MASTER Conference PowerPoint slides for upload.pdf

Whole Family Mental Health and Recovery:
Building Practice, Policy and Research
in the Community Conference Dublin 3rd September 2024

1. Whole Family Mental Health and Recovery:
Building Practice, Policy and Research
in the Community

2. Shauna Diamond
National Programme Lead
Head of Operations
Family Resource Centre National Forum
Fergal Landy
CEO of the Family Resource
Centre National Forum
Your MCs for the Day

3. #FamilyMentalHealth
Network: CAI Public
Username: caiguest
Password: S3cur3K3y$

4. Conference Steering Committee
Kerry Cuskelly

Professor Sinéad McGilloway Michael John Norton
Gina DelaneyMary O’Connell Gannon Sushil Teji
Dr Christine Mulligan
Sharon Maher

5. Michael Ryan
Director, HSE Office of Mental Health
Engagement and Recovery (MHER)
Professor Linda Connolly
Director of the Maynooth University
Social Sciences Institute
Opening Speakers

6. Professor Sinéad
McGilloway
Founder Director, Centre for Mental Health and
Community Research,
Maynooth University Department of
Psychology & Social Sciences Institute
Brief introduction to the
PRIMERA Project:
A focus on lived experience

7. Almost 1 in 4 children have,
or have had, a parent with a
mental health illness
Impact on
children
Gaps in service
provision
Background to the PRIMERA Project

8.  Explore current service provision and supports in Ireland (2017- 2018)

 Identify, help to implement and evaluate a family-focused
intervention for families where a parent has mental health
challenges
 Help to promote a whole- family care delivery agenda in Ireland

Project Aims

9. Evidence-based 6 -8 week programme (1-hour
sessions)
 Strengths-based, psycho-educational

Whole-family approach
 Suitable for all mental health challenges
 Free online training (10-hrs) and resources
(
https://learning.emergingminds.com.au/course/family-talk)
Adopted as part of state/national initiatives in US,
Australia, Scandinavia
Family Talk
Early Intervention Foundation Guidebook
https://guidebook.eif.org.uk/files/pdfs/programmes-
programme- 4.pdf

10. 1. Scoping, installation and implementation of Family Talk programme
(across 10 sites and several service organisations)
2. RCT and cost analysis of Family Talk
(N=86 families: 360: 139 parents, 221 children)
3. Exploring the experiences of families (n=45) and service providers
(n=41)
(https://cmhcr.eu/primera-programme/
4. Exploring the experiences of adult children of parents with mental illness (n=18)
What we did

11. Significant improvements in family relationships
Improved child behaviour
Better parent & child mental health
Very good VfM -> €415 per family (non- recurring)
Reduced stigma
Giving children and partners a voice

Family experiences
(RCT and Process Evaluation)
“I felt like the course has helped quite
a lot. Family life has got a lot easier.
We're not arguing as much, we're not
shouting. It's just easier to talk to
people now.” (16 year-old child)
“There was nobody out there for me or the
kids… I can't compliment it enough. It's just
the best thing that happened.”(Partner)
“I did not realise my eldest was being bullied
for two years. He kept it to himself because
he worried about me killing myself.” (Parent)

14. Thank you
[email protected]
https://cmhcr.eu

15. Professor Camilla
Lauritzen
Professor of Educational Science,
Arctic University of Norway (UiT)
A Family-Focused Approach
in Mental Health Services:
The Norway Experience

16. Mary Butler
Minister for Mental Health
and Older People
Opening Address

17. Tea & Coffee are
now being served
on Level One
11.20 – 11.30am

18. Mary Donaghy Dr Gráinne Fadden
Ger Brophy Robert DervinNicola Byrne Dr Anne Cullen
Ber Grogan Mary G Killion
Panel Discussants

19. Paula Callaghan
The Lived Experience of
Family Mental Health and
Recovery
Person, parent, family member,
‘accidental’ advocate

20. Include families so that they can support their loved ones

21. Real Interagency working
No more “them and us”

22. Acknowledge and address
the lack (Non-Existence) of
services for Neurodivergent
people

23. “NO WRONG DOOR”
Inclusion of family throughout all
stages of a person’s journey
Peer Networks / Encourage
connections across systems
KEY TAKEAWAY

24. 13.00 – 14.00pm
Lunch is now being
served on Level One

25. David McDaid
Associate Professorial Research Fellow in
Health Policy and Health Economics
London School of Economics.
The Economic Case for
Implementing Family-Focused Practice
and Promoting Family Recovery
in Mental Health Services

26. Substantial evidence on long
term and profound impacts of
poor mental health in Ireland

27. Institute for Health Metrics and Evaluation 2023
Mental Ill Health: a leading contributor to Years Lived in Poor Health in Ireland

28. If the mental health needs of people are missed the consequences could
include:
oPoor educational outcomes
oLow employment rates  income losses
oPoor health behaviours (smoking, poor diet etc.)  higher long-term
health risks
oSubstance misuse  crime, health damage etc.
oAntisocial behaviour & crime  social costs
oDamage to quality of life / wellbeing
oSuicide & self-harm
What happens when mental health needs are
unrecognised and untreated?

