Family Interventions in Psychosis Change Outcomes in Early Intervention Settings – How Much Does the Evidence Support This?

Globally, several million people will be living with a schizophrenia spectrum disorder diagnosis. The first episode is often characterised by high levels of loss, trauma, confusion and uncertainty. Substance misuse, aggression and self-harm are elevated and long delays, spanning several months and years, before relevant services are accessed and appropriate support and interventions commenced are still not uncommon. We know the typical period of first onset is during late adolescence and early adulthood, when important milestones marking transition to adult independence are being negotiated. It is also a period when many service users are still embedded within a family setting or return to live with a close family following a period of treatment (e.g. hospital admission), because their social networks can plummet following the onset of psychosis and psychosis-like symptoms. Consequently, there will be many family members who will assume or find themselves, unexpectedly, thrust into a caregiving role. Given the relapsing and remitting course of these conditions, these roles can be long-term.

The importance of families in supporting the care, progress and recovery of individuals with psychosis, and optimising outcomes, is frequently highlighted by clinicians and researchers and within policy documents and treatment guidelines worldwide. Interestingly, however, our understanding of what therapeutic interventions can best target and address their needs and how to increase access to, and deliver, effective interventions, remains the subject of ongoing debate. Over the last four decades, we have witnessed the development of cognitive behavioural based family interventions. These have been designed to reduce the risk of relapse and hospitalisation for individuals with psychosis and minimise the negative emotional impact on the wider family that can all too often follow the emergence of initial psychotic symptoms in a relative. The evidence base for this work, including its ability to positively change outcomes for patients and their relatives, predominately originates from longer-term and repeat episode populations. However, our increasing understanding of the impact of psychosis on carer functioning and family relationships shows a need to identify effective family focused approaches aimed at addressing family issues as early as possible.

The current Frontiers Research Topic seeks original papers and reviews on the application and implementation of family treatments in clinical services serving ultra-high risk and early psychosis populations. It aims to include a range of papers detailing recent theoretical and clinical developments. The topic is designed to promote discussion and inform effective clinical, service and research efforts to support families and their relationships once they are affected by psychosis. Given the incidence and prevalence rates for psychosis conditions, and the populations affected, the topic area and final collection of papers will be of interest to a diverse audience.