Family Intervention for Psychosis + Expressed Emotion

• The poster is titled "Barriers to Implementing Family Intervention for High Expressed Emotion in Psychosis" by Hannah Cleary

Why Family Intervention (FI) Matters

• FI effectiveness is proven, with early meta-analyses showing it can reduce relapse rates by up to 25%.
• FI reduces hospital admissions and improves family functioning.
• Variability in FI models and inconsistent methodologies suggests the need for further research.
• The lack of long-term follow-up limits understanding of the sustained benefits of FI over time.

Implementation Gap

• 1.5-3.5% of the population will meet diagnostic criteria for a psychotic disorder in their lifetime.
• A higher percentage will experience at least one psychotic symptom.
• The National Clinical Audit of Psychosis (NCAP) found that only 29% of individuals with psychosis receive FI in England in 2025.
• A pie chart shows that 29% of individuals received FI, while 71% did not.

What is Expressed Emotion (EE)?

• EE includes criticism, hostility, or emotional over-involvement from family members.
• EE is linked to higher relapse rates in psychosis.

What is Family Intervention (FI)?

• FI is structured therapy to support families and reduce EE.
• FI helps improve communication & coping strategies.
• FI is recommended by NICE guidelines.

Barriers to Implementation

• Barriers to implementation are split into three categories: organizational, clinician, and family.

Organizational Barriers:

• Inconsistent service provisions across regions due to poor service coordination.
• Limited resources and funding contribute to poor integration into standard care.
• Prioritization of acute care over preventative interventions.

Clinician Barriers:

• Limited training and confidence in skills to deliver FI.
• Lack of awareness, or skepticism about the evidence supporting FI.
• High workload and competing priorities prevent clinicians from allocating time for FI.

Family Barriers:

• Stigma surrounding mental illness and fear of being blamed.
• Misunderstandings about the goals and benefits of FI, leading to reluctance to participate.
• Logistical issues, such as location, scheduling, and lack of childcare support.

National Clinical Audit of Psychosis (NCAP) Findings: England

• Low engagement with FI: The 2021/22 NCAP report found a 43% refusal rate of FI, persisting in the 2023/24 report.
• Increase in FI uptake: The 2024 NCAP State of the Nation report shows FI uptake rose from 21% in 2021/22 to 29% in 2023/24.
• Assessing Engagement: NCAP defines 'uptake' as receiving just one session.
• Variability across trusts: The 2021/22 NCAP report found FI uptake ranged from 4% to 50% across NHS Trusts.

NCAP Case Study: Improving Uptake of Family Intervention

• The NAVIGO team in Grimsby transformed their approach to Family Intervention following engagement in the 2nd Quality Improvement Collaborative.
• The team quickly recognised the positive impact, despite initial hesitation due to workload concerns.

Key Changes of the NCAP Case Study

• Reframed FI as a core service rather than an "add-on".
• Improved communication with families via tailored service menus.
• Doubled the number of staff trained in FI.
• Reinstated peer supervision as protected time, integrating it into routine practice.
• Their success inspired a neighboring team to join their peer supervision sessions.

Future Direction

• Recommendations to improve implementation include the following:

• Expand clinician training & supervision to ensure staff have the confidence and skills to efficiently deliver FI.

• Dedicated implementation strategies to embed FI into routine care.

• Enhance service coordination to reduce regional inequalities and ensure equitable access to support for all families.