Family group conferences for suicidal adolescents: Promising results from naturalistic case study research.

Can thwarted belongingness and perceived burdensomeness, risk factors for suicidal adolescents, be turned around by family group conferences? In this case study on Nick, a 17-year-old who undertook six suicide attempts, we (including Nick) share insights and learning opportunities on how family group conferences can be used. The thematic analysis suggests that family group conferences might be a promising intervention for suicidal adolescents. For Nick, the conference was a turning point in his life, correcting perceptions of being a burden, pushing back passiveness, and boosting connection with and support from the broad social network.

Family Group Conferencing in Coercive Psychiatry: On Forming Partnership Between the Client, Social Networks and Professionals.

Family Group Conferencing is a new decision model to assign caring responsibilities among various actors in society, including the client, social networks, and professionals. The process of Family Group Conferencing in coercive psychiatry is delicate; nevertheless, it paves the way for courageous conversation, and it facilitates ownership over the problematic situation and the formation of a partnership. Different actors co-construct an open and new actuality by taking initiative during and after the Family Group Conference, by confronting each other; by sharing information about the situation and so forming a partnership. Family Group Conferencing requires a change in thinking and doing of mental health professionals that is close to nursing; instead of focusing on the treatment of individual clients, they support primary groups to deal with the situation at hand.

Nursing and the Emergence of Egoless Care: A Discussion on Social Engineering in Mental Health.

The narrowing of the diverse fields of psychiatry to just the single dimension of the biomedical model has resulted in a situation where professions with a focus on curing (psychiatrists and psychologists) are favoured over those with a focus on caring and encouraging near communities to care for each other (nurses). The social engineering of mental problems leads to a state of helplessness. This paper contributes to an understanding of the barriers to utilise the social resources of people with mental health problems and argues for forms of "indirect social engineering" and "egoless care," and, ultimately, a rediscovery of nursing, using the mental health care in the Netherlands as a case study.

Regaining ownership and restoring belongingness: impact of family group conferences in coercive psychiatry.

AIM: This study examined the impact of family group conferences on coercive treatment in adult psychiatry. BACKGROUND: Coercive treatment in psychiatry infringes the fundamental rights of clients, including the right to control their lives. A promising intervention is the family group conferences, which has the potential to prevent crises through the integration of the expertise of informal and professional networks. DESIGN: A responsive evaluation, including qualitative and quantitative methods, was deployed to study the process leading up to the FGC, the proceedings and the impact of the conference. METHOD: From 2013-2015, 41 family group conferences were studied in three regions in the Netherlands. The impact of every conference was examined with scales (ranging from 0-10) during interviews with attendees (clients, family members, friends, mental health professionals and family group conferences coordinators) who reflected on three outcome measures: belongingness, ownership and coercion. RESULTS: After the family group conferences, respondents indicated a slight reduction in their experience of coercive treatment. They also mentioned an increase in ownership and belongingness. CONCLUSION: Family group conferences seems a promising intervention to reduce coercion in psychiatry. It helps to regain ownership and restores belongingness. If mental health professionals take a more active role in the pursuit of a family group conferences and reinforce the plans with their expertise, they can strengthen the impact even further.

Am I My Brother's Keeper? Moral Dimensions of Informal Caregiving in a Neoliberal Society.

Within the current Dutch policy context the role of informal care is revalued. Formal care activities are reduced and family and friends are expected to fill this gap. Yet, there is little research on the moral ambivalences that informal care for loved ones who have severe and ongoing mental health problems entails, especially against the backdrop of neoliberal policies. Giving priority to one's own life project or caring for a loved one with severe problems is not reconciled easily. Using a case study we illustrate the moral ambivalences that persons may experience when they try to shape their involvement and commitment when a relative is in need. The case comes from a research project which explores whether it is possible to reduce coercive measures in psychiatry by organizing a Family Group Conference. The purpose of the article is to explore what theoretical concepts such as 'communities of fate', 'communities of choice' and 'personal communities' add in understanding how persons shape their involvement and commitment when a family member experiences recurrent psychiatric crises.

Family Group Conferencing-Its Added Value in Mental Health Care.

Worldwide, there is a growing emphasis on reducing coercion and involving social networks in the care of mental health clients. Nurses should encourage their clients to regain control over their lives, preferably with less coercion and with help from their social network. During four years, a Dutch evaluation study was deployed to determine the applicability of mobilising help from social networks of people with psychiatric problems. Specifically the potential of Family Group Conferencing was examined. In this discursive article the question, 'what Family Group Conferencing adds to the existing methods that aim to reduce coercion in mental health care and promote inclusion' is addressed.

