Family Matters: Family-Focused Practice in Adult Mental Health Services

Abstract

This thesis explored adult mental health practitioners’ experiences of the implementation of family-focused practice (FFP), a ‘whole-family’ approach to care, using qualitative methodologies. The thesis consists of three papers. The systematic review (Paper 1) is a qualitative metasynthesis of the international qualitative literature examining adult mental health practitioners’ experiences of implementing FFP within adult mental health services (AMHS). Nineteen papers, spanning 17 years of research with 469 practitioners were included. A thematic synthesis derived three main themes and 14 sub-themes. This review identified that practitioners’ approach to FFP was variable. Moreover, practitioners engaged in a constant ‘balancing act’ between FFP stakeholders (service-users, families, professionals and organisational contexts) to achieve meaningful outcomes, a novel conceptualisation. Whilst ‘working together’ unified teams, a greater need for external interagency collaboration was identified. The use of strength-based approaches with clients and dedicated staff resources, within clear guidelines and frameworks, facilitated the delivery of FFP. Service recommendations are provided to maximise the delivery of FFP and therefore improve outcomes for ‘whole-families’. The empirical paper (Paper 2) is the first of its kind in the UK, exploring adult mental health practitioners’ experiences and views of FFP in a unique service context, namely within Early Intervention Psychosis Services. Semi-structured interviews with 16 adult mental health practitioners were thematically analysed. Practitioners’ understanding and implementation of FFP was variable and typically excluded children. Practitioners’ characteristics, professional experience and preconceptions of families influenced delivery of FFP, and the engagement approach they adopted impacted families’ responsiveness. The diversity and dynamics of service-users and their families had further implications for the delivery of FFP. An operational context characterised by insufficient resources compromised FFP; however, organisational structures were also identified to facilitate FFP. Findings were considered in relation to existing literature and service recommendations for overcoming barriers to the implementation of FFP were offered. Paper 3 provides a critical appraisal of the research process. The strengths and limitations of the work, the challenges faced and its contribution to this field of research were considered. The researcher offered personal reflections on the process.

Date of Award	31 Dec 2022
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Anja Wittkowski (Supervisor) & Lynsey Gregg (Supervisor)