A New Role for the Community Psychiatric Nurse in Working with Families Caring for a Relative with Schizophrenia

Over the last 20 years research has convincingly demonstrated that the illness, schizophrenia, is amenable to social and environmental influence (Leff et at. 1982; Falloon et al. 1985; Hogarty et al. 1986). The impetus for the research is the fact that, at best, genetic inheritance explains only 70% of the disorder's aetiology. The findings of the studies allow certain basic but important principles to be for mulated. These are that some people inherit a genetic predisposition or "vulnerability" to schizophrenia which develops either in response to the acute stress of "life events" or the chronic stress encountered in some families. Originally the term "Expressed Emotion" was coined to describe emotional atmosphere at home which was thought to consist particularly of criticism, hostility or emotional over-involvement (Brown et al. 1962). intervention strategies have arisen from the studies which demonstrate that stress in families caring for a relative with schizophrenia can be reduced, leading to not only a smaller risk of relapse in the relative with the illness, but also an improvement in the carer's own mental health status (Tarrier et al. 1988). Intervention consists of health education for carers and family stress management techniques which may help to lessen over-stimulation in family life. Community Psychiatric Nurses (CPNs) are a rapidly expanding sector of most men tal health service provision in the United Kingdom but the evidence is that their role with the sufferer from schizophrenia consists largely of the administration of depot medication and very little else. An experimental teaching programme, funded by the Department of Health, has been established in the Department of Nursing, Manchester University, which is evaluating the effect of training CPNs to deliver psychosocial intervention to families caring for a relative with schizophrenia. This paper will briefly review the literature relating to the needs of informal carers; describe the experimental course; and present data which shows that the family's view of the service markedly improves when psychosocial intervention strategies are adopted by CPNs.