Archives of Psychiatric Nursing 31 (2017) 4854

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Archives of Psychiatric Nursing

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Intervening Early with Family Members during First-Episode Psychosis:

An Evaluation of Mental Health Nursing Psychoeducation within an
Inpatient Unit
Melissa Petrakis , Simon Laxton
St Vincent's Mental Health Service, Melbourne, Australia

a b s t r a c t

Provision of psychoeducation to families of service users experiencing a rst-episode psychosis has been found to
assist with relapse prevention and promoting recovery for service users. Psychoeducation also assists families to
reduce isolation and gain relevant information and support. This study aimed to clarify the role inpatient staff can
best have with families, targeted to the acute phase and early stage of the illness. Family members were provided
an inpatient carer psychoeducation meeting and recruited for a feedback interview 6 months later. Findings
suggest that family members require information provision and support during the admission, in addition to
benecial psychoeducation groups offered later in the community.
2016 Elsevier Inc. All rights reserved.

In addition to the challenges presented for the individual experienc- The symptoms and challenging behaviours displayed by their family
ing major mental illness, caring for a person experiencing such illness member can give rise to a wide variety of reactions in family members
has been found to involve considerable demands for family members including profound anxiety, distress, a sense of confusion, anger, and
(Hazel et al., 2004; Pickett-Schenk, Cook, & Laris, 2000; Yen, 2008). denial (Addington, Coldham, Jones, Ko, & Addington, 2003; Jeppesen
The stress experienced impacts the physical, social, and emotional et al., 2005; McFarlane, Lynch, & Melton, 2012).
wellbeing of these carers, often contributing to mental or physical ill
health for the carers themselves in the longer term. [Carer is the
PSYCHOEDUCATION WITH CARERS
preferred language nominated by family members who support and
care for people experiencing serious mental illness in Australia; it may
Carers of a person rst experiencing psychosis are generally unfamil-
include friends, and it is also associated with the potential availability
iar with many aspects of mental illness and its treatment, including
of government income support benets and allowances.] The subjective
symptoms and behaviours associated with psychosis, medications and
demands, coupled with the feelings associated, have been termed
side effects, mental health services and systems of care, and awareness
burden (Hazel et al., 2004).
of the need to develop coping mechanisms (Lowenstein et al., 2010; Sin,
For family members of people in their rst episode of psychosis,
Moone, & Newell, 2007). Meetings held with carers to deliver informa-
compared with family members of people experiencing more long-
tion on these topics, and provide the opportunity for carers to ask ques-
established major mental illness, there is some indication in the litera-
tions and receive tailored answers, are termed psychoeducation
ture of increased carer burden (Bulger, Wandersman, & Goldman,
sessions. Such psychoeducation is frequently provided in a group format
1993). Carers of individuals experiencing a rst episode report higher
so that carers might additionally benet from mutual support. Typically,
distress levels (Gibbons, Horn, Powell, & Gibbons, 1984; Gopinath &
groups to support carers of individuals experiencing early psychosis
Chaturvedi, 1992; Martens & Addington, 2001). This has been associat-
have been provided through specialist teams or psychological clinics
ed with experiencing various emotional stressors including stigma,
rather than within public community psychiatric services (Leavey
fears regarding the future for the person they support, a sense of loss
et al., 2004; Lowenstein et al., 2010). Furthermore, these groups are typ-
in the changed relationship they have with their family member,
ically located in the community rather than inpatient settings (Kelly,
and feelings of grief and guilt (Lowenstein, Butler, & Ashcroft, 2010).
Wellman, & Sin, 2009).
While provision of psychoeducation and support to family and
carers is a clear recommendation in the literature (Addington et al.,
2003; Gerson et al., 2009; Leavey et al., 2004; Lowenstein et al., 2010;
Sin et al., 2007) and is established in international and local clinical
Corresponding Author: Melissa Petrakis, St Vincent's Hospital (Melbourne), Mental
Health Service, Hawthorn Community Mental Health Centre, 642 Burwood Road,
guidelines (Early Psychosis Guidelines Writing Group, 2010; Petrakis,
Hawthorn East, 3123, Australia. Oxley, & Bloom, 2013), there is not yet clarity or specicity regarding
E-mail address: Melissa.Petrakis@svhm.org.au (M. Petrakis). the content of the psychoeducation, the timing, the format through

