Barriers to Family Care in Psychiatric Settings
Linda E. Rose, RN, PhD, Nu Beta, Associate Professor, Johns Hopkins University, School of Nursing, Baltimore, MD; R. Kevin Mallinson, RN, PhD, ACRN, Tau, Assistant Professor, Georgetown University, School of Nursing & Health Studies, Washington, DC; Benita Walton-Moss, RN, DNS, CS, FNP, Nu Beta, Assistant Professor, Johns Hopkins University, School of Nursing, Baltimore, MD. This research was supported by Grant 1R03 HS10378-01 from the Agency for Health Care Research and Quality (AHRQ). Correspondence to Dr. Rose, 525 North Wolfe Street, Baltimore, MD 21205. E-mail: [email protected]
Abstract
Purpose: To identify barriers to family care in psychiatric settings and to describe family and provider perspectives about what constitutes effective family care.
Design and Methods: A qualitative exploratory approach with focus groups. Seventy-eight people participated in 11 focus groups conducted with families, patients, and health professionals.
Findings: Families identified poor quality care, conflict with health professionals about treatment, and lack of a role for families in the treatment. African American families also identified isolation of their communities from the mental health care system. Adolescents emphasized their role as caregivers and their needs for support. Health professionals conveyed concerns about system-based barriers, professional practice-based barriers, and family-based barriers to care. Patients stated the need for their families to be better educated about mental illness.
Conclusions: The lack of family care in psychiatric settings is a multifaceted problem. Current health policies do not show endorsement of a family care approach. Responses from families and health professionals indicated conflicting opinions about content of family care. Health professionals reported they often lacked training and resources to deal with complex family issues. Families believed that lengthy and intensive interventions were neither necessary nor desired to address their concerns. Family care can be improved by focusing on building rapport and communicating problems and concerns between families and health professionals.
