Background:
The important role of families and other caregivers in the lives of adults with schizophrenia is well documented. Persons with schizophrenia frequently live with their families of origin, and the vast majority have regular family contact. Families of persons with schizophrenia have also been demonstrated to have significant needs. Families most frequently cite the need for education and support in helping them to cope with their family member's illness. Further, numerous studies have documented the benefits of interventions designed to meet the needs of family members. Aims of the Study: This paper identifies critical issues and challenges in the provision of services to families of persons with schizophrenia and other serious and persistent mental illnesses. Methods: This study draws from both a literature review and a summary of pertinent data from the Schizophrenia Patient Outcomes Research Team (PORT). Results: Recent best practices standards and treatment recommendations specify that families should be given education and support. One of the PORT treatment recommendations states that 'Patients who have on-going contact with their families should be offered a family psychosocial intervention which spans at least nine months and which provides combinations of: Education about the illness; Family support; Crisis intervention; and, Problem solving skills training'. The PORT treatment recommendations are based on well designed and rigorous research on family psychoeducation programs that demonstrate reduced relapse rates and improved patient and family well-being for persons whose families receive psychoeducation. While family psychoeducation programs have been the subject of extensive treatment trials, family members and family organizations have endorsed a variety of other models of services such as family education and consultation models. These models have not been as rigorously researched as family psychoeducation. Control groups are generally lacking. No consistent findings have been reported, although isolated studies have found increased knowledge, self-efficacy and greater satisfaction with treatment among families who have participated in family education programs. Remarkably little is known about the extent to which families actually receive appropriate services. However, PORT data from administrative claims and client interviews suggest that family services are minimal. Further, previous research has consistently revealed that families have high levels of dissatisfaction with mental health services. Discussion: If family psychoeducation is effective, why do all the data suggest that it is scarcely offered? Even use of family