Family intervention for psychosis

Research led by Professor Elizabeth Kuipers

Our researchers ran the first ever trial of family intervention for schizophrenia in the UK – now a recommended treatment for people with psychosis in the UK.

Family intervention’ helps people who have a diagnosis of schizophrenia stay well – and can also make a difference to the wellbeing of their relatives.

Professor Elizabeth Kuipers and colleagues have helped prove this to be the case and the National Institute for Health and Care Excellence (NICE) recommends at least 10 sessions of family intervention for people with schizophrenia who are in contact with their families.

Professor Kuipers’ research over the past three decades has shown that people with schizophrenia who have family intervention are less likely to relapse and are less likely to be admitted to hospital.

‘During family intervention sessions, the person who has schizophrenia is encouraged to talk to their family and explain what sort of support is helpful – and what makes things worse,’ says Professor Kuipers. She led the first ever trial of family intervention for schizophrenia in the UK, the results of which were published in 1982.

‘Family intervention can improve relationships within the household because the therapists who lead the sessions encourage family members to listen to each other and openly discuss problems and negotiate potential solutions together,’ she says.

Family therapists make sure relatives have all the information they need about schizophrenia so they can better understand the symptoms that can influence someone’s behaviour. For example, people who have been given a diagnosis of schizophrenia may sometimes talk to themselves: this may be because they are responding to voices they are hearing.

‘Supporting someone who has schizophrenia can be a stressful job and family members understandably feel anxious and worried. They can also feel ashamed, isolated and rejected because of the stigma associated with mental illness. Family therapists can help them realise that the emotional responses they have are normal,’ says Professor Kuipers. ‘Family intervention helps families begin to move from feeling exhausted and defeated to feeling that things can improve.’

The 1982 results, and the results of three other studies carried out by our researchers, were included in the evidence used to inform 2009 and 2014 NICE treatment guidelines about schizophrenia.

A manual detailing how to deliver family intervention for psychosis was published in 1992 and updated in 2002.

Giving information to relatives is a key part of family intervention for psychosis. Since 2010, Professor Kuipers has led the development of mentalhealthcare.org.uk, a website that contains information about psychosis created primarily for family members. In 2012, there were more than 230,000 visitors to the site. Professor Kuipers is also the co-author of a book for family members of people who have a diagnosis of schizophrenia and other serious mental health problems – Living with Psychosis. Living with Mental Illness, a book for relatives and friends.

References

• Leff J et al. A controlled trial of social intervention in the families of schizophrenic patients. British Journal of Psychiatry, 1982 Aug; 141: 121-34
• Leff J et al. A controlled trial of social intervention in the families of schizophrenic patients: two-year follow-up. British Journal of Psychiatry, 1985 June; 146: 594-600
• Kuipers L et al. Psychosocial family intervention in schizophrenia: a review of empirical studies. British Journal of Psychiatry, 1992 February; 160: 272-5
• Elizabeth Kuipers et al. Family intervention in psychosis: who needs it? Epidemiologia e Psiciatria Sociale (editorial), 1999; 8(3): 169-173
• Pilling S et al. Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychological Medicine, 2002 July; 32 (5): 763-782
• Szmukler G et al. An exploratory randomised controlled trial of a support programme for carers of patients with psychosis. Social Psychiatry and Psychiatric Epidemiology, 2003; 38: 411-418
• Kuipers E et al. An RCT of early intervention in psychosis: Croydon Outreach and Assertive Support Team (COAST). Social Psychiatry and Psychiatric Epidemiology, 2004 May; 39(5): 358-63
• Garety PA et al. Cognitive behavioural therapy and family intervention for relapse prevention and symptom reduction in psychosis: randomised controlled trial. British Journal of Psychiatry, 2008; 192: 412-423