Family interventions in psychosis: A review of the evidence and barriers to implementation.

Objective
Family interventions for schizophrenia are recommended psychological interventions worldwide. The National Institute for Care and Clinical Excellence (UK) and the Royal Australian and New Zealand College of Psychiatrists recommend family interventions as a first-line treatment and “treatment essential,” respectively, at all stages of psychosis and with all aspects of care. However, the success of the integration of these interventions into routine clinical services has been problematic and remains a major challenge.
Methods
We outline the national guidelines on family interventions for schizophrenia and review the evidence for this approach. Drawing on recent systematic reviews and through searching electronic databases for relevant articles, we review the barriers and facilitators associated with implementing family interventions into routine clinical services.
Results
National guidelines continue to recommend psychological interventions for schizophrenia, reflecting the evidence base to support the provision of this approach across the psychosis spectrum. Reported estimates of implementation rates remain low and vary between 0% and 53%. Barriers to implementing family interventions exist at the service user, clinician, and organisational level. Factors that facilitate implementation of family interventions have been reported to a lesser extent.
Conclusions
Implementation of family interventions for schizophrenia remains poor and is below recommended levels, with wide variation of implementation rates reported. This reflects inequality in the provision of family interventions for schizophrenia. Barriers at the service user, clinician, and organisational level have influenced the implementation of family interventions. A research agenda for improving consistent implementation of family interventions for schizophrenia is discussed.