Schizophrenia impacts not only people with the disorder but also their families. Uncertainty about diagnosis, treatment and the future can trigger high levels of anxiety and stress within the family. And, all this adds to the burden.
Caqueo-Urízar A, Rus-Calafell M, Urzúa A, Escudero J, Gutiérrez-Maldonado J. The role of family therapy in the management of schizophrenia: challenges and solutions. Neuropsychiatr Dis Treat. 2015 Jan 14;11: 145-51.
Depending upon where you live, mental health services may be able to provide support to families of people with schizophrenia so, if possible, take the opportunity to engage with them for assessment of your own needs and to discuss your strengths and views, and develop your own personal care plan to address your needs.
https://www.nice.org.uk/guidance/cq178/chapter/1-Recommendations#support-for-carers
Families can be involved as partners in care. A ‘triangle of care’ is encouraged between the person with schizophrenia, their relatives and their healthcare team.
Burbach FR. BJPsych Advances 2018; 24: 225-234. doi: 10.1192/bja.2017.32
Family interventions, also called family psychoeducation programs, have been developed as a collaborative approach to information sharing and to provide training in coping, communication and problem-solving skills so that the family may better support their relative’s recovery.
Even if you think your family doesn’t need or want lengthy interventions such as those offered through family psychoeducation, brief educational interventions with a focus on information sharing about the illness, early warning signs and relapse prevention as well as practical resources and support may be useful.
Harvey C. Family psychoeducation for people living with schizophrenia and their families. B J Psych Advances 2018; 24 (1): 9-19. doi:10.1192/bja.2017.4
For people with schizophrenia, family psychoeducation may reduce the risk of relapse and help them to consistently take their medication as prescribed. It can also make family life less burdensome and tense and may prevent re-hospitalization.
Pharoah F, Mari J, Rathbone J, Wong W. Family intervention for schizophrenia. Cochrane Database Syst Rev. 2010;(12):CD000088. Published 2010 Dec 8. doi:10.1002/14651858.CD000088.pub2
Family psychoeducation had considerable positive effects on relatives’ burden and psychological distress, the relationship between relatives and the person with schizophrenia, and family functioning.
Harvey C. Family psychoeducation for people living with schizophrenia and their families. B J Psych Advances 2018; 24 (1): 9-19. doi:10.1192/bja.2017.4
Family psychoeducation programs also reduce the stigma associated with mental illness. Stigma is the most challenging care responsibility in families of people with mental illness. And, unsurprisingly, stigma has been shown to have a negative impact on those with schizophrenia.
Vaghee S, et al. Effects of Psychoeducation on Stigma in Family Caregivers of Patients with Schizophrenia: A Clinical Trial. Evidence Based Care Journal 2015; 5 (16): 63-76.
Morgan AJ, et al. Interventions to reduce stigma towards people with severe mental illness: Systematic review and meta-analysis. Journal of Psychiatric Research. 2018; 103: 120-33.
It’s important to consider that schizophrenia can impair a person’s ability to understand or recognize their condition. This lack of insight is not due to denial, defensiveness, or stubbornness but is a symptom of the condition itself and can be the reason why they refuse medication or do not seek treatment.
https://www.treatmentadvocacycenter.org/key-issues/anosognosia
It’s therefore highly recommended to avoid arguing with a person who lacks insight as constant confrontation and denial may invariably lead to avoidance.
The principles of LEAP can be an effective tool to gain the trust of someone who lacks insight. LEAP stands for Listen, Empathize, Agree, and Partner. The crux of this approach is reflective listening: to have your point of view considered seriously, the other person needs to feel that you have seriously considered theirs. A related principle is called the ‘three As’: Apologize for a difference in opinion, Acknowledge the existence of different perspectives, and Agree to disagree.
https://psychiatryonline.org/doi/10.1176/appi.ajp-rj.2016.110306
