Dirik Aysegul, Sandhu Sima, Giacco Domenico, Barrett Katherine, Bennison Gerry, Collinson Sue, Priebe Stefan
Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK.
East London NHS Foundation Trust, London, UK.
BMJ Open. 2017 Sep 27;7(9):e017680. doi: 10.1136/bmjopen-2017-017680.
Family involvement is strongly recommended in clinical guidelines but suffers from poor implementation. To explore this topic at a conceptual level, a multidisciplinary review team including academics, clinicians and individuals with lived experience undertook a review to explore the theoretical background of family involvement models in acute mental health treatment and how this relates to their delivery.
A conceptual review was undertaken, including a systematic search and narrative synthesis. Included family models were mapped onto the most commonly referenced underlying theories: the diathesis-stress model, systems theories and postmodern theories of mental health. Common components of the models were summarised and compared. Lastly, a thematic analysis was undertaken to explore the role of patients and families in the delivery of the approaches.
General adult acute mental health treatment.
Six distinct family involvement models were identified: Calgary Family Assessment and Intervention Models, ERIC (Equipe Rapide d'Intervention de Crise), Family Psychoeducation Models, Family Systems Approach, Open Dialogue and the Somerset Model. Findings indicated that despite wide variation in the theoretical models underlying family involvement models, there were many commonalities in their components, such as a focus on communication, language use and joint decision-making. Thematic analysis of the role of patients and families identified several issues for implementation. This included potential harms that could emerge during delivery of the models, such as imposing linear 'patient-carer' relationships and the risk of perceived coercion.
We conclude that future staff training may benefit from discussing the chosen family involvement model within the context of other theories of mental health. This may help to clarify the underlying purpose of family involvement and address the diverse needs and world views of patients, families and professionals in acute settings.
临床指南强烈推荐家庭参与，但在实施方面存在不足。为了从概念层面探讨这一主题，一个由学者、临床医生和有实际经验的个人组成的多学科评审团队进行了一项综述，以探究急性心理健康治疗中家庭参与模式的理论背景及其与实施方式的关联。
进行了一项概念性综述，包括系统检索和叙述性综合分析。将纳入的家庭模式映射到最常被引用的基础理论上：素质-应激模型、系统理论和心理健康的后现代理论。总结并比较了这些模式的共同组成部分。最后，进行了主题分析，以探究患者和家庭在这些方法实施中的作用。
一般成人急性心理健康治疗。
确定了六种不同的家庭参与模式：卡尔加里家庭评估和干预模式、埃里克（危机快速干预团队）、家庭心理教育模式、家庭系统方法、开放对话和萨默塞特模式。研究结果表明，尽管家庭参与模式所基于的理论模型差异很大，但它们的组成部分有许多共同之处，例如都关注沟通、语言使用和共同决策。对患者和家庭角色的主题分析确定了实施过程中的几个问题。这包括在模式实施过程中可能出现的潜在危害，如强加线性的“患者-照顾者”关系以及被视为强制的风险。
我们得出结论，未来的员工培训可能会受益于在其他心理健康理论的背景下讨论所选择的家庭参与模式。这可能有助于阐明家庭参与的潜在目的，并满足急性环境中患者、家庭和专业人员的多样化需求和世界观。
