The uneven triad: a qualitative study of perspectives of relatives, patients, and professionals on (not) involving relatives in mental health.

INTRODUCTION

Recognition of the value of involving relatives in mental health care is growing. This study explores the ambivalence surrounding their role, including formalisation, instrumental use, burden, and potential benefits. Collaboration between relatives, patients, and professionals is essential to recovery-based approaches. Thus, despite challenges, the involvement of relatives remains crucial. This study aims to understand perspectives on involving relatives in mental health care, within the larger context of collaboration across the triad of relatives, patients, and professionals.

METHODS

We conducted a qualitative study using semi-structured interviews with relatives (n = 7), patients (n = 7), and professionals (n = 10) connected to various mental health care organizations. The study took place in The Netherlands. Data were analysed using thematic analysis.

RESULTS

For collaboration in the triad, we found five aspects to be of importance: the significance of involving relatives, changing roles from relative to caregiver, relatives' intermediary role in patient-professional relationship, negative experiences of relatives in the triad, and ambivalence about patient's autonomy. Notably, because collaboration between professionals and relatives is often challenging, it often leads to tensions.

CONCLUSION

Our study uncovers varying perspectives both on involving relatives and on collaboration within the triad. Recovery-oriented approaches do not always align with patients' and relatives' intentions and values. Although relatives want to be involved, they often feel unheard and unseen by professionals. Relatives' roles -especially the intermediary role- are surprisingly underrepresented in the recovery-oriented literature. This study reveals several tensions between the three perspectives, culminating in a so-called uneven triad. We conclude that although the concept of involving relatives is highly advocated in recovery-based approaches, actual practice is lagging behind.