Variations in definitions used for describing restrictive care practices (seclusion and restraint) in adult mental health inpatient units: a systematic review and content analysis.

PURPOSE: The main purpose of this review was to (1) identify thematic elements within definitions used by recently published literature to describe the constructs of physical/mechanical restraint, seclusion and chemical restraint in adult mental health inpatient units. METHODS: We conducted a comprehensive literature search of six databases (Scopus, MEDLINE, PsycINFO, Web of Science, Embase, and CINAHL-Plus). In this review, we conducted content analysis to synthesize evidence to understand and compare the commonalities and discrepancies in conceptual elements that were incorporated within the definitions of different forms of restrictive care practices. RESULTS: A total of 95 studies that provided definitions for different forms of restrictive care practices [physical/mechanical restraint (n = 72), seclusion (n = 65) and chemical restraint (n = 19)] were included in this review. Significant variations existed in the conceptual domains presented within the applied definitions of physical/mechanical restraint, seclusion, and chemical restraint. Conceptual themes identified in this review were methods of restrictive care practice, reasons and desired outcomes, the extent of patient restriction during restrictive care practice episodes, timing (duration, frequency, and time of the day), the level of patient autonomy, and the personnel implementing these practices. CONCLUSIONS: Inconsistencies in the terminologies and conceptual boundaries used to describe the constructs of different forms of restrictive care practices underscore the need to move forward in endorsing consensus definitions that reflect the diverse perspectives, ensuring clarity and consistency in practice and research. This will assist in validly measuring and comparing the actual trends of restrictive care practice use across different healthcare institutions and jurisdictions.

Healthcare professionals' experiences and perceptions about LGBTIQA+ safety and responsiveness in a mainstream Australian health service: Qualitative findings.

OBJECTIVE: To explore experiences and perspectives of healthcare workers regarding LGBTIQA+ safety and responsiveness. METHODS: Thematic analysis of semi-structured, in-depth interviews, and pre-surveys to collect demographics and knowledge self-rating scales. RESULTS: Of 38 multidisciplinary healthcare staff, 44.7 % identified as LGBTIQA+ and 55.3 % as heterosexual and cisgender allies. Participants discussed experiences, noting strengths and gaps in affirming practice and organisational support, and training and education opportunities. CONCLUSIONS: Health services need to prioritise LGBTIQA+ safety and responsiveness for staff, patients, carers and families. LGBTIQA+ healthcare staff report that they have had experiences of trauma, minority stress, discrimination, homophobia and/or transphobia, and look for visible safe spaces at work and see safer clinical care.

Prevalence and variability of restrictive care practice use (physical restraint, seclusion and chemical restraint) in adult mental health inpatient settings: A systematic review and meta-analysis.

BACKGROUND: There is a growing consensus to reduce the use of restrictive care practices in mental health settings to minimise the physical and psychological complications for patients. However, data regarding restrictive care practice use and factors contributing to variations in the proportion estimates has not previously been synthesised. AIMS: This study aimed to synthesise evidence on (1) the pooled proportions of physical restraint, seclusion or chemical restraint in adult mental health inpatients and (2) sources of variability in these proportion estimates. METHODS: Studies were identified from Scopus, MEDLINE, PsycINFO, Web of Science, Embase and CINAHL databases following the PRISMA 2020 guidelines. We conducted a meta-analysis of studies published in English language from 1 January 2010 to 15 August 2022. Binomial data were pooled using a random effect model, with 95% confidence intervals. Meta-regression was also computed to identify factors that may contribute to variations in the proportion estimates. RESULTS: A total of 77 studies were included in this meta-analysis. The pooled prevalence of physical restraint, seclusion and chemical restraint was 14.4%, 15.8% and 25.7%, respectively. Data were heterogeneous across studies (I2 > 99%). Reporting practices and geographical locations contributed to the variability in the reported estimates of restrictive care practices, with studies from Asian countries reporting higher proportions. CONCLUSION: There appear differences between geographical locations in the proportion of restrictive practices in mental health inpatients; however, this is complicated by how these prevalence data have been measured and defined. Consistency in the reporting of restrictive care practices in mental health is required to make valid comparisons between geographical regions, policy settings and practice innovations. RELEVANCE TO CLINICAL PRACTICE: Efforts are needed to develop training programmes and policy changes to ensure consistency in defining and reporting of restrictive care practices in mental health facilities. PATIENT/PUBLIC CONTRIBUTION: This is a systematic review that analysed data from previously published studies, and there was no patient/public contribution in this study. PROTOCOL REGISTRATION: The protocol for this review has been registered to PROSPERO: CRD42022335167.

