Table Of Contentfamily psychoeducation for
serious mental illness
EVIDENCE-BASED PRACTICES SERIES
series editors:
David E. Biegel, Ph.D.
Elizabeth M. Tracy, Ph.D.
Mandel School of Applied Social Sciences,
Case Western Reserve University
Family Psychoeducation for Serious Mental Illness
Harriet P. Lefl ey
The Evidence-Based Practices Series is published in collaboration with
the Mandel School of Applied Social Sciences at Case Western Reserve University.
FAMILY PSYCHOEDUCATION FOR
SERIOUS MENTAL ILLNESS
Harriet P. Lefl ey
1
2009
1
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Library of Congress Cataloging-in-Publication Data
Lefl ey, Harriet P.
Family psychoeducation for serious mental illness / Harriet P. Lefl ey.
p. cm.—(Evidence-based practices)
Includes bibliographical references and index.
ISBN 978-0-19-534049-5
1. Mental illness—Treatment. 2. Family psychotherapy. 3. Evidence-based psychiatry. I. Title.
RC480.L435 2009
616.89'156--dc22
2008046056
1 3 5 7 9 8 6 4 2
Printed in the United States of America
on acid-free paper
This book is dedicated to consumers with serious mental illness,
and to the families and friends who love them.
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PREFACE
W hen I was asked to contribute a book to a series on evidence-based practices in
mental health treatment, I could only claim some degree of expertise in family
psychoeducation for schizophrenia and other serious mental disorders. However,
this is not my personal area of research. I must rely on the work of the greats in this
fi eld, the pioneers whose work I have noted in the Acknowledgments section.
A lthough my research has been in other areas of mental illness, family psycho-
education and family education have been a major source of interest to me for at
least a quarter of a century. This book focuses on family psychoeducation, which
targets eff ects of family interventions on the persons with mental illness. However,
I am including a substantial section on family education, which targets the needs of
their families for coping skills. (Further distinctions between these two concepts
will be carefully discussed in Chapter 2 . ) Mental illness has a huge impact on fami-
lies, and alleviating psychological distress in caregivers is a legitimate c oncern for
mental-health professionals.
S everal important books have been written about various models of family
psychoeducation and numerous overviews of the research can be found in the
l iterature. To the best of my knowledge, most of these are cited here and hopefully
integrated into a larger picture of what is actually going on in the fi eld today. To this
end, I have also included descriptions of programs that are not readily available in
scientifi c journals. This book covers a wide range of models, from randomized
c ontrolled studies to ongoing brief educational courses, with and without evalu-
ation data. The selection is based primarily on family psychoeducation programs
with rigorous research designs and outcome data, those that exemplify evidence-
based practice. However, briefer family education models are also included, con-
tingent on available research fi ndings, but also on a program's longevity, updated
VII
VIII PREFACE
manualization, and number of people served. I have tried to give as broad and
inclusive a picture as possible of what is actually off ered to families of individuals
with serious mental illness today, and apologize for any inadvertent omissions.
F or practitioners wishing to implement evidence-based family psychoedu-
cation, with full fi delity to the research model, the most valuable resource is the
f amily psychoeducation toolkit developed primarily by Dr. William McFarlane and
Dr. Lisa Dixon, under the auspices of the Substance Abuse and Mental Health Ser-
vices Administration (SAMHSA). The toolkit is available online and in manual form
(see Department of Health and Human Services, 2003, and www.samhsa.gov ).
During the last quarter century, family psychoeducation has proved effi cacious
in signifi cantly deterring relapse and re-hospitalization in patients with schizo-
phrenia, bipolar disorder, and various other diagnostic categories, and in many
cases enhancing families’ well-being. Although most of the research has focused
on schizophrenia, this intervention has proved benefi cial across a range of severe
psychiatric disorders. But evidence-based family psychoeducation has reached
at best a few thousand families. National Alliance on Mental Illness's (NAMI)
Family-to-Family has been taught to over 125,000 families. Some empirical data are
now available for the eff ectiveness of this program, as well as for Journey of Hope.
Because there have been numerous other attempts to provide family education,
I decided to include a description of some of these other models, with whatever
data have become available on their outcomes. These may be helpful to clinicians
who wish to implement their own programs, but lack the resources a vailable in
well-funded research projects.
For the past quarter century I have also been engaged in leading a psychoedu-
cational support group for families of people with severe mental illness at one of
the largest psychiatric centers in the southeast. This is an open-ended group, a
free service available to the public as well as to families of our patients. Families
come and go according to need. Some come only during a crisis. Others have come
consistently for ten or more years. Over the years thousands of families have told
me their stories.
W hen I speak about family experiences and family burden in the forthcoming
pages, much of what I say will be derived from stress theory and from the copi-
ous research on family burden. But research data provide a picture that is only as
comprehensive as the questions asked and answered. Few of the instruments that
measure stressful life events or family burden deal with patients’ access to hospi-
talization, legal constraints, or other aspects of mental-health systems that impede
timely treatment and cause frustration and grief to families. Nor do the research
instruments mention the eff ects of incorrect theories and ineff ective treatments
on the psychological well-being of families. Distancing behaviors and failure to
communicate on the part of mental-health staff are serious aspects of family bur-
den, but they are not found in the measurement scales. Many issues that arise in
PREFACE IX
support-group discussions regarding malfunctioning mental-health systems,
which manifestly contribute to family disorder, are not found in the literature.
So, some of the observations in this book will be based on my years of listening to
families, as well as on citations from theory and research.
In the main, I have tried to present a comprehensive picture of what is currently
available to educate caregivers of people with serious mental illness, to distinguish
the aims of family psychoeducation and family education, and to present an argu-
ment for the usefulness of both. At the end, I speak of the potential for introducing
family psychoeducation as standardized treatment in mental-health systems, and
what we can expect for the future.
C linicians and clinicians-in-training are well aware of the importance of social
context for recovery from mental illness. In current mental-health systems, not
only service providers, but other patients—consumers in recovery—are fulfi ll-
ing a long-needed, tremendously important role in helping people recognize their
strengths and lead satisfying lives. But for many consumers, families may be even
more critical, because caring, knowledgeable family members are lifetime support
systems. It is clear that they need information and understanding from the clini-
cians who treat their loved ones. I hope this book fulfi lls its aim of educating men-
tal-health professionals on the importance of educating families, friends, and all
others concerned with the welfare of persons with serious mental illness.
