“The mental health of families is an important public health issue with implications for individuals, the services they use, those who provide them, as well as policy makers and society in general” (Falkov, 2012; p.24).
Our new PRIMERA (Promoting Research and Innovation in Mental hEalth seRvices for fAmilies) programme of research – funded by the HSE from 2017-2021 – is investigating how best we can deliver mental health services and interventions to families where a parent has a diagnosed mental illness.
Collaborating partners in the study include the HSE, Tusla, Saint John of God Hospitaller Ministries, Children and Young People’s Services Committees, Advancing Recovery Ireland, and organisations from the community/voluntary sector.
Mental illness exacts a significant personal and social toll on individuals, families and communities whilst incurring huge economic costs – €11 billion per year in Ireland alone. Recent years have seen growing recognition of the importance of parental mental health and the need for more integrated and effective service responses to parents with mental illness and their children (e.g. Wilson et al., 2010; HSE, 2015).
Up to one in five young people live in families with a parent who has a mental illness (Reupert et al, 2012) whilst in the UK, approximately 1.7 million adults and 2.5 million children are affected by parental mental illness (Tunnard, 2004). However, the complex needs of these vulnerable families often go unrecognised and untreated, whilst the evidence for family-focused mental illness interventions is also very underdeveloped.
What are the aims of the research?
- To identify/develop, implement and evaluate family-focused interventions for families where a parent has mental health difficulties (and has children 0-18 years);
- To promote a ‘think family’ care delivery agenda in supporting such families in Ireland; and
- To develop national guidance on working with these families
Family-focused service delivery and evaluation
Fifteen sites from across the Republic of Ireland have agreed to deliver a family-focused intervention as part of the PRIMERA research. Organisations involved in delivery include: HSE adult and child mental health services, primary care, Tusla Child and Family agency, Saint John of God Hospitaller Services, Recovery College South East and the community/voluntary sector. In many sites, the family-focused intervention is being delivered on an interagency basis.
Twelve sites are involved in delivering Family Talk and three sites are delivering another model of family-focused practice (systemic family therapy, and multi-family group work). The Family Talk sites will be evaluated using a randomised controlled trial design, with embedded implementation and costs evaluations. The other three sites will be evaluated using a mix of questionnaires, surveys and interviews. Experiences of all participants will be consulted, including families (parents, children, and partners), service providers (clinicians, managers) and higher-level management within collaborating organisations.
Outcomes assessed in the evaluation include:
- Parent and child understanding of parental mental health difficulties
- Family functioning
- Child resilience and coping
- Child mental health and wellbeing
- Parental mental health symptoms
- Parental resilience and coping
- Partner wellbeing
What is Family Talk?
Family Talk is an evidence-based, manualised, 6-8 session programme for families where a parent has mental health difficulties. Family Talk involves trained clinicians seeing parents, children and the whole family. Family Talk has been identified as an intervention with promising evidence for improving: child and parent understanding of mental illness/mental health, family functioning, child mental health, coping and resilience, and parental mental health, coping and resilience (Siegenthaler et al. 2012). Family Talk has been adopted within several national initiatives – Australia, Finland, Norway, and Greece – that have been established in recent years to support children and families when a parent has mental health difficulties (Beardslee et al. 2013). Advantages of Family Talk include:
- Evidence-based programme
- See parent, children and the whole family
- Addresses key child, parent, partner and family outcomes
- Can be used for a wide range of mental health difficulties (e.g. depression, anxiety disorders, bipolar disorder, post-traumatic stress disorder, personality disorders, psychosis, substance misuse)
- Free online training for clinicians on Emerging Minds website (takes 10 hours) – see Family Talk online training here and see the Training and Resource Hub sections below.
- Free online manual and supplementary resources
- Scope for flexibility in adding other relevant elements, e.g. family care crisis plan. See Resources Hub below
- Guidance and support from programme developer, across sites, and international experts in field
What is Systemic Family Therapy and multi-family group work?
Systemic Family Therapy involves working therapeutically with individuals together with their families and/or significant others and enables the use of individuals’ relationships as a resource, and reduces stress and difficulties for all family members. Systemic family therapy has been found to be effective for children’s and adults’ difficulties, both when individuals have acquired a mental health diagnosis and when there is more general or complex distress. It is effective across the lifecycle, spanning developmental stages from young children to old age (Carr, 2014).
Multi-family group work involves a two-day workshop with 4-5 families (parents and children) at the workshop. Therefore there will be 15-20 participants at the workshop. The workshop will be preceded by preparatory meetings with each family and follow-up meetings will also be conducted. The intervention has been co-produced with service users and will also be co-facilitated by trained service users. The intervention draws from a range of family work models, including the Maudsley model, McFarlane’s multi-family work model, systemic family therapy, narrative therapy, dialogical approaches, recovery principles and transformative group work.
There is a strong evidence base for both methods in mental health family work (NICE, 2014), although this evidence is not specific to families where a parent has mental health difficulties. Therefore, we are interested to investigate their effectiveness in an Irish service context.
The early phase of the research has led to considerable media coverage from national radio, newspaper and social media platforms, thereby enhancing public and service awareness of the need to support these families. Click on the hyperlinks to see the coverage.
Supporting families with parental mental illness: peer-reviewed paper just published
The PRIMERA research team have recently published a peer-reviewed paper in a special edition of the Advances in Mental Health Journal. The paper details the scoping phase of this (HSE-funded) research which investigates family-focused practice for families impacted by parental mental illness in the RoI. Below is a short video abstract which summarises the content and importance of the paper. A full copy of the paper can be accessed at https://www.tandfonline.com/
Current Project Team
Family Talk Surveys (for families)
Children and Adolescents
Thank you for taking part in the PRIMERA research project. Below you will find a link to a survey for children and adolescents (8 years to 18 years) who are taking part in Family Talk.
Also, if this is your FIRST time doing the survey, click on the link below to enter our online survey.
Thank you for taking part in the PRIMERA research project. Below you will find a link to a survey for adult PARTNERS who are taking part in Family Talk.
If this is your FIRST time doing the survey, click on the link below to enter our online Partner survey.
The second survey is only completed 6 months after you have completed the first survey
If for some reason you are not able to access the survey, check that you have clicked on the right link. If you are still not able to do the survey, please email PRIMERA@mu.ie
Family Talk Online training
Clinicians who are interested in offering Family Talk will find a free eLearning training programme at the following hyperlinks:
- A prerequisite Keeping Families and Children in Mind course (We recommend that this course is done before doing training in Family Talk as it gives a more general grounding to the area of parental mental health difficulties and impact on children)
- Family Talk intervention training course for clinicians interested in a family-focused approach to families impacted by parental mental illness. A certificate is provided once the course is completed
- It takes approx. 10 hours in total to complete both courses (to be clear – it takes 10 hours combined, not 10 hours for each course)
- Following doing the Family Talk training, we advise that clinicians look at the PRIMERA Resource Hub (at the bottom of the webpage). It contains excellent supplementary material on how to identify and work with families impacted by parental mental illness, including: (a) how to initiate conversations with parents, (b) recruit partners and children, (c) psycho-education tip-sheets on different mental illnesses; and (d) includes the manuals for the Family Talk intervention with many other relevant resources.
- Engaging Fathers
- Family Care Plans for times of Crisis
- Family Talk Training Manuals
- Keeping Families and Children in mind
- PRIMERA timeline
- Recovery Practice and Family Talk
- Identifying & engaging families
- Responsibilities Documents
- Clinicians collecting data