Workforce Perspectives of Sustaining the Utilisation of a Harm Reduction Instrument in a Mental Health Residential Setting.

PURPOSE: This exploratory study investigated worker experiences of utilising the Before During After (BDA) harm reduction instrument to engage well with service users in a residential mental health service setting. Stakeholder interviews were conducted with a purposive sample of two senior nurses and one senior allied health staff at the study site to explore the impacts of BDA implementation on their work after 3 years of its use. A thematic analysis was conducted, including two-level coding. Five major themes were discussed. Of particular interest, and the focus of this paper, are the themes of effect on service users and effect on staff. The study found improved engagement between staff and service users, reduced stigma and more holistic care that was collaborative. In regard to staff, it was found that staff knowledge and confidence increased in addressing harm reduction issues with consumers and this was sustained over 3 years. Use of the BDA clinical instrument and package was reported to enhance worker engagement, knowledge and confidence in dual diagnosis work with service users.

What does consumer and community involvement in health-related education look like? A mixed methods study.

Consumer and community involvement (also referred to as patient and public involvement) in health-related curricula involves actively partnering with people with lived experience of health and social care systems. While health professions education has a long history of interaction with patients or consumers, a shift in the way consumer and community engage in health-related education has created novel opportunities for mutual relationships valuing lived experience expertise and shifting traditional education power relations. Drawing on a mixed methods design, we explored consumer and community involvement practices in the design and delivery of health-related education using the capability, opportunity, motivation and behaviour framework (COM-B). In our results, we describe educator capabilities, opportunities and motivations, including identifying barriers and enablers to consumer and community involvement in health-related education. Educators have varying philosophical reasons and approaches for involving consumers and community. There is a focus on augmenting student learning through inclusion of lived and living experience, and on mutual transformative learning through embedding lived experience and co-creating learning. How these philosophical positionings and motivations shape the degree by which educators involve consumers and community members in health-related curricula is important for further understanding these educational partnerships within universities.

Mental Health Clinician Attitudes about Service User and Family Agency and Involvement in Recovery-Oriented Practice.

BACKGROUND: Recovery-oriented practice (ROP) is a framework focusing on recovery through hope, choice, and meaning, to live with or without enduring symptoms and challenges. AIMS: To examine clinicians' attitudes about the involvement of service users and family or supporters in ROP. METHODS: A bespoke Qualtrics survey obtained views of mental health clinicians working in an Australian public mental health service about service user and family involvement in ROP, using a five-point Likert scale of agreement and free-text responses. Data were analysed with descriptive statistics and content analysis methods. RESULTS: Two hundred and three clinicians completed the survey. Most (79%) clinicians agreed with the statement that service users want clinicians to use ROP principles, and the majority (63%) also 'strongly believed' that ROP made a difference to service users' mental health outcomes. Only 15% 'strongly agreed' and 57% somewhat agreed with the statement that service users know what treatment is best for them, and only 20% of clinicians 'strongly agreed' that supporters of service users believed in and wanted ROP for their family member or friend. FUTURE DIRECTIONS: This study adds to the literature on clinicians' views about ROP and shows that although clinicians are supportive of ROP, they also express substantial ambivalence about whether service users and families know what treatment is best. For ROP implementation to be successful, workforce training needs to support clinicians to reflect on these views with service users and families, and to encourage supported decision making. Future studies should focus on changes in clinicians' views and practice post ROP training.

Employment interventions to assist people who experience borderline personality disorder: A scoping review.

BACKGROUND: Employment is an important social determinant of health and is associated with positive health outcomes. However, individuals who have been diagnosed with borderline personality disorder (BPD) are significantly underrepresented in the workforce. Whilst there is an array of evidence based therapeutic interventions, there remains a gap in knowledge regarding the most effective ways to enhance employment outcomes for people with a diagnosis of BPD. AIM: To explore employment interventions for people with BPD, map the available evidence and identify key concepts and knowledge gaps. METHODS: A scoping review was conducted to identify and map the relevant literature. Findings were summarised using a narrative approach. Consultation was provided by a reference group including peer support workers with lived experience of BPD and mental health clinicians. RESULTS: Seven articles met the inclusion criteria, including non-randomised and case study/series designs and a randomised controlled trial protocol, with participant numbers generally low. All programmes combined a psychotherapeutic component with work related goals; however, there were notable differences in relation to the conceptual/theoretical approach of the psychotherapeutic component and delivery of the work-related components. Barriers and enablers to programme participation and success are explored. CONCLUSIONS: This review provides important insights into the characteristics of vocational rehabilitation interventions for people diagnosed with BPD. The findings will inform the co-production of approaches to support people with BPD to engage in employment.