Understanding how older adults living in deprived neighbourhoods address ageing issues.

Older adults living in deprived areas are at risk of developing frailty and becoming care dependent. The aim of this qualitative study is to explore how community-dwelling, older adults living in deprived neighbourhoods address ageing issues. In-depth interviews were conducted with 20 participants who were community-dwelling (independently living), aged 65 years and older, not dependent on care, and living in a socioeconomically deprived urban neighbourhood in the northern part of the Netherlands. Data were analysed using the constant comparative method. Our findings emphasise the resourcefulness of these older adults when coping with apparent adversities. Simultaneously, the findings convey deficits concerning knowledge about ageing and health. Despite this, it appeared that these older adults possess an optimistic view of life, accept their situation, and are content with the capacities they still possess. Perspectives on how older adults address ageing issues are important for developing leads for nursing practice. Nurses will be challenged to recognise the coping strategies of older adults, particularly considering their deficits in health knowledge. The results of this study may serve as a basis for community nurses to manage care for older adults in deprived neighbourhoods.

Prevention of involuntary admission through Family Group Conferencing: a qualitative case study in community mental health nursing.

AIM: To understand whether and how Family Group Conferencing might contribute to the social embedding of clients with mental illness. BACKGROUND: Ensuring the social integration of psychiatric clients is a key aspect of community mental health nursing. Family Group Conferencing has potency to create conditions for clients' social embedding and subsequently can prevent coercive measures. DESIGN: A naturalistic qualitative case study on the process of one conference that was part of 41 conferences that had been organized and studied from January 2011-September 2013 in a public mental health care setting in the north of the Netherlands. METHODS: Semi-structured interviews (N = 20) were conducted with four stakeholder groups (N = 13) involved in a conference on liveability problems in a local neighbourhood wherein a man with schizophrenia resides. FINDINGS: To prevent an involuntary admission to a psychiatric ward of a man with schizophrenia, neighbourhood residents requested a family group conference between themselves, the sister of the man and the mental health organization. As a possible conference aggravated psychotic problems, it was decided to organize it without the client. Nine months after the conference, liveability problems in the neighbourhood had been reduced and coercive measures adverted. The conference strengthened the community and resulted in a plan countering liveability problems. CONCLUSION: The case indicates that social embedding of clients with severe psychiatric problems can be strengthened by Family Group Conferencing and that hence coercive measures can be prevented. A shift is required from working with the individual client to a community driven approach.

Establishing contact and gaining trust: an exploratory study of care avoidance.

AIM: This paper is a report of a study conducted to explore the competencies - especially deep-rooted personal qualities - of care providers who succeed in making contact and gaining trust with clients who are inclined to avoid the care they need. BACKGROUND: Demands, thresholds and fragmentation of services hinder the accessibility of health care, such that some severe mentally ill people do not receive the treatment they need or avoid healthcare services. Methods of establishing contact and gaining trust in mental health care include practical assistance, realistic expectations, establishing long-term goals, empathy and a client-centred and flexible approach. METHOD: A public mental healthcare practice in The Netherlands with outstanding performance was studied from 2002-2007 using participant observation, interviews with experienced care providers and interviews with clients with a long history of avoiding care facilities, conflicts and troubled relationships with care providers. FINDINGS: A number of personal qualities are vital for establishing contact and gaining trust with these clients: altruism, a degree of compassion, loyalty, involvement, tenacity, a critical attitude to the mainstream, flexibility, optimism, diplomacy, patience, creativity, and a certain degree of immunity to stress. CONCLUSION: Care providers who establish contact and win trust employ 'non-judgemental appreciation'. They start from the acceptance of what is and try to connect with the client and their world. These professionals use their initial actions to identify and praise qualities and achievements of clients. This style of work is supported by a set of deep-rooted personal qualities we can summarize as 'empathy'.

The Weakening of Kin Ties: Exploring the Need for Life-World Led Interventions.

The protective features that families and wider social relationships can have are required to meet the demands of life in contemporary Western societies. Choice and detraditionalization, however; impede this source of solidarity. Family Group Conferencing (FGC) and other life-world led interventions have the potential to strengthen primary groups. This paper explores the need for such a social intervention, using insights from sociological and philosophical theories and empirical findings from a case study of the research project 'FGC in mental health'. This need is understandable considering the weakening of kin ties, the poor qualities of state agencies to mobilise self-care and informal care, its capacity to produce a shift of power from public to private spheres and its capacity to mitigate the co-isolation of individuals, families and communities. A life-world led intervention like FGC with a specific and modest ambition contributes to small-scale solidarity. This ambition is not inclined to establish a broad social cohesion within society but to restore; in terms of the German philosopher Peter Sloterdijk; immunity (protection) and solidarity in primary groups, and consequently, resolve issues with those (family, neighbours, colleagues) who share a sphere (a situation, a process, a fate).