29. But this is only part of
the picture. It does not
usually account for the
broader impacts on
families

30. Four key
economic
questions to
inform policy
planning and
practice

31. Zechmeister-Koss et al 2023 VALUE HEALTH. 2023; 26(5):704– 711
Many impacts on families, e.g. on children of
parents living with mental health conditions
Impact across multiple sectors;
Short mid and long term outcomes
Critical that evaluation takes account of all
major impacts and not just short-term
health sector impacts

32. o332 children /adolescents in 215 families with parents with mental illness in
six regions of Germany
o12-month costs were calculated based on diagnosis and service user status
oMean parent age: 42; 75% female
o52% of parents had an affective disorder, e.g. depression
oChildren: mean age 12; 52% female
o186 children also had a psychiatric diagnosis
oRelationship between child mental health status and cost also examined
Estimating health & social service costs inchildren ofparents
withmental illness in Germany
Waldmann et al. Child Adolescent Psychiatry Mental Health (2021) 15:10

33. Health & social service costs inchildren ofparents withmental illness in Germany
€288
€131
€0
€171
€656
€0
€1,245
€2,540
€581
€789
€327
€1,384
€70
€5,692
€0
€1,000
€2,000
€3,000
€4,000
€5,000
€6,000
Psychiatric InpatientPsychiatric OutpatientChild & Youth Services
Inpatient
Child & Youth Services
Outpatient
School help Medication Overall
One year costs (€s)
No Mental Health ConditionMental Health Condition
Waldmann et al. Child Adolescent Psychiatry Mental Health (2021) 15:10
With each one unit increase in child (psychiatric) functioning
on a specific scale (Skala zur Gesamtbeurteilung von Kindern
und Jugendlichen) there was a decrease of €214 in annual
costs.

34. Four key
economic
questions to
inform policy
planning and
practice

35. oEconomics is about helping inform choices for
decision makers
oCritical to know budgetary impact of any
intervention.
oAs part of PRIMERA evaluation in Ireland initial
and recurrent costs associated with delivery of
the Family Talk programme were collated
oOnline anonymised practitioner diaries on how
time spent and resources consumed
Important to routinely estimate the costs of taking action
Furlong M, McGuinness C, Mulligan CM, McGarr SL and McGilloway S (2024) Family Talk versus usual services in improving child
and family psychosocial functioning in families with parental mental illness: a randomised controlled trial and cost analysis.
Front. Psychiatry 15:1287378.doi: 10.3389/fpsyt.2024.1287378

36. And what about the cost
effectiveness of interventions
focused on children/families of
people living with mental
health conditions?

37. oAppears to be limited assessment of the economic case for intervention
oStudies potentially promising, but need a broader approach to assessing the
economic case
oExisting studies tend to have a very short- term focus, often limited to health
care system, and not looking at impacts on all of family in addition to
children.
oMissed opportunity to learn more about what works
Economic case for action to support families where parents have
lived experience of poor mental health

38. •99 families in Netherlands controlled trial and economic evaluation of preventive program
targeting threats to parenting quality; children aged 3-10.
•Family- focused strength-oriented rehabilitation model strengthening positive parenting plus
community and network support
•Personal PBCM coordinator and integrated preventive plan for tailored preventive care,
•Families linked to childcare for young children, clubs for older children, community health
services, services for debt restructuring and financial resources
•18 month follow-up.
The case for preventive basic care management
Wansink et al. BMC Health Services Research (2016) 16:228

39. •Improved parental outcomes
•But did not look at health impacts on children and
other family members
•Outcome measure not helpful for policy makers;
•Short term follow up – just 18 months – longer time
period will show more impact if effective
The case for preventive basic care management
€175 per unit
parental quality
improvement
€461 per unit parental quality improvement
€215 per unit parental quality improvement
Wansink et al. BMC Health Services Research (2016) 16:228

40. •Randomised controlled trial in Germany of CHIMPS: a manualised program with eight semi
structured sessions (50–90 min) provided by a psychiatrist or psychotherapist over 6 months.
•Separate sessions with parents, each child and entire family.
•209 families with 337 children
•Measured impact on quality of life for children, over two one- year periods
•Economic analysis from societal perspective
Economic evaluation of manualised programme for families with a
parent with a mental health condition
Waldmannetal. Child and Adolescent Psychiatry and Mental Health (2023) 17:141