http://dx.doi.org/10.1016/j.apnu.2016.07.015
0883-9417/ 2016 Elsevier Inc. All rights reserved.
 M. Petrakis, S. Laxton / Archives of Psychiatric Nursing 31 (2017) 4854 49

which it can best be given and received, nor the appropriate phase and
stage of the service user's illness experience to which to match content
and support. There has been a suggestion in the literature that it would
be advisable to nd a way for families to be brought in sooner for infor-
mation provision and support (Gerson et al., 2009).
A systematic review of randomised control trial (RCT) outcomes for
relatives of people experiencing psychosis examined 50 studies, in each
case a study comparing an intervention to support relatives with a con-
trol group (Lobban et al., 2013). Thirty studies (60%) reported a statisti-
cally signicant positive outcome for a relative. Overall, the review
noted that Future research should focus on what works for whom,
when and why. There is very limited literature regarding how to con-
duct carer interventions in the acute context.
A still more recent systematic review and meta-analysis examined
21 RCTs with 1589 carers (Yesufu-Udechuku et al., 2015a). The authors
found that psychoeducation improves carer experience of care and also
has a benet in terms of reducing levels of psychological distress more
than 6 months later but not immediately post-intervention. Support-
oriented interventions on the other hand were found to have a positive
impact on psychological distress immediately following the interven-
tion. A combination of support and information then seems efcacious.
That nurses are well situated to provide focused prevention and
early intervention for service users with serious mental illness has
been highlighted in recent articles regarding enhancing physical health
care to promote recovery (Faulkner & Biddle, 2002; Happell et al., 2011).
The important role for mental health nursing in rst-episode care
should similarly be emphasised, not only with service users but also
with their families. In the inpatient setting, there needs to be a balance
between concise and comprehensive psychoeducation provision.
Lengths of stay are increasingly brief, and the shock of adjustment to a
new psychiatric diagnosis renders it difcult for service users to take
in large amounts of information and retain the key elements. It is there-
fore important to share relevant information with family members at
the acute context to support them in their own right and support
them to assist their family member. Nurses are well placed to provide infor-
mation on the biological, psychological and emotional, and social impacts of
the new diagnosis. Even with short length of stay, this is achievable through
a single-session methodology (Cade & O'Hanlon, 1993).
of early psychosis cases and assist in timely referral to community and
completion of care pathway documentation (Petrakis, Penno, Oxley,
Bloom, & Castle, 2011). At the time of this evaluation, 58% of Early Psy-
chosis Program clients into the community setting for case manage-
ment had their rst contact with psychiatric services through an
inpatient admission.
EARLY PSYCHOSIS FAMILY AND CARER PSYCHOEDUCATION
ESTABLISHED WITHIN THE SERVICE
The Journey to Recovery group, a facilitated multifamily
psychoeducation and support group for carers, was established and de-
livered in 2009, 2010, twice in 2012, in 2015 and 2016 across the two
community-based continuing care teams in the service. It evolved
using an action research methodology, with qualitative research in
2009 informing a shift from an open support group format to a 5-
session structure in 2010. Quantitative research established that this
format signicantly increased perceived understanding of psychosis, re-
covery, and preventive strategies for group participants (Petrakis, Oxley,
& Bloom, 2012).
The previous qualitative ndings (Petrakis, Bloom, & Oxley, 2014)
revealed that benets from participation were reduced isolation, sense
of collective experience, opportunity to speak and feel heard by peers,
reduced stigma and shame, increased knowledge about mental illness,
and enhanced skills in supporting the care recipient. Barriers to partici-
pation included discomfort with a social situation, revealing emotions,
discomfort with hearing emotions in others, and a belief that their expe-
riences were private matters. This feedback, coupled with our clinical
awareness that the rst inpatient experience is highly distressing for
families, inuenced the approach taken by the nurse senior clinician
based in the inpatient unit in providing information and support.
AIM OF THE STUDY
The aim of the study was to evaluate an inpatient psychoeducation
meeting for families and carers of service users experiencing rst-
episode psychosis delivered by a senior nurse specialising in early psy-
chosis care, based in the inpatient unit.

