October 11, 2005

A West Midlands family therapy programme claims to have achieved remarkable results in equipping families with the skills to reduce "relapse" and hospital re-admittance rates for family members diagnosed with a mental illness. Adam James finds out how, and examines why - if the programme is so good - it's not been rolled out to the rest of country

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Val Strawford's tree-lined garden with its Buddha statue oozes calmness. How far removed it is from the torment of her life seven years ago.

Her son Rob had been diagnosed with schizophrenia, precipitating a total breakdown in family life. Overcome with paranoia and anxiety, Rob spent most daylight hours locked in his bedroom. Distraught and confused, Val and her husband no longer spoke to each other. Pent-up anger was vented by smashing windows and doors.

"I had effectively lost my son and my friends drifted away," remembers Val. "I lost my job and my husband was going to leave me - we were not talking. We treated each other like animals. It was living hell."

Val, 51, says no professional explained the schizophrenia diagnosis to her family, let alone offer advice. This was despite Rob at times fearing his mother was a secret KGB agent. For one six week period he did not eat, and had to be sectioned and force fed in hospital to save his life.

This was the predicament facing Martin Atchison, a project worker from the Meriden West Midlands Family Programme, when he offered to intervene four years ago.

Since 1998 the programme has provided behavioural family therapy (BFT) for 3,000 families, of which one member has a severe mental health problem. Eighty per cent of the time it's a psychotic diagnosis, such as schizophrenia.

The intervention involves workers conducting assessments with family members and then working with the whole family on problem-solving, decision-making, power dynamics, goal-setting and communication skills. The family member's psychiatric diagnosis is discussed and methods of preventing "relapse" are taught.

The therapy is extremely practical-based. Therapists might address - sometimes through role playing - flash points of family contention, or discuss how to ensure household bills are not ignored, how to prevent one family member being excluded from household decisions, how to express difficult feelings or understand why someone should stay in bed all day.

"It's about getting the message of trying to move everyone in the family forward - and not just the person who is ill," explains Atchison.

"Sometimes a family will interpret all of one person's behaviour to the illness - so a person will have, for example, no freedom to be angry. It will always interpreted as them being unwell. But, maybe it's more to due with the way that person is spoken to."

Huge importance is placed on looking to the future, and family members interacting positively with each other. "Many families find this very powerful," says Atchison. "One family told me that they had sat down after I'd left and realised they had not said a positive thing to each other for three months."

The project claims huge success. Its manager clinical psychologist Gráinne Fadden says research demonstrates BFT reduces patient "relapse" rates to less than 10%, compared to the 40% rate of patients on medication alone.

Since the Strawford family's participation in the programme Rob has not needed to be admitted to hospital. For Val, the skills and confidence the project taught them kept Rob from permanent confinement in a psychiatric unit.

"It was the first time in four years that I had got to talk to someone about Rob," says Val. "Within three months there were improvements - Rob started having cups of tea with us and then joining us for meals. BFT brought Rob back to us. It gave us a kick up the backside and taught us the basic life skills of how to be nice with each other, to sit and have a meal together, to have respect and to solve problems together."

While the Strawfords are a glowing endorsement of the Meriden programme Atchison admits families "regularly" turn down offers of assistance, often fearing they will be judged. Some service users find the proposal too daunting.

"Every family I have worked with has been sceptical at first," says Martin. "Families often feel blamed - there is an awful lot of guilt"

Val agrees. "As Rob's mother, I felt responsible for his illness. I thought I whole can of worms would be opened. But it was not like that. From the start Martin told us to forget what had happened, and look to the future."

The Meriden project is run by Birmingham and Solihull Mental Health NHS Trust. In partnership with 12 neighbouring trusts, it has trained 1,900 psychiatrists, psychologists, nurses and other staff in BFT. Last year, the Meriden project won an award from the National Institute for Mental Health for its contribution to modernising mental health services.

Yet the west Midlands remains the only region in the country with such a dedicated family therapy service. Fadden finds this frustrating, especially since it's now three years since National Institute for Clinical Excellence (NICE) guidelines on schizophrenia concluded that family interventions - such as BFT - should be available to all families living with people diagnosed with schizophrenia.

Fadden says this lack of commitment to family therapy is largely because the intervention lacks the massive commercial and marketing backing of the pharmaceutical firms which psychiatric drugs benefit from.

"We would need a whole power and culture shift for this to change," says Fadden.

Rob, now aged 27, did not have to wait so long. He feels his days of destructive and acute paranoia are behind him and is looking forward to starting voluntary work next month.

"It's comforting to see everyone in the family getting on so much better," he says. "Everybody made the effort to live with me, and it gave me the inspiration to carry on."

* A shortened version of this article appeared in The Guardian

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