Family-Friendly Services: A Modest Proposal

To the Editor: Numerous studies show that family collaboration with mental health professionals improves the long-term outcome of persons with severe mental illnesses (1,2). Nevertheless, community mental health centers (CMHCs) provide few services to families (3), and true collaboration remains an unattained goal.

Different explanations have been offered to account for the lack of family services, such as theories that blame families for mental illness, limited funding, and a lack of training in family work for professionals. However, these explanations have not led to an increase in the services provided to families. We posit a new hypothesis for the failure to implement evidence-based practices for family collaboration and propose a solution to this problem.

We suggest that the major obstacle to implementing family-friendly services at CMHCs is the absence of specific individuals who have the authority to see that family services are provided. With no single person in an agency responsible for ensuring that family collaboration happens, responsibility is diffused, services are not provided, and families remain in the dark about their loved ones.

To address the need for accountability, we propose that each CMHC designate an individual as the director of adult family services. This person would be empowered by the agency to ensure that appropriate, culturally competent, and collaborative services are provided to families of persons with serious mental illness. The director must have the administrative authority to implement family services and the support of the leaders of the agency.

Depending on the size of the CMHC, the directorship would be a quarter-time to a full-time position. In addition, funds would need to be budgeted to support the continuing growth of the director's expertise in family services and to train other clinicians. For example, funds would go toward educational materials, attendance at conferences, and membership in professional organizations.

We developed the following position description.

The primary functions of the director of adult family services are to develop, coordinate, and oversee services provided to the families of consumers with severe mental illness in the community support program. The person must have experience working with families of adult persons with severe mental illness, including parents, spouses, and children of clients, and must be able to train new clinicians in the principles and practice of family work. The director is expected to perform the following tasks:

• Identify and train clinicians in family work

• Lead and supervise family work

• Monitor the delivery of family services

• Develop, implement, and oversee family programs

• Work with a family advocate as a liaison with the National Alliance for the Mentally Ill

• Participate in continuing education activities.

Many CMHCs recognize the importance of providing services for specific areas, such as vocational rehabilitation and dual disorders, and have established directors of services in these areas. We propose a similar position for family services for adults with severe mental illness. By establishing a director position, CMHCs will formally acknowledge the importance of families and hold themselves accountable for providing evidence-based family services for their clients. Families and service providers have much to gain through developing collaborative relationships. We believe that our modest proposal is crucial for bridging the gap between the lip service currently given to family collaboration at most CMHCs and the provision of truly collaborative, family-friendly services for persons with severe mental illness.

Dr. Mueser and Ms. Fox are affiliated with the New Hampshire-Dartmouth Psychiatric Research Center in Concord, New Hampshire.