THE EARLY PSYCHOSIS PROGRAM WITHIN THE SERVICE MATERIALS AND METHODS

The Early Psychosis Program (EPP) within the service commenced in
2006 and includes senior clinicians embedded within each team to both
hold a clinical load and act as a resource for secondary consult, monitor-
ing, and training of other case managers regarding work with early psy-
chosis service users. Case management is provided for up to 3 years, as
per international best practice guidelines (Early Psychosis Guidelines
Writing Group, 2010; Petrakis et al., 2010). Referral criteria to the
Early Psychosis Program are outlined in Fig. 1.
Early engagement with the service user and family was further
enhanced after the introduction of a specic early psychosis nurse in
the inpatient unit setting, to support acute service staff in identication
Inpatient Carer Psychoeducation Session Content
The psychoeducation session content was evidence-based and
consistently delivered (Fig. 2). There was some individualisation in
delivery, pace of session, level of discussion, and use of interpreters
as required.
Materials that were Provided to Carers
In addition to oral information, materials provided to carers were in
varied formats, to be utilised in the session and then taken away to be

Referral criteria
1) No prior history of psychosis, or early psychosis treated for less than 18
months
2) Age 16-65 (*16-18 can be referred to Child & Adolescent Mental
Health Services or EPP)
3) Experiencing active psychotic symptoms, or suspected to be
experiencing in at risk mental state for psychosis
4) Misuse of substances is not an exclusion criterion.

Fig. 1. Referral criteria to the Early Psychosis Program.

