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Why involve families in acute mental healthcare? A collaborative conceptual review
  1. Aysegul Dirik1,
  2. Sima Sandhu1,
  3. Domenico Giacco1,2,
  4. Katherine Barrett1,
  5. Gerry Bennison1,
  6. Sue Collinson1,
  7. Stefan Priebe1
  1. 1 Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
  2. 2 East London NHS Foundation Trust, London, UK
  1. Correspondence to Aysegul Dirik; a.dirik{at}


Objectives Family involvement is strongly recommended in clinical guidelines but suffers from poor implementation. To explore this topic at a conceptual level, a multidisciplinary review team including academics, clinicians and individuals with lived experience undertook a review to explore the theoretical background of family involvement models in acute mental health treatment and how this relates to their delivery.

Design A conceptual review was undertaken, including a systematic search and narrative synthesis. Included family models were mapped onto the most commonly referenced underlying theories: the diathesis–stress model, systems theories and postmodern theories of mental health. Common components of the models were summarised and compared. Lastly, a thematic analysis was undertaken to explore the role of patients and families in the delivery of the approaches.

Setting General adult acute mental health treatment.

Results Six distinct family involvement models were identified: Calgary Family Assessment and Intervention Models, ERIC (Equipe Rapide d’Intervention de Crise), Family Psychoeducation Models, Family Systems Approach, Open Dialogue and the Somerset Model. Findings indicated that despite wide variation in the theoretical models underlying family involvement models, there were many commonalities in their components, such as a focus on communication, language use and joint decision-making. Thematic analysis of the role of patients and families identified several issues for implementation. This included potential harms that could emerge during delivery of the models, such as imposing linear ‘patient–carer’ relationships and the risk of perceived coercion.

Conclusions We conclude that future staff training may benefit from discussing the chosen family involvement model within the context of other theories of mental health. This may help to clarify the underlying purpose of family involvement and address the diverse needs and world views of patients, families and professionals in acute settings.

  • mental health
  • adult psychiatry
  • anxiety disorders
  • qualitative research

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors AD designed the study, conducted searches and data extraction (in consultation with SS and SP), led on the analysis and prepared the manuscript. All authors contributed to the analysis, critically reviewed the paper and approved the final manuscript. SP and SS also provided overall guidance and supervision for the study.

  • Funding This article presents independent research funded by the National Institute for Health Research (NIHR), the East London NHS Foundation Trust and the Centre for Public Engagement (CPE) at Queen Mary University of London (QMUL). AD is funded by the NIHR Doctoral Research Fellowship (DRF-2015-08-071). DG was supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Barts Health NHS Trust. KB, GB and SC were supported by the Centre for Public Engagement at QMUL.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the CPE, NHS, the NIHR, or the Department of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional unpublished data to share.

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