MASTER Conference PowerPoint slides for upload.pptx

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 Delaney Mary 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. Background to the PRIMERA Project

8. WORK PCKAGES 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. 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)

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

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

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

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

16. Mary Donaghy Dr Gráinne Fadden Ger Brophy Robert Dervin Nicola Byrne Dr Anne Cullen Ber Grogan Mary G Killion Panel Discussants

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

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

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

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

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

22. 13.00 – 14.00pm Lunch is now being served on Level One

23. 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

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

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

26. If the mental health needs of people are missed the consequences could include: Poor educational outcomes Low employment rates  income losses Poor health behaviours (smoking, poor diet etc.)  higher long-term health risks Substance misuse  crime, health damage etc. Antisocial behaviour & crime  social costs Damage to quality of life / wellbeing Suicide & self-harm What happens when mental health needs are unrecognised and untreated?

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

28. Four key economic questions to inform policy planning and practice The costs of inaction: What are the economic consequences of not taking action to addressing risks to families? The costs of action: What would it cost to intervene by prevention, treatment, ongoing support? The economic case for action : What is the balance between costs of effective intervention and the likelihood of better health and wider outcomes to families? The budgetary impacts of scaling up access to effective packages of interventions? What resources are required to sustain implementation, how can this be achieved, and where will the resource come from ?

29. 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

30. 332 children /adolescents in 215 families with parents with mental illness in six regions of Germany 12-month costs were calculated based on diagnosis and service user status Mean parent age: 42; 75% female 52% of parents had an affective disorder, e.g. depression Children: mean age 12; 52% female 186 children also had a psychiatric diagnosis Relationship between child mental health status and cost also examined Estimating health & social service costs in children of parents with mental illness in Germany Waldmann et al. Child Adolescent Psychiatry Mental Health (2021) 15:10

31. Health & social service costs in children of parents with mental illness in Germany 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.

32. Four key economic questions to inform policy planning and practice The costs of inaction: What are the economic consequences of not taking action to addressing risks to families? The costs of action: What would it cost to intervene by prevention, treatment, ongoing support? The economic case for action : What is the balance between costs of effective intervention and the likelihood of better health and wider outcomes to families? The budgetary impacts of scaling up access to effective packages of interventions? What resources are required to sustain implementation, how can this be achieved, and where will the resource come from ?

33. Economics is about helping inform choices for decision makers Critical to know budgetary impact of any intervention. As part of PRIMERA evaluation in Ireland initial and recurrent costs associated with delivery of the Family Talk programme were collated Online 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

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

35. What is economic evaluation? The effectiveness question: Does this intervention work? The economic question: Is it worth it?

36. Appears to be limited assessment of the economic case for intervention Studies potentially promising , but need a broader approach to assessing the economic case Existing 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. Missed opportunity to learn more about what works Economic case for action to support families where parents have lived experience of poor mental health

37. 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

38. 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

39. 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. S eparate 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 Waldmann et al. Child and Adolescent Psychiatry and Mental Health (2023) 17:141

40. Economic evaluation of manualised programme for families with a parent with a mental health condition Waldmann et al. 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

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

42. 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

43. 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.

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

45. Small randomised controlled trial in Spain – 88 families Int: 12 months family psychoeducation Families living with an adult with a diagnosis of schizophrenia 40% reduction in risk of hospitalisation ‘Social disability’ significantly reduced at 12 and 18 month follow up Mayoral F, Berrozpe A et al. Rev Psiquiatr Salud Ment ( Barc .). 2015;8:83---91. . . Family psychoeducation

46. Small randomised controlled trial in Japan Int: 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). People living with depression: mainly spousal carers Potentially cost effective as significantly increases number of relapse-free days over one year. Many studies on cost for caring for particular conditions Shimodera et al. BMC Psychiatry 2012 12 :40. . . Family psychoeducation

47. 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

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

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

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 Impacts similar for all mental health conditions

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

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

55. Going forward Profound impacts on mental, physical / social circumstances of families. Doing nothing is not a good option. S ubstantial costs for families and people living with mental health conditions & society Families are part of the solution; evidence base on effectiveness of different approaches for different age groups/conditions for prevention / treatment /recovery But we don’t measure all the value. Need longer-term/broader economic perspective to capture impacts on all of family 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 .

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

57. Family Peer Support

58. W ORKSHOP 1: 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 Sinéad McGilloway & 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

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

60. We want to hear from you!

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