50 M. Petrakis, S. Laxton / Archives of Psychiatric Nursing 31 (2017) 4854
Content delivered
Carer understanding of psychosis
Positive and negative symptoms of psychiatric illness
Stress-vulnerability model
Timeline of psychosis phases and stages
Recovery principles
Understanding the service system
Community follow-up
Carer support (Social Worker/ARAFEMI the Association for
Relatives and Friends of the Emotionally and Mentally Ill)
Fig. 2. Inpatient carer psychoeducation session content.
kept and used by the family: fact sheets from the Early Psychosis
Prevention Intervention Centre (EPPIC), a state-wide specialist training
and education centre in Victoria, Australia; medication booklet (Castle &
Tran, 2009); carer information booklet an information DVD about
psychosis, relapse prevention, and recovery; and details of ward-based
relatives and friends information sessions that carers could also attend.
Session Timing and Duration
The psychoeducation session was typically delivered within the rst week
of the family member's admission. Outlier sessions occurred at day 1 and, for
one family where a key member could not attend till then, at day 42. The
mean was the session occurring at day 8. The length of session ranged from
45 minutes to 2.5 hours (mean duration was 1 hour 40 minutes).
Ethical Considerations
The EPP obtained ethics approval from the Research Governance
Unit Human Research Ethics Committee-A on the 19th March 2009 for
a delity evaluation of the program, prior to data collection for the cur-
rent study in the inpatient unit. An amendment to this application was
approved 15 June 2011, detailing numbers of follow-up records to be
evaluated for this sub-study, the process of de-identication, and staff
granted access to the data.
Research Design
The study approach was designed to collect information regarding a
program innovation (Yesufu-Udechuku et al., 2015b) to answer the
question Was the inpatient carer psychoeducation session helpful to
early psychosis family members?
The data-collection method of qualitative interviewing was
selected over a posted survey approach to facilitate naturalness to the
conversation and space for spontaneous feedback, a higher response
rate, exibility, and to gain additional responses as a follow up to closed
questions if possible (Gochros, 2011). This additional information was
of interest since the authors sought descriptive information as to carer
needs and carer experiences, recognising the subjective nature of care-
giving. Telephone contact was selected over face-to-face interviews to
reduce logistical and time demands on families participating and enable
them to select and control the interview environment.
Evaluation of Inpatient Carer Psychoeducation
There were thirty inpatient carer psychoeducation sessions deliv-
ered within the 5-month study period of September 2010January
2011 inclusive. Some sessions were attended by a single family
member; however, it was more common for 2 family members to
attend, and attendance included ve family members in one instance
(55 carers were provided with psychoeducation at the inpatient unit
through these 30 sessions). Each family was approached to nominate
one family member to provide consent to be contacted by the early psy-
chosis senior clinician for a follow-up interview at approximately six
months. A plain language statement was provided, and signed consent
was sought for 2 things: for data being collected in the interview and
follow-up phone call, and to being contacted for a follow-up phone
call by the investigator.
Twenty-eight of the 30 families consented to participate in the
evaluation, and each nominated a member to be contacted at 6 months.
All but one carer could be reached within the follow-up period. There
were twenty-seven participants (N = 27) who participated in the
evaluation (90% of families who received a psychoeducation session
were therefore represented).
A 14-item semi-structured telephone interview questionnaire was
utilised (Fig. 3). The questionnaire was developed within the EPP,
utilising input from nursing and allied health staff familiar with the pur-
pose of the group and with experience running such groups over some
years. It comprised questions on timeliness, correct people invited, suf-
cient time, useful information (written, oral, DVD, booklet, fact sheets),
support offered, family use of information, follow-up in community, and
improvement suggestions.
Since the goal was to determine whether planned psychoeducation
content was recalled as having taken place and whether it had been
perceived as helpful, closed questions were used (questions 18,
1011, and 13; i.e., 11 of 14 questions). Response options were typically
Yes/No followed by the prompt to elaborate, for example item 5: Did
you receive written information on psychosis? Was this helpful or not;
how? Open-ended questions were therefore included (questions 9, 12,
and 14 prompted such additional content) as supplementary items to
capture greater detail as to the way in which psychoeducation content
was or was not used within families and communities in the period of
time following the inpatient session.
The methodology for the qualitative interview follow-up involved
the original senior clinician, who had conducted the psychoeducation
session, phoning the carer to arrange a convenient time for the
telephone interview. When the clinician next phoned for the telephone
interview, responses were recorded verbatim on a pre-prepared semi-
structured interview schedule. The use of a single interviewer was con-
sidered optimal to reduce challenges in inter-rater reliability inconsis-
tencies, increasing the trustworthiness of the data.
Notes from all 27 interviews were typed and reviewed independent-
ly by the interviewer (the inpatient EP senior clinician) and a senior re-
search fellow within the service, who had not been engaged in data
collection, to offer complimentary independent review. The two staff
then met to review the themes that were typical across the interviews;
discussion also highlighted quotes that illustrated the key themes that
 M. Petrakis, S. Laxton / Archives of Psychiatric Nursing 31 (2017) 4854 51

Semi-structured Questionnaire
1. Was the meeting providing information on psychosis conducted in a timely
manner?
2. Did you feel all relevant parties were invited? If not who else should have been
invited?
3. Did the meeting provide sufficient time to find out about psychosis?
4. Was the verbal information you received helpful?
5. Did you receive written info on psychosis? Was this helpful?
6. Did you receive the medication booklet? Was this helpful?
7. Did you receive the carer booklet? Was this helpful?
8. Was carer support offered? Was this helpful?
9. How did you as a family use the information? (i.e did you watch the DVD
together, distribute the fact sheet, etc).
10. Would you encourage other carers to attend the initial carer psycho-education
meeting?
11. Would you have found follow up education sessions on psychosis in the
community useful?
12. Any suggestions on how the service could improve the presentation and content of
information made available to carers?
13. With hindsight was the meeting useful?
14. With hindsight what additional or different information would have been useful
prior to leaving the ward?

