Working with families caring for a relative with schizophrenia: the evolving role of the community psychiatric nurse.

This paper describes the effect on the role and function of the community psychiatric nurse (CPN) after training to deliver psychosocial intervention to families caring for a relative with schizophrenia living at home. The study was undertaken as part of a larger investigation, commissioned by the Department of Health, which is examining outcome in families after CPNs have received training in psychosocial intervention strategies. In the last decade four major controlled studies have shown that relapse in schizophrenia can be improved if families receive; detailed assessments of individual need, health education about schizophrenia, and family stress management programmes, often defined as "psychosocial intervention". Whilst these research programmes have been underway, CPN services have been developing closer links with Primary Health Care and individual CPN's work with clients with severe and long-term mental illness has, as a consequence, been reducing. This trend has been rightly criticized, as has the tendency for CPN work to focus on the individual rather than the family with whom the client often lives. Informal carers willingly accept the burden of care for their relatives but their own needs are all too often neglected. The pilot phase of the outcome study demonstrated that after CPNs had received experimental training in psychosocial intervention, families reported a number of positive benefits when followed up for 12 months. First, for the clients there were improvements in the symptoms of their illness and in their social functioning. Second, carers' satisfaction with the service received showed a marked improvement as did their estimates of minor psychiatric morbidity. These changes in outcome entailed a cost. Experimental CPNs reported that undertaking family intervention was more time-consuming than "traditional" CPN care of the client with schizophrenia. Further, the data reveal that the training led to CPNs extending their role in a variety of other ways even though they received only a modicum of support from colleagues within their own health authorities. This preliminary paper concludes that although family work undertaken by CPNs should be seen as an important priority, problems may arise as services attempt to juggle finite resources with ever growing demands. Guidance on the future role of the CPN from the Department of Health is essential and would greatly enable planners and managers alike to rank order service priorities.