FAMILY PSYCHOEDUCATION PROGRAMME: SOUTH LEE MENTAL HEALTH SERVICES

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FAMILY PSYCHO-EDUCATION PROGRAMME SOUTH LEE
MENTAL HEALTH SERVICES

• Margaret Fitzgerald Principal Social Worker,
  Adult Mental Health

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INTRODUCTION PART ABACKGROUND, DELIVERY,
STRUCUTRE CONTENT

• This part to the presentation will look at
• How the current programme evolved
• The ways in which the past and current programmes
  are delivered
• How the programme was structured
• The aims and content of the programme

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INTRODUCTION PART ASOUTH LEE MENTAL HEALTH
SERVICE

• Highest population, 79,000, in HSE South.
• Poorly developed community resources.
• Low nos of allied professionals, i.e.,
  psychology, social work, occupational therapy.
• Up to 2003, low nos of CMHNs.
• Poorly developed community mental health teams
• Low nos of community residences.

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HISTORY OF FAMILY PSYCHO-EDUCATION IN SOUTH LEE

• No education programme in which HSE staff
  participated prior to 2003.
• 3 programmes of Schizophrenia Ireland family
  education programme, six sessions, run between
  early 2003 and mid 2005.
• These were delivered by
• 1. Psychologist Nurse.
• 2. Social Worker Nurse
• 3. Social Worker Nurse.

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HISTORY (cont)

• Meetings called in Autumn of 2005 to discuss
  programme.
• Difficulties identified with using SI programme
• Not designed to suit specific needs of South Lee.
• South Lee could not evaluate programme.
• Changing facilitators was preventing development
  of skill increase of knowledge.

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HISTORY (cont)

• Autumn 2005. Committee formed, with interested
  professionals, plus two Carers, both parents, one
  male, one female.
• Decision made to write own programme, following
  research, literature review and consultation with
  both Carers.
• Programme written between Autumn 2005 and Summer
  2006.
• Both Carers gave feedback comments throughout
  process, programme altered accordingly.

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2006 PROGRAMME

• Oct/Nov/Dec 2006. 9 week programme was run. Two
  hours duration approx.
• 15 people attended every session, representing
  seven families.
• Feedback indicated satisfaction and increased
  levels of knowledge.

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2008 PROGRAMME

• Improved evaluation.one of facilitators, Marian
  Brady, researched effectiveness of programme as
  part of a masters thesis in CBT (Cognitive
  Behavioural Therapy).
• Preparation in Autumn 2007.
• Programme changed and improved.

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SELECTION OF PARTICIPANTS

• Through Consultant Psychiatrists.
• 4 criteria
• Family Relative must have been informed that
  relative had a confirmed diagnosis .
• Diagnosis had been given in past 1 to 4 years,
  i.e. relatively recent diagnosis.
• Discussion should have taken place between
  consultant family about programme.
• Families to be prioritised on basis of need for
  information support.

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PROCESS

• Phone call to family members identified.
• Follow up letter, outlining details of programme.
• Follow up, lengthy interview of interested
  families
• Follow up letter phone call
• Invitation to programme.

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PRE-PROGRAMME INTERVIEW

• Allowed for rapport /relationship building with
  family members
• Allowed for clarification of programme content.
• Family members had opportunity to express fears,
  sadness, worries, ask questions.
• Allayed fears re attendance.
• In most cases, two hours long.

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PRE-PROGRAMME INTERVIEW

• Allowed facilitators, (social workers), to
  complete pre-programme questionnaires, which were
  administered again on last night of session.
• General Health Questionnaire. measures stress
  levels of family members.
• Family Questionnaire. Knowledge about
  Schizophrenia.

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AIMS OF PROGRAMME

• Increase knowledge on Schizophrenia
• Increase family members coping strategies.
• Allow discussion interaction with others in
  same situation, reducing stigma and sense of
  isolation.
• Decrease stress levels of family members.
• Improve communication within family.

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SETTING AND STRUCTURE

• A closed programme, based on psycho-educational
  cognitive behavioural principals methods.
• Eight Sessions, approx two hours in duration, tea
  break half way through.
• Three facilitators Two social workers and a
  Psychiatrist.
• Held in Day Hospital, Ravenscourt , in Cork City.

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PHILOSOPHY

• Emphasis on confidentiality.
• Emphasis on safety.
• Hope important.
• Participants to share experiences/strategies that
  help.
• Concept of Recovery .

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DELIVERY

• Combination
• Teaching presentation by facilitators.
• Small group discussion, with feedback to larger
  group on topic /theme/ questions from session.
• Combination of these two methods effective.

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PROGRAMMESESSION 1 SIGNS AND SYMPTOMS

• A general description of schizophrenia.
• A detailed description of signs symptoms.
• How a diagnosis is made.
• Possible causes .
• Course of schizophrenia.

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SESSION 2 PART 1 MEDICATION

• An overview of anti psychotic medications.
• How medications exert their therapeutic effect.
• Side-effects.
• Benefits of medication.
• Specific review of Clozapine.
• Evidence base for use of fish oils.

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SESSION 2 PART 2 COPING WITH RISK OF SUICIDE

• Information on stats.
• Outline of risk factors protective factors.
• Explore how families can help.
• Information on current developments in suicide
  prevention.

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SESSION 3 COMING TO TERMS WITH SCHIZOPHRENIA

• Examine experience of Change Loss for
  relatives.
• Explore ways of coping using a Task based
  Model.
• Developing Realistic Expectations.
• Introduce concept of Recovery.
• How families can help with Recovery.

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SESSION 4 IMPROVING COMMUNICATION

• How schizophrenia can lead to difficulties in
  communication.
• How patterns of communication can affect the
  person with schizophrenia.
• Most helpful styles of communication
• Identify areas of potential difficulties.
• Explore ways of reducing resolving these
  difficulties.

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SESSION 5 BURDEN OF CARE COPING STRATEGIES

• Understand how stress can affect your life.
• Learning to cope with stress
• Session 5. Part Two. Coping with Stigma.
• Understand what stigma is how it affects the
  family.
• Learn to cope with stigma how to reduce it.

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SESSION 6 TOWARDS RECOVERY RELAPSE PREVENTION

• Explanation of Early Warning Signs.
• Description of how EWS can help reduce relapse.
• Learn how a family can respond to EWS.
• Developing a personal care plan.
• Examine how plan can be put into action

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SESSION 7 INFORMATION ON SERVICES

• Knowledge on Presentations by Schizophrenia
  Ireland and the National Learning Network. (guest
  speakers)
• Information on Housing options, benefit
  entitlements, employment training options.
• Participants given a comprehensive Information
  package on above.

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SESSION 8 SUMMARY

• Summary Recap of first six sessions.
• Outstanding questions.
• Administer post programme questionnaires.
• Discussion on development of possible follow on
  self help/support group.
• Setting date for one follow up session,
  presentation on problem solving open questions.