Fig. 3. Questionnaire to evaluate utility of the psychoeducation session at 6 months.

had emerged. Data analysis was carried out according to the approach parents (in particular mothers), siblings (especially sisters), spouses
described by Ritchie, Spencer and OConnor (Ritchie, Spencer, & (a greater proportion being wives), and adult children.
O'Connor, 2003; Spencer, Ritchie, & O'Connor, 2003). Results of the follow-up evaluation interview are presented in
Table 2 (N = 27). Material provided in each psychoeducation session
RESULTS had been recorded, and perception of provision at approximately 6
months later could be compared (and expressed as a percentage of ac-
Participants tual provision). What was provided was typically recalled at follow-
up; however, the booklet information was not as clearly remembered.
The 27 participants were carers of individual service users between Many carers emphasised particular material received as very help-
16 and 65 years, who had experienced a rst-episode psychosis and ful, and when asked about this, they elaborated on how the information
were receiving treatment from the inpatient unit. Age of carers ranged was utilised within the family. Verbal information was shared, and
from 18 to 68 years. As Table 1 indicates, the caregiving roles included carers reported it helped us cope. Psychosis fact sheets were reported
to be used through carers reporting variously that they shared them
in the family, to friends, or, as one carer noted, placed them in a folder
Table 1 on coffee table for reference (this carer elaborated a hope that it would
Characteristics of Carers.
be a conversation starter, rather than for them to have to initiate con-
Characteristics of carers Number of Percentage versation on the topic).
carers (N = 27) For the medication booklet, it was emphasised by one of the carers
Relationship of evaluation participants to service user that the version in Mandarin (was) very appreciated. Regarding the
Mother 15 55.6% DVD, the feedback was that carers Viewed it together as a family. The
Father 6 22.2% carer booklet was highlighted as very helpful. Additional carer support
Sibling (sister) 4 14.8%
Partner (wife) 2 7.4%
provided since the hospital admission that was arranged by the service
was also acknowledged, including individual carers noting specic re-
Service user's living situation at admission sources who they appreciated help from: via the social worker, carer
With parents 3 11.1%
With mother only 3 11.1%
consultant, group work, and through community organisation
With sister 1 3.7% ARAFEMI (the Association for Relatives And Friends of the Emotionally
With partner 5 18.5% and Mentally Ill).
With other family members 7 25.9%
Alone 8 29.6%
Qualitative Feedback from Participants
Service user's living situation at discharge
With parents 0 0% In their own words, participants provided additional feedback when
With mother only 0 0%
invited (Table 3). In analysing the content of the interviews to derive
With sister 1 3.7%
With partner 4 14.8% key themes, ve were evident and recurrent. The emergent themes of
With other family members (incl. adult children) 10 37.0% what was important to family members and carers in rst navigating
Alone 7 25.9% the psychotic experience and services were: sharing information; pro-
Residential rehabilitation service 1 3.7% cessing experiences and information; feelings of being unprepared for
Unknown 4 14.8%
discharge; requesting the option of further psychoeducation later in
52 M. Petrakis, S. Laxton / Archives of Psychiatric Nursing 31 (2017) 4854

Table 2
Carer Perceptions of Information and Support Received and Its Helpfulness.

