title: Barriers to family care in psychiatric settings.
abstract: OBJECTIVE
  To identify barriers to family care in psychiatric settings and to describe family and provider perspectives about what constitutes effective family care.
  
  
  METHODS
  A qualitative exploratory approach with focus groups. Seventy-eight people participated in 11 focus groups conducted with families, patients, and health professionals.
  
  
  RESULTS
  Families identified poor quality care, conflict with health professionals about treatment, and lack of a role for families in the treatment. African American families also identified isolation of their communities from the mental health care system. Adolescents emphasized their role as caregivers and their needs for support. Health professionals conveyed concerns about system-based barriers, professional practice-based barriers, and family-based barriers to care. Patients stated the need for their families to be better educated about mental illness.
  
  
  CONCLUSIONS
  The lack of family care in psychiatric settings is a multifaceted problem. Current health policies do not show endorsement of a family care approach. Responses from families and health professionals indicated conflicting opinions about content of family care. Health professionals reported they often lacked training and resources to deal with complex family issues. Families believed that lengthy and intensive interventions were neither necessary nor desired to address their concerns. Family care can be improved by focusing on building rapport and communicating problems and concerns between families and health professionals.
authors.affiliation: Johns Hopkins University, School of Nursing, Baltimore, MD, USA. lrose2@son.jhmi.edu
authors.forename: Linda E
authors.initials: LE
authors.lastname: Rose
authors.forename: R Kevin
authors.initials: RK
authors.lastname: Mallinson
authors.forename: Benita
authors.initials: B
authors.lastname: Walton-Moss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D017028:Caregivers / Q000193:education / Q000523:psychology*; D002983:Clinical Competence / Q000592:standards; D003142:Communication; D003220:Conflict, Psychological; D005190:Family / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy; D008873:Mid-Atlantic Region; D008875:Middle Aged; D020380:Needs Assessment; D011368:Professional-Family Relations; D011570:Psychiatry / Q000592:standards*; D036301:Qualitative Research; D011787:Quality of Health Care