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Excerpt
The discovery of antipsychotic medications and the increasing trend towards community treatment of the mentally ill have given the patient's family a primary care-giving role. Families face difficult problems in this role; problems which are often not fully appreciated by many psychiatrists. The result has been that the needs of families have been ignored. In developing countries such as India, Africa and South America where there are very few psychiatrists, families are often the only providers of care and protection. They carry a heavy burden without accurate information, education and support to assist them.
In western countries, some psychiatrists still consider the families as ‘pathogenic’. Recent scientific developments indicate a neurobiological basis for the major psychotic disorders so families should no longer be blamed for causing these illnesses. When families experience problems which have existed before the onset of mental illness, and frequently as a result of the mental illness, there must be help available.
Unless families worldwide, and particularly in the developing world, are not given support, they will be unable to continue caring effectively. This is not ‘in the best interest of the patient’.
In setting out ethical guidelines for the practice of psychiatry worldwide, the Declaration of Madrid does not adequately acknowledge or pay attention to the important care-giving role of the family of the patient.
Family members can assist psychiatrists to provide ‘the best therapy available in consistence with accepted scientific knowledge and ethical principles’. They can give ‘advice in areas of their work in which they (psychiatrists) do not have primary expertise’ (point 1 - Declaration of Madrid). Family members have intimate knowledge of their mentally ill relative, so they should be listened to very carefully. They have information as well as social, emotional and material resources (although this varies considerably) that psychiatrists should utilise in planning their patients' comprehensive treatment and care.
At the same time, psychiatrists can help family members overcome other problems that may be interfering with their capacity to care effectively. Families must be included as a valuable resource, not only in the day-to-day care for their mentally ill relative, but as advocates for the better and more ‘equitable allocation of health resources’, particularly the newer medications. In countries where family organisations are well developed, the role of advocacy by families has produced some amazing results.
‘Since 1980, twenty-two controlled studies of long-term cognitive-behavioural interventions integrated with optimal drug treatment and case management’ (statement from an annotated bibliography prepared for the World Schizophrenia Fellowship by Ian Falloon, Professor of Psychiatry, University of Auckland, New Zealand) have shown many positive results for patients primarily with schizophrenia when their family members and friends have been incluced as partners in treatment and care. Major exacerbations of psychotic symptoms are significantly reduced. There are fewer hospital admissions, better compliance with medications, and reduced social disabilities. Family burden is lessened and an improvement is shown in the emotional and physical health of family members. Although there are some small additional costs in the beginning, these are more than compensated for by reduction in the need for acute hospital admissions and the expenses incurred by families through social disruptions (often involving the law) associated with treatment delays. The involvement of families, therefore, leads to high cost effectiveness.
