• generate ideas (no holds barred) 10
• toss around up and down side 20
• locate workable solutions 5
• generate a plan with the family 5
• socialising 10

22
Picking the problem

• Dont ignore medication, safety or drug issues!
• Simplify
• Narrow
• Concentrate on behavior
• Focus on relapse risk
• Avoid crisis issues too complex or risky for the
  group setting

23
Brainstorming

• All members can contribute
• All suggestions are welcome
• No suggestion is analyzed or critiqued during
  brainstorming
• Suggestions are limited to 10 - 12 ideas
• The person with the identified problem chooses 1
  - 2 suggestions to try

24
Taking Action

• An action plan is developed for the chosen
  suggestion(s)
• Tasks are identified and assigned
• Consensus is achieved prior to leaving the
  meeting
• The plan is reviewed at the next meeting to
  determine success or the need for further
  problem-solving

25
Working on Problems

• It was great to have that creativity from the
  group by exploring it on the whiteboard and then
  getting a photocopy on different issues and
  different suggestions (E- ill family member)
• It was a space where we could actually have
  mental health issues talked about. My dad and I
  had never spoken about it (E- ill family member)
• Being with people in the same boat means you are
  compelled to find solutions (A-ill family
  member)
• One older member talked about the importance of
  forgiving each other so their change in behaviour
  was not always as great as their way of thinking
  (A-facilitator)