Think Family/Whole Family: Working with families with parental mental illness

Scott Yates, Lina Gatsou
De Montfort University Leicester
Quality Improvement in research and education

Summary

This is an ongoing research, education and intervention project consisting of: i) a programme of awareness-raising, education and training for multi-agency professionals into the nature of parental mental illness (PMI) and its impacts on children and families, ii) an eight-session intervention protocol, and iii) research into the characteristics of PMI in families, experiences with existing services and impact of the new intervention.

The project uses a train-the-trainer approach in which trainers receive four days training and go on to train peers using a two-day training programme. Trained professionals undertake an agreement prior to training to implement the eight-session intervention with at least one family on their caseload. Participating professionals also receive regular supervision from trained members of the project team throughout their work with families.

Research and evaluation consists of i) pre- and post-training questionnaires to assess workforce development for professionals, ii) one-to-one semi-structured interviews with family members and professionals to assess the nature of the illness and its impacts, experiences of the intervention and changes that resulted, and iii) focus groups with professionals to share experiences of practice prior to training, impacts of training on working practice and experiences of implementing the intervention with families.

What are the Aims?

i) Improve the knowledge, skills and practice of multi-agency professionals in working with families with PMI and implementing whole-family approaches

ii) Reduce the impacts of PMI on families, particularly the burden on children and young people

iii) Promote recovery for parents and other family members with mental health problems and associated form of distress

iv) Produce new knowledge relating to families’ experience of PMI, the influence of social and economic context on their experiences, families’ needs for support and good practice

It's improved relationships and working relationships with the families.

Who was/is involved?

One project funded by the East Midlands NHS Health Innovation and Education Cluster, completed in 2013, trained 100 professionals from a variety of multi-agency background in Leicestershire. These professionals worked with 32 families over the course of the project.

An ongoing project with Leicestershire Early Intervention workers has trained 75 professionals who are currently working with families across the county.

A half-day version of the training to raise awareness of the key issues began being rolled out in 2013 to all newly-trained school nurses and health visitors, and in 2014 this began being rolled out to all LPT staff (5,600 employees in total).

What has changed/will change?

Results from the HIEC-funded project show statistically significant improvements across the set of indicators assessing professionals’ knowledge, skills and confidence in working with PMI with whole families. Qualitative data support these findings and demonstrate significant improvements in practice from professionals, increased engagement with families with PMI, improvements in family relationships and the wellbeing of family members.

What lessons have we learnt?

Our evidence showed that although most multi-agency workers who participated had contact with families with PMI, they lacked the confidence and skills to work with it. Families were frequently left without support for the issues. PMI was shown to have complex interactions with other negative lift events (such as job loss, economic hardship, insecure housing, school resistance and teenage parenthood). It was also shown to have marked negative impacts on family relationships and the self-esteem and mental wellbeing of all family members. The new intervention had significant positive impacts on families' abilities to discuss and manage PMI, improved their understanding of its symptoms and impacts, reduced the burdens of caring on children and young people and had knock-on impacts on employment and childrens school engagement and behaviour.

Example quote from a professional reflecting on their work with families after training: "It's improved relationships, working relationships with the families. They're communicated better and from a working relationship, their engagement was good but not it's even better because the trust is there, there's no secrets anymore within the family"

Example quote from a mother with depression and anxiety reflecting on the impact of the work with her family: "it helped us get past that point where people do a lot of talking but not listening. I think it got us to a point where we were all listening to each other...helped us all to take a bit of ownership for how our behaviour was affecting each other... the sessions probably made me realise that I needed to address the situation at work, that the depression and anxiety wasn't me as a person...and I think it made me realise what an impact it was having on the children."

Contact details

Dr Scott Yates, School of Applied Social Sciences,
De Montfort University. 01162078703. syates@dmu.ac.uk

Links to further information and resources

Gatsou, L. & Yates, S. (in press) The Challenges Presented by Parental Mental Illness and the Potential of a Whole Family Intervention to Improve Outcomes for Families, Child and Family Social Work, http://onlinelibrary.wiley.com/doi/10.1111/cfs.12254/abstract

Gatsou, L. & Yates, S. (2015) Parental mental illness: incidence, assessment and practice, Mental Health Practice, http://journals.rcni.com/doi/10.7748/mhp.19.5.25.s18