Implementation of family interventions in routine clinical practice following staff training programs: A major cause for concern

The efficacy of family interventions in schizophrenia is now well established. Major reviews of the literature all conclude that family psycho-educational interventions result in reduced relapse rates, hospitalisation rates and costs of care, in improved compliance with medication, and that they are applicable across cultures. However, there is no evidence that family approaches to schizophrenia are being offered on a global scale in mental health services. A number of studies have shown that clinicians can be trained effectively in family intervention skills, but there are major obstacles to the implementation of these interventions in routine clinical practice. The present study describes the results of a survey of 86 therapists who received training in Behavioural Family Therapy (BFT); 70% of therapists reported that they had used the approach in their work, but the mean number of families seen per therapist was only 1.7. Forty per cent of the families were seen by 8% of the therapists trained. The two factors which emerged as significant in influencing the number of families receiving BFT were the location in which the therapists worked (community v. in-patient units) and the number of therapists trained in each service area. The difficulties reported by therapists and the implications of these results for staff training and the dissemination of family interventions into clinical services are discussed.