支持患有精神疾病的父母及其子女——英国和爱尔兰以家庭为重点的实践的发展

IF 1.4 Q3 PSYCHIATRY
J. Devaney, G. Davidson, A. Grant, S. Lagdon
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引用次数: 2

摘要

据估计,全球接受精神卫生服务治疗的成年人中有五分之一至三分之一有子女,10%至23%的儿童与至少一位有精神卫生问题的父母一起生活(Maybery, Reupert, Patrick, Goodyear, & Crase, 2009;Parker et al., 2008)。然而,父母的性别、种族和社会环境等特征意味着整体情况更加微妙,我们对家庭成员有心理健康问题时的生活经历的理解仍在发展中(Stambaugh等人,2017)。虽然绝大多数与有精神健康问题的成年人生活在一起的儿童得到了关爱和良好照顾,但这并不意味着这些儿童所处的环境,包括那些与使用药物有问题的成年人生活在一起的儿童,对他们没有影响。此外,在少数家庭中,父母在满足孩子的需求方面面临着更大的挑战,包括保护孩子免受虐待或忽视(Nevriana et al., 2020)。在过去的20年里,人们越来越关注如何支持家庭处理成年父母或成年子女的心理健康问题。这源于一种认识,即家庭成员需要感到得到支持,以便支持其亲属的心理健康,并且支持成年人的心理健康对整个家庭都有更广泛的好处。通常,不同的专业人员和机构分别负责照顾和治疗有精神健康问题的成年人以及支持和保护儿童。传统上,这些服务和干预措施是串联而不是一起运作的,这导致许多有精神健康问题生活经历的人提倡采用更综合的方法来满足他们及其家庭的需求(Reupert等人,2018)。这促使政策制定者考虑如何让服务和实践更加以家庭为中心,同时认识到不同专业人士的价值和重要性,他们拥有自己的专业知识和角色,协同工作(Leonard, Linden, & Grant, 2018)。这种以家庭为重点的实践被描述为具有许多明确的特征。Foster等人(2016)在以家庭为中心的实践中确定了六个核心和重叠的实践:(1)家庭护理计划和目标设定;(2)家庭和服务之间的联络,包括家庭倡导;(3)工具支持、情感支持和社会支持;(4)家庭成员及家庭功能评估;(5)心理教育和(6)家庭成员和服务机构之间协调的护理系统(例如,包罗式、家庭协作、伙伴关系)。马斯顿等人(2016)对心理教育的主要组成部分进行了类似的分析;直接治疗和支持精神健康和/或药物使用;注重养育子女的行为;儿童风险和复原力;家庭沟通;家庭支持和功能。以家庭为中心的实践是一种以家庭为关注单位的方法,而不是只处理和解决单个服务用户的需求,无论这是患有精神疾病的父母,还是他们的孩子(ren) (Afzelius, Plantin, & Östman, 2018)。它要求专业人士将自己的角色扩展到他们的主要客户之外,无论是成人还是儿童。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Supporting parents with mental illness and their children – developments in family focused practice in the United Kingdom and Ireland
It is estimated that globally between a fifth and a third of adults receiving treatment from mental health services have children, and that between 10% and 23% of children live with at least one parent with mental health problems (Maybery, Reupert, Patrick, Goodyear, & Crase, 2009; Parker et al., 2008). However, characteristics such as the gender, race and social circumstances of parents mean that the overall picture is more nuanced and that our understanding of the lived experience for families when a member has a mental health problem is still developing (Stambaugh et al., 2017). While the overwhelming majority of children living with an adult with mental health problems are loved and well cared for, that does not mean that the circumstances such children find themselves in, including those who live with adults whose use of substances is problematic, does not have an impact upon them. Additionally, in a small number of families there are more significant challenges for parents in meeting the needs of their children, including keeping children safe from abuse or neglect (Nevriana et al., 2020). Over the past 20 years, there has been an increased focus on how to support families dealing with the mental health problems of an adult parent or adult child. This is borne from a recognition that family members need to feel supported in order to support their relative with their mental health, and that supporting an adult with their mental health has wider benefits for the entire family. Often different professionals and agencies are separately tasked with the responsibility for the care and treatment of the adult with mental health problems, and the support and protection of children. Such services and interventions have traditionally operated in tandem rather than together, leading to many individuals with lived experience of mental health problems to advocate for a more integrated approach to meeting the needs of them and their family (Reupert et al., 2018). This has led policy makers to consider how services and practice could be more family focused, while recognising the value and importance of different professionals, with their own expert knowledge and role, working in unison (Leonard, Linden, & Grant, 2018). Such family focused practice has been characterised as having a number of defining features. Foster et al. (2016) identified six core and overlapping practices within family focused practice: (1) family care planning and goal setting; (2) liaison between families and services, including family advocacy; (3) instrumental, emotional and social support; (4) assessment of family members and family functioning; (5) psychoeducation and (6) a coordinated system of care (e.g. wraparound, family collaboration, partnership) between family members and services. Marston et al. (2016) provided a similar analysis of the main components as psychoeducation; direct treatment and support for mental health and/or substance use; a focus on parenting behaviour; child risk and resilience; family communication; and family support and functioning. Family focused practice is an approach that focuses upon the family as the unit of attention, as opposed to only working with and addressing the needs of an individual service user alone, whether this is the parent with mental illness, or their child(ren) (Afzelius, Plantin, & Östman, 2018). It requires professionals to see their role as extending beyond their primary client, whether the adult or the child.
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CiteScore
3.20
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