At IPU At follow-up contact (~6 months later)

Information received Perceived helpfulness of information

Provided N = 27 Perceived as received Unsure whether received Unhelpful Neutral Helpful

Verbal information 27 (100%) 24 (88.9%) 3 (11.1%) 0 2 (8.3%) 22 (91.7%)

Psychosis fact sheets 27 (100%) 22 (81.5%) 5 (18.5%) 0 0 22 (100%)
Medication booklet 27 (100%) 18 (66.7%) 9 (33.3%) 0 0 18 (100%)
DVD 16 (59.3%) 12 (75%) 4 (25%) 0 0 12 (100%)
Carer booklet 25 (92.6%) 16 (64%) 9 (36%) 0 0 16 (100%)
Carer support 27 (100%) 18 (66.7%) 9 (33.3%) 0 0 18 (100%)

the community; and heartfelt appreciation and gratitude for a
timely and exible opportunity to receive targeted information at the
acute setting.
DISCUSSION
The service user lived with a carer in 19 out of 27 (70.4%) instances
in this study (Table 1), so carer psychoeducation is important, both to
support the recovery of the service user and to provide support to the
carers in their own right. Carer roles present included parents, partners,
siblings, and adult children. Since this EPP includes in its eligibility
criteria a broader age range of service users than is typical 1665
years rather than 1625 years the needs of these carers are more di-
verse. It is necessary to provide a range of informational resources to
meet the needs and questions of such a group. It is additionally neces-
sary to provide time and opportunity to discuss and answer questions
arising from the very good educational resources available such as the
EPPIC fact sheets, which, despite originating from a youth-oriented ser-
vice model, are appropriate to adult service users to provide information
and reassurance about rst-episode psychosis treatment and recovery.
Since these were produced with a youth audience and their parents in
mind, it is not appropriate to provide these to the families of adults
experiencing psychosis for the rst time without opportunity to trans-
late the material to their own experiences and circumstances.
The follow-up interview conrmed which items of information and
support carers recalled having been given and which they identied as
being useful. Of the twenty-seven carers interviewed, twenty-four were
able to provide a clear recollection approximately six months later
whether they perceived they had received the information. Three of
the carers were not able to remember whether they had received the in-
formation. This may be attributable to attempting to remember events
from approximately six months earlier, when they were experiencing
an extremely stressful situation concerning someone they care about.
Carers noted that verbal information, fact sheets that they shared
and distributed amongst family (Table 3) and varied support options

Table 3
Participant Qualitative Responses.

Question 9. How did you as a family use the information?

We went through it (together) and tried to discuss it.

