title: A qualitative analysis of relatives', health professionals' and service users' views on the involvement in care of relatives in Bipolar Disorder.
abstract: BACKGROUND
  Relatives of people with bipolar disorder report that services do not meet their own needs, despite clinical recommendations for the development of care plans for relatives, provision of information regarding their statutory entitlements, and formal involvement in decision making meetings. Further, there is now conclusive evidence highlighting the benefits of relatives' involvement in improving outcomes for service users, relatives, and the health system as a whole. This qualitative study explored the views of relatives of people with bipolar disorder, service users and healthcare professionals regarding the barriers and the facilitators to relatives' involvement in care.
  
  
  METHODS
  Thirty five people were interviewed (12 relatives, 11 service users and 12 healthcare professionals). Audio recordings were transcribed verbatim and common themes in participants' narratives emerged using framework analysis.
  
  
  RESULTS
  Participants' accounts confirmed the existence of opportunities for relatives to be involved. These, however, were limited and not always accessible. There were three factors identified that influenced accessibility namely: pre-existing worldviews, the quality of relationships and of communication between those involved, and specific structural impediments.
  
  
  CONCLUSIONS
  These themes are understood as intertwined and dependent on one another. People's thoughts, beliefs, attitudes, cultural identifications and worldviews often underlie the ways by which they communicate and the quality of their relationship. These, however, need to be conceptualised within operational frameworks and policy agendas in health settings that often limit bipolar relatives' accessibility to opportunities for being more formally involved.
  
  
  CONCLUSIONS
  Involving relatives leads to clear benefits for relatives, service users, healthcare professionals, and the health system as a whole. Successful involvement of relatives, however, depends on a complex network of processes and interactions among all those involved and requires strategic planning from policy makers, operational plans and allocation of resources.
authors.affiliation: Doctorate in Clinical Psychology, Division of Health Research, Faculty of Health and Medicine, Lancaster University, C38, Furness Building, Lancaster, LA1 4YG, UK. g.chatzidamianos@lancaster.ac.uk.
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Chatzidamianos
authors.affiliation: Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK. f.lobban@lancaster.ac.uk.
authors.forename: Fiona
authors.initials: F
authors.lastname: Lobban
authors.affiliation: Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK. s.jones7@lancaster.ac.uk.
authors.forename: Steven
authors.initials: S
authors.lastname: Jones
mesh_terms: D001291:Attitude of Health Personnel; D001714:Bipolar Disorder / Q000451:nursing*; D017028:Caregivers / Q000523:psychology*; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research