1. Zoning: Focused Support Christine Lewis A Carer’s Perspective

2. Why do Families need support? Families do most of the caring. It’s a difficult, complex job - we need the tools and techniques to do it well. Evidence-based research shows that families can have a big influence (for good or bad) on preventing relapse. Important to help us to give our loved ones the right kind of support Diagnosis of psychotic illness is outside most people’s experience and knowledge - families often confused, shocked, bewildered, frightened We are often left to cope on our own. Information, communication, support and help for families is too often inadequate and “hit and miss”

3. How Zoning techniques are used in family work. Family workers and families together: Identify and categorise all the “early warning signs” that the person is becoming ill Analyse a previous relapse to identify “trigger” points Using the zoning “traffic light” model, produce a relapse prevention plan This enables the family to be aware of the signs for themselves and to know how and when to take preventative action, or seek help.

4. Stages, Signs, Action Plan Traffic Light Stages “Signs” Thoughts Feelings Behaviours Actions to be taken by Staff Actions to be taken by Client Actions to be taken by Parents Red No sleep Don’t talk Very Irritable No eye contact Will respond immediately visit & assess Try to talk to staff or family Contact Dr. & CPN Amber Intermittent sleep Smirks Doesn’t Wash Wears odd clothes Visit frequently – three times a week Discuss vulnerability Provide relapse prevention advice Talk to sister Try to avoid too stressful events Avoid alcohol Be available, listen and problem solve Use this plan, contact GP/or Team Green Staying Healthy Getting on with life, Seeing friends more; enjoying company, working again. Will discharge to GP if this status continues for over six months Go to the gym Play footie in the park on Sunday Support listen, get on with our lives.

5. How does zoning help families? Breaking down the psychotic illness into small components makes the condition more understandable and less frightening. “Traffic light” system is easy to understand - an everyday concept which everyone - including the service user - can engage with. A non-threatening and non judgmental approach. Linked firmly to the situation of the individual service user and their family. More useful than generalised advice or training sessions. Helps families to manage the condition for themselves - and become much less dependent on professionals.

6. Zoning is all about recovery It’s all about recovery - use zoning to help families “accentuate the positive” and recognize (small) steps towards recovery. Puts the service user and their family back into control. Reduces everyone’s stress and anxiety - makes families feel better - this in itself helps the service user, and helps to avoid relapse.

7. Zoning respects everyone’s experience and expertise The service user, the family and the mental health professionals working together all contribute, all learn from each other. The approach families need and want. Families’ top priority is to have our expertise acknowledged, and to be treated as “partners in care” ( Rethink and Carers UK research) Essential to complete a care plan (CPA approach) to which everyone contributes, and there is a shared understanding of what everyone has to do.

8. “Wicked issues” for service users, families, friends and carers Zoning approach can help everyone. How can we roll it out more widely? Professionals need to be much more open and honest about discussing risk and vulnerability with service users and their families. Key objective of self management is to enable people to be discharged from secondary mental health services ………………………………….. But Essential to have a fast track back if needed - and to build people’s trust in the system.