Background
“… deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and roles. It is a way of living a satisfying, hopeful and contributing life even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.”
Aim
Methods
Design and setting
Procedure and sampling
Participants
Age | Median = 47 years (range: 23–59) |
Gender | 72% female, 28% male |
Background | mental health nursing (5), social work (2), social/community welfare (2), psychology (1) occupational therapy (1) |
Workplace setting | public acute care services = 4 |
public community services = 5 | |
private practitioners = 2 | |
Years working in mental health with families | Median = 6 years (range: 0.5–30) |
Data collection and analysis
Results
Synthesizing family-focused practice and recovery
We all know …that if you don’t engage the family meaningfully, peoples’ recoveries [are] really limited. (nurse)andWe make sure that the person and the family is that which we hold sort of at the centre at all times, and that if we’re really looking at recovery we look at how we assist the family unit to work better together. (social worker)
Recovery in terms of becoming as well as you can … to, you know get your life sort of re-established or back on track. (occupational therapist)
Who is it that you want to be, who is it that you are now that this illness has come into your life in this way; how do you want to be in relation to this illness, it doesn’t have to define you. (social worker)
If you don’t have hope and share hope with them that they can do it differently if they want to, then I think we have our obligations [as] therapists to assist people to try and hold onto hope somewhere. (social worker)
So the family members having access to working with somebody as well, to look at recovery for them, for the ordeal that they’ve been through too. (welfare worker)
Enactments of family-focused practice within a recovery framework
… whether it be administering the medications, or observing for side effects for them, or the direct care… yeah the more hands-on stuff, it’s taking the person to appointments, whether it be with us or a GP, collecting the medication from the pharmacy or bringing the medication in with the patient when they come in – yeah that’s probably what most of our role with the families would be, and yeah that’s probably it. (nurse)
… if we’re really looking at recovery we look at how we assist the family unit to work better together. (social worker)
…even if you don’t directly work with other family members in the room there has to be conversations about family and how the person who has the illness deals with family and how they deal with them. (psychologist)
I do quite a bit of … education with families when I have a client that has struggled to kind of express to family how life is for them. So sometimes I would invite family or carer in, often, parent or close relative to kind of explore a little bit with them, with the client in the room, about what it's like to live together. (nurse)
I’ve had a mum discuss with me several times about a conversation that she might have had or some things that she might have said to a child that is inappropriate for that child’s age. So obviously we would go into what things did you say, how could you have said that differently. (community support worker)
Engaging together as a family; so when we look at her behavioural activation plan; we've included time, meaningful time with the children on that and so we’re looking at getting brokerage dollars to support them in buying bikes so they can go riding together. (social worker)
… my role is, is about [saying] “yeah okay now when you're frustrated you know just remember that you know your mums got this illness and sometimes it's difficult for her to remember things and you know, and she becomes very tired and she needs the sleep. When you're feeling this way you know what tools can we, what can you learn to deal with that”. (community support worker)
Barriers and enablers to family-focused recovery practices
Family relationships
… If part of their difficulties that they’re experiencing is related to the family, then it’s hard to work with the family… if there’s relationship problems with the family and it’s impacting on their current mood and mental state and other risks, then it’s going to be hard to approach the family and say this person is feeling this way because they’ve said that the relationship with you is not good. (nurse)
Service context
I've been in an ideal space where a medical practice is a family practice. So families wander into the room together anyway, because they're kind of used to it whereas in another service that I work it's always by invitation. (nurse)andI'm co-located there with community health services. People are much more comfortable to present to their session with their mum, with their dad, with their partner, with their kids, whereas I think here because it's seen as much more medical, and much more clinical it's fairly rare. (social worker)
The way we’re structured at the moment you have, you’ve got to do 2 hours doing rounds, so there’s 2 hours during the day where you go and do that, 2 hours where you sit out in the HDU (High Needs Unit) so that’s where you’re targeted to 4 patients…and when, they’ve got family members… [you] actually don’t get a lot of time…
Staffing
There's no possible way that we can do a proper assessment… talk to them about their illness, talk to them about their recovery plan, engage their family in a meaningful way. Our comprehensive assessment [form] is 14 pages long and out of all that there a box … a couple of inches for family. (social worker)
Stigma and language
There’s often real resistance on the part of consumers to having their families involved in a meaningful way because they have so much shame about their diagnoses and so much fear… (welfare worker)
He was a farmer. He was so insulted, humiliated, he was already really depressed and embarrassed about what had happened to the farm and they were on the brink of financial ruin then [to] have to have his wife called his carer… it was irretrievably broken down. (welfare worker)
Very few of them [carers] turned up because … [they] didn’t want to be out in public and known to be as a carer of a mental illness person. And some of them don’t like their photos taken and put in the local paper. (welfare worker)
I'm always reassuring people in a family that if I am speaking to another family member I’ll give them summary of exactly what I think I’ll share, so that they're – they don’t think I'm going to go out of kind of their boundary of what's okay. (nurse)