Evaluating Family Group Conferencing: Towards a meaningful research methodology.

There is discussion on the most appropriate research methodology to examine the efficacy of Family Group Conferencing (FGC). Randomised controlled trials (RCTs), despite their pitfalls, are considered by many to be the 'golden standard', but the argument is not compelling. In this paper, the theory on programme evaluation is discussed which offers an alternative methodology to study FGC. It is argued that reaching a comprehensive image of truth in the social sciences is never within reach. A RCT is an abstraction of reality, it only provides a partial image of the complex reality of families and the impact that FGC has on safety issues and the quality of their lives. Moreover, the rigour of a study depends heavily on the researcher's interpretative skills. In studying the efficacy of a complex intervention, such as FGC, it is a challenge to provide a valid and reliable picture of its impact. The context of such a conference, where the lifeworld of families constantly interacts with the system world of professionals, is characterised by multiplicity, polyvalence and interference. The methodology used to examine the efficacy of FGC should meet this 'interplexitiy'.

Family Group Conferencing as a Catalyst for Recovery and Ownership in Mental Health.

BACKGROUND: Recovery is a journey not only of personal change but also of social reengagement. It underlines the essence of social environments that are supportive to the recovery of people with ongoing mental health issues. The process of recovery also affects other actors, and likewise these actors exert their influence on the recovery of their family member or friend. OBJECTIVE: Since 2009, we have been studying whether the decision-making model called family group conferencing (FGC) helps mental health clients increase their self-reliance. The essence of FGC is that individuals who experience problems have the opportunity to develop a plan together with people from their social network. Clients in mental health have to deal with different forms of disempowerment, especially when they are threatened with compulsory measures. It is an aim to help them regain ownership over their problems as well as over the potential solutions. METHOD: From 2011 to 2013, we evaluated 41 family group conferences that were organized for clients in a public mental health care setting in the north of the Netherlands. Each conference was analyzed in a qualitative case study framework. RESULTS: This article highlights two case portraits. It gives insight into how ownership was restored and what this meant regarding clients' recovery process. CONCLUSION: FGC seems a promising tool to shift the attention from disorders and inabilities to capacities and the rediscovery of social resources.

Involving Undergraduate Nursing Students in Participatory Health Research: Implications from the Netherlands.

Internationally, there are increasing initiatives that involve undergraduate nursing students as co-researchers. This paper discusses the inclusion of final year undergraduate nursing students as co-researchers in participatory health studies. It reports on a large-scale study (2009-2015) on the process and outcomes of Family Group Conferencing in mental health care that demonstrates how undergraduate students in the Netherlands got involved as co-researchers and how their contribution was optimally utilised. The project revealed that the benefits for students participating in a large-scale, participatory health research are twofold. Firstly, students could conduct a research thesis tailored to their studies where they learn from experienced supervisors through demonstration and the transference of tacit knowledge. Secondly, they meet real clients and gain insights and ideas for transferable skills to meet changing demands in the nursing profession such as activating self-care and social resilience, utilising social resources and supporting near communities. From a broader perspective, the project demonstrated sensitivity to the needs of different spheres (professional care, education, civil society) so that these can learn from each other and enrich interim study findings with different viewpoints.

Family group conferences in public mental health care: an exploration of opportunities.

Family group conferences are usually organized in youth care settings, especially in cases of (sexual) abuse of children and domestic violence. Studies on the application of family group conferences in mental health practices are scarce, let alone in a setting even more specific, such as public mental health care. The present study reports on an exploratory study on the applicability of family group conferencing in public mental health care. Findings suggest that there are six reasons to start family group conference pilots in public mental health care. First, care providers who work in public mental health care often need to deal with clients who are not motivated in seeking help. Family group conferences could yield support or provide a plan, even without the presence of the client. Second, conferences might complement the repertoire of treatment options between voluntary help and coercive treatment. Third, clients in public mental health care often have a limited network. Conferences promote involvement, as they expand and restore relationships, and generate support. Fourth, conferences could succeed both in a crisis and in other non-critical situations. Sometimes pressure is needed for clients to accept help from their network (such as in the case of an imminent eviction), while in other situations, it is required that clients are stabilized before a conference can be organized (such as in the case of a psychotic episode). Fifth, clients who have negative experiences with care agencies and their representatives might be inclined to accept a conference because these agencies act in another (modest) role. Finally, the social network could elevate the work of professionals.