Families, only us. For better for worse In sickness and in health Val Jackson March 11 th 2015

Put your hand up if there are people in your life who are important to you? For most of you this is likely to be a family member, but even if it isn’t a family member they are here, in our heads. Where was my dad when I was growing up? Why didn’t my mum love me the same way as she did my sister?

Research Evidence Meta analyses of research studies show that systemic therapy is at least as effective as other therapies and/ or medication (and is not harmful). “The review of the existing evidence base finds substantial evidence for the efficacy and the effectiveness of family interventions. Where economic analyses have been carried out, family therapy is found to be no more costly, and sometimes significantly cheaper, than alternative treatments without loss of efficacy.” Peter Stratton (2011:4) Russell Crane (2008) The cost effectiveness of Family Therapy: A summary and progress report. Journal of Family Therapy, 30: Alan Carr’s reviews of evidence base for child and adult studies (2011) Journal of Family Therapy, 36: 107–157 & 158–194. 3

Key messages Involving a partner & /or the family improves outcome Relapse rates in psychosis are more than halved when family interventions are added to standard care (including medication). Well-being of all family members improves and visits to GP are reduced. Family therapy reduces carer stress/burden which may otherwise precipitate serious mental health problems in carers. 4

NATIONAL POLICIES 1. (NSF) for Mental Health (1999) 2. (NSF) for Older People (2001) 3. Valuing People: A new strategy for learning disability (2001) 4. MH Policy Implementation Guide: CMHTs (2002) 5. MH PIG: Adult Acute Inpatient Care (2002) 6. MH PIG: Psychiatric Intensive Care Units & low Secure (2002) 7. NICE Clinical Guidelines for Schizophrenia (2014) 8. NSF for Children, Young People and Maternity Services (2004) 9. NICE Clinical Guidelines for Eating Disorders (2004) 10. NICE Clinical Guidelines for Depression (2004) 11. NICE Clinical Guidelines for Dementia (2006) 12. Think Family: Improving the life chances of families at risk (2008) 13. Triangle of Care; NMHDU/ Carers Trust (2010/13) 5

What’s different? If we expect our clients to talk about their backgrounds we must consider our own, or we may be confronted with unexpected reactions that influence the conversations we have with our clients.

SOCIAL GWRRAACCEESS (JOHN BURNHAM ET AL ) Gender Culture Wealth Class Race Education Religion Ethnicity Age Spirituality Ability Sexuality

Family life cycle Births Deaths Marriage Children starting school Children leaving home Moving house Divorce/separation Illness Change of occupation

Polyphonic (inner)voices Mother Wife Sister Daughter Aunt Friend Clinician Supervisor Dog owner

Write down your own polyphonic voices

Mary Sue 29 Peter Tom 25 Ben 27 Joe 32 2 serious psychotic episodes, 2nd one after stopping his meds Both after visits to his father Left the family home when Ben 11, very successful business man, travels the world, paid no maintenance, several partners Lots of violence in the home, father had destroyed all the internal doors Worked full time as a shop assistant to raise her children alone, no new partner. Raised in Kenya as an only child, her 4 elder siblings having been killed in ‘ethnic cleansing

Turn to your neighbour and ask them which ‘polyphonic’ voice was the loudest ?

Beth I chose to speak to my sister about some key events during our early life. Despite growing up in the same home I was really surprised that we had such different experiences and memories of events. What surprised me most was my surprise at this revelation. I often think about this perspective talking with my clients and help them understand the responses of friends, family and loved one though the idea that you can be next to someone experiencing the same thing and yet tell a different story or have a different memory of the event as we are all different yet somehow I hadn’t applied this to my own family and our experiences. It’s funny how you can know the theory and yet not really get it. It’s the difference between head knowledge and heart knowledge. Talking with my sister really helped me feel and fully understand this reality more than ever before. I’m not going to forget that quickly.

Only us