41. Economic evaluation of manualised programme for families with a
parent with a mental health condition
Waldmannetal. Child and Adolescent Psychiatry and Mental Health (2023) 17:141
•Lower costs for intervention group
•Small improvements in child quality of
life
•Positive net benefits ranging between
€25,000 and €125,000
•Impacts not statistically significant;
but impacts on wider family not
included; nor longer time frame
Lower costs and higher quality of life

42. Family intervention can
be hidden within
evaluations of broader
programmes

43. Early intervention in psychosis
Behan, Kennelly, Roche et al 2020 British Journal of Psychiatry 217, 484–490.
•Two cohorts of adults with first episode
psychosis in Ireland
•One cohort referred to early intervention in
psychosis teams. CBT for psychosis sessions and
family education sessions
•One cohort received treatment as usual –
community mental health treatment teams
(home treatment and assertive outreach)
•Followed over 1 year period
•Impacts on health service utilisation
•Impacts on time out of work as well as impacts
on carers time

44. 95% chance of better
outcomes AND lower
costs from health
system and societal
perspectives
Behan, Kennelly, Roche et al 2020 British Journal of Psychiatry 217, 484–490.

45. Interventions for adults
in families with adults
living with mental
health conditions

46. oSmall randomised controlled trial in Spain – 88 families
oInt: 12 months family psychoeducation
oFamilies living with an adult with a diagnosis of schizophrenia
o40% reduction in risk of hospitalisation
o‘Social disability’ significantly reduced at 12 and 18 month follow up
Mayoral F, Berrozpe A et al. Rev PsiquiatrSalud Ment(Barc.). 2015;8:83---91.
•.
•.
Family psychoeducation

47. oSmall randomised controlled trial in Japan
oInt: Brief four session family psychoeducation. Four 2-hour multiple-family sessions consisting of didactic
lectures about depression (30 minutes) and group discussion and problem-solving (60–90 minutes).
oPeople living with depression: mainly spousal carers
oPotentially cost effective as significantly increases number of relapse-free days over one year.
oMany studies on cost for caring for particular conditions
Shimodera et al. BMC Psychiatry 2012 12:40.
•.
•.
Family psychoeducation

48. •Network meta-analysis on
psychological and psychosocial
interventions for relapse
prevention in schizophrenia
•“robust benefits in reducing the
risk of relapse for family
interventions, family
psychoeducation, and cognitive
behavioural therapy….for
[people] with schizophrenia”
•Source: Bighelli et al 2021 Lancet
Psychiatry 2021; 8: 969– 80
•This will have economic benefits
Relapse Prevention in Schizophrenia

49. The importance of protecting the
mental and physical health of family
carers

50. McDaid & Park, 2022, Int J Environ Res Public Health

51. McDaid & Park, 2022,
Int J Environ Res Public
Health

52. McDaid & Park, 2022, Int J Environ Res Public Health

53. McDaid & Park, 2022, Int J Environ Res Public Health

54. Whole of family approaches should
have some focus on importance of
protecting the mental and physical
health of all family carers

55. oVery few economic studies have looked at interventions for adult family
carers supporting people with most mental health conditions.
oHowever, there is good evidence on the long term economic case for
interventions to support carers living with someone with dementia
oThis gap needs to be filled…………
•.
•.
More to do on protecting mental health of carers……….

56. Going forward
A.Profound impacts on mental, physical / social circumstances of
families.
B.Doing nothing is not a good option. Substantial costs for families
and people living with mental health conditions & society
C.Families are part of the solution; evidence base on effectiveness of
different approaches for different age groups/conditions for
prevention / treatment /recovery
D.But we don’t measure all the value. Need longer-term/broader
economic perspective to capture impacts on all of family
E.Important to also look at ways to protect health /wellbeing of
adult informal carers. This remains neglected, other than for
dementia – but the contribution of families immense.

57. Mary O’Connell Gannon
Mayo Mental Health Family Peer Support
Service
Family Peer Support
Video : An Introduction

58. Family Peer Support

60. WORKSHOP1:Family Recovery -with policy in ‘MIND’
Mary Donaghy & Sharon Maher
The Valencia
WORKSHOP 2:‘The challenges of implementing family-focused practice in Adult
Mental Health Services’
Mary G Killion, Professor SinéadMcGilloway & Fran MacKiever
The Lambay
WORKSHOP 3:‘Providing peer support for families to promote
recovery’
Michael Norton & Mary O’Connell Gannon
The Tory
WORKSHOP 4:‘The use & understanding of language in the context of family
mental health and recovery’
Gina Delaney & Kerry Cuskelly
The Rathlan
WORKSHOP 5:‘The importance of perinatal mental health in a whole- family
context’
Dr Gráinne Fadden& Cherly O’Hara
The Aran

61. Dervila Eyres
Assistant National Director
Head of Operations, HSE Mental
Health
Closing Remarks

62. We want to hear from you!

63. Whole Family Mental Health & Recovery:
Building Practice, Policy and Research
in the Community