Fact sheets sent to my family and my partners family.
We went through the fact sheets together and sat down and watched the DVD together. It was helpful; we got more of an understanding.
Watched the DVD together.
Discussed the Bucket Model. I read the drug booklet and all the material front to back. Lent A4 sheets to friends.
Because we are many all the family took some (information). It proved to other family (members) this is real.
Question 12. Any suggestions on how the service could improve the presentation and content of information made available to carer's?
(It would be) helpful to have the patient in there as well.
No more information at that early stage.
For us (it would have been) crucial (to get) post education follow up.
Maybe the timing of the information was a bit overwhelming maybe a shorter version. (meeting lasted 1 hour)
Question 13. With hindsight was the meeting useful?
Informative./ Very informative.
It was helpful.
It was very useful, it explained the differences: what psychosis was compared to anxiety and depression. We had a better understanding of what (family member) was going through.
Don't know how you would cope or begin to understand without it.
It explained so much to us so we could understand what was going on.
I quite liked that it was informal. I could ask questions.
Happy with the information we got.
Meeting was great, you people did everything correct.
Question 14. With hindsight what additional or different information would have been useful prior to leaving the ward?
It would have been useful to know the model that the psychiatrists were using.
More information on medication and its effects.
Getting medication for ADHD, information and contacts on psychiatrists on wider prescribing spectrum would have been useful.
More what comes next: now I worry that we've got a lot more to lose if he goes back. (meaning of goes back claried to mean becomes unwell)
Being included in the discharge meeting. (Family did meet with treating team separately, but patient's partner did not want to have family included in discharge meeting.
There was a lot of friction between patient's partner and his family.)
It would have been nice to have found out that he was being discharged.
Might have been good to sit down with treating team before discharge to discuss. We didn't know there would be paranoia, delusions on discharge.
Everything was wonderful till the day we left and then it was instant (discharge); we felt they sent us home unprepared.
Maybe just help afterwards. I didn't get any help after she was discharged.
It would be good to have a peer support group.
I think maybe how to respond in the case of a future crisis. Not knowing when would be the appropriate time to bring him to hospital and when not to.
Really couldn't think of anything extra because you covered everything so well.
 M. Petrakis, S. Laxton / Archives of Psychiatric Nursing 31 (2017) 4854
were helpful. No carers found any of the information provided to be un-
helpful. Highlighted as important and appreciated was that the medica-
tion booklet was available in different languages. Carers also mentioned
in qualitative feedback that greater inclusion in discharge planning,
more information on medication and side effects, and later peer support
would have been useful (Table 3).
While previous international literature has noted the reluctance of
carers to take up psychoeducational interventions offered in the com-
munity (Gerson et al., 2009), this was not our experience at the inpa-
tient unit. Findings in the present study suggest that early psychosis
carers are open to receiving psychoeducation at rst contact with psy-
chiatric services. Despite feeling overwhelmed by a service user's
acute presentation and rst contact with the service system, they are in-
terested in psychoeducation in this setting. The high (100%) uptake for
psychoeducation offered during an inpatient admission indicated a de-
sire for this intervention. The equally high level of participation in the
evaluation suggested three things: an interest in continuity of support
from someone known to them at the acute setting, an interest in evalu-
ating progress in adjusting to changes in their family, and a willingness
to contribute to service evaluation and improvement.
Limitations
This was a sample of family members attending inpatient family and
carer early psychosis psychoeducation meetings across a six-month pe-
riod at a single site. Though a considerable number consented to follow-
up and participated, the overall study numbers are still modest at
twenty-seven in terms of the generalisability of the ndings. The
study design of inviting families to nominate one family member to be
contacted at 6 months for the evaluation, rather than interviewing all
psychoeducation session attendees, was in retrospect a limitation
since different members within a family may have offered diverse data.
The one-group post-test-only evaluative design did not include a
control group. Demographic data beyond gender, relationship to service
user, and living arrangements were not sought from carers; a limitation
since education level and other factors could potentially have impacted
receipt of education. Long-term needs of family and carers were not
assessed, nor the impact that these carer interventions might have
had for service user outcomes in these cases.
Furthermore, the telephone interview methodology while
practical and relatively non-intrusive did not readily enable depth of
qualitative information to be gathered from the carers. Answers to
questions asked were typically brief.
CONCLUSIONS
The ndings in the current study suggest that carers of individuals
experiencing rst-episode psychosis require detailed information pro-
vision and support at the time of their family member's admission, in
addition to later community psychoeducation groups. This early inter-
vention psychoeducation can be provided within a public adult mental
health service. The feedback from carers six months later was that infor-
mation received was helpful, even if specic content received could not
be recalled in all instances.
Acknowledgement
We thank the participants: family members and carers of people
challenged by rst-episode psychosis. Thank you to the management
and clinicians of the Adult Inpatient Service for supporting the develop-
ment of the inpatient early psychosis senior clinician role. Thank you to
Julia Oxley and Hannah Bloom for sharing approach and ndings from
earlier group work conducted in the community continuing care ser-
vices, to Angela Spiller for reviewing an earlier version of the paper,
and to Steve Penno for input regarding broader service data. Preliminary
ndings from this study were presented as an oral presentation and
53
proceedings at the 21st Annual TheMHS (The Mental Health Services)
Conference for Australia and New Zealand, in Adelaide, Australia, 69
September 2011, and the potential benets of the mental health nursing
role in psychoeducation within the inpatient unit were shared at the
International Early Psychosis Association Conference, in San Francisco,
USA, 1113 October 2012.
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