Spiritual Diversity in Personal Recovery from Mental Health Challenges: A Qualitative Study from Chinese-Australian Service Users' Perspectives.

Spiritual diversity and the positive role of spirituality in personal recovery have received growing attention in mental health literature. However, the spiritual experiences and views of service users from cultural communities, particularly the Chinese community, are understudied in Australia. This research explores Chinese service users' spiritual identities and their views and perspectives on the roles of spirituality in their mental health recovery and attempts to provide inspiration for practitioners to engage with service users' spirituality in non-clinical mental health practice. A qualitative exploratory approach guided this study. Semi-structured interviews were employed with four Chinese participants with spiritual identities, who were recruited through the community Psychosocial Support Service in Victoria. The template analysis method supported the data analysis. The results indicate that spirituality has a positive impact on the mental health recovery of participants, primarily through coping, self-regulatory, and social support mechanisms. The findings also present that Chinese service users' understanding and approaches to spirituality are shaped by both original and Australian Cultures. These findings suggest that practitioners should provide a creative understanding and cultural awareness when discussing with service users their spiritual identities, perspectives, and spirituality in the wider context. The research fills a gap in the spiritual views and perspectives of service users accessing a non-clinical mental health service from the Chinese community.

Staff Perspectives in Mental Health Research Regarding Restrictive Interventions: An Australian Scoping Review and Thematic Analysis.

Service users and their families have raised concerns about safety in current acute mental health service delivery. Restrictive interventions are routinely used across mental health settings despite increasing awareness of the negative impacts. Underfunding and risk-averse management practices are implicated as key challenges. Utilizing a scoping review and thematic analysis method, this review explored the existing literature of mental health staff perspectives across various settings (including psychiatric wards and emergency departments), focusing on their experience of restrictive interventions. Four themes were developed: 1. Safety (both staff and patient); 2. Barriers to staff reducing their restrictive interventions; 3. Strength in current practice; 4. Recommendations for change. Key gaps in the literature were the limited perspectives of emergency and crisis clinicians (despite these areas being settings where restrictive interventions are utilized) and limited perspectives from allied health disciplines (despite their employment as clinicians in these settings). It also noted a divide between staff and patient safety, as though these concerns are mutually exclusive rather than cooccurring, which is the experienced reality. Advocacy bodies, governments and the media are calling for a reduction in restrictive interventions in crisis settings. This research synthesis proposes that, to achieve this, clinical staff must be involved in the process and their perspectives actively sought and drawn upon to enable reform.

Using photovoice to explore women's experiences of a women-only prevention and recovery care service in Australia.

Women should be able to access mental health services that are safe, free from harassment and abuse. Yet, research indicates that women experiencing mental health issues are often not safe in mixed gender environments, and especially in inpatient settings. This qualitative study draws on a photo-elicitation method ('photovoice') and semi-structured interviews to explore women's experiences of a sub-acute women-only prevention and recovery care (PARC) service in Australia. Twelve women experiencing mental health issues were recruited via an aftercare peer support group for recent service participants. The women took photographs guided by the central question: 'What were your experiences of a women-only prevention and recovery care service?' They then shared these photographs with the researchers and each other, and described them in detail. Four key themes were identified by thematic analysis of the photovoice visual and narrative data: (a) Only women can understand what women go through; (b) I feel safer with no men around due to my history of trauma; (c) This environment feels safe, making it easier to talk and (d) Staff are accessible and make time for me to talk about difficult topics. Woven throughout the women's narratives was the expressed desire to feel safe and supported during the process of recovering. Aspects of service delivery that contributed to these feelings and facilitated shared support were also valued in this setting. These findings indicate that access to women-only services and peer support are not only valued by women experiencing mental health issues, but need to be more widely available to support their recovery. They also underline the importance of a trauma-informed approach for improving the gender sensitivity of services.

Engaging with Transformative Paradigms in Mental Health.

When graduates of Australian social work courses embark on a career in mental health, the systems they enter are complex, fragmented and evolving. Emerging practitioners will commonly be confronted by the loneliness, social exclusion, poverty and prejudice experienced by people living with mental distress; however, social work practice may not be focused on these factors. Instead, in accordance with the dominant biomedical perspective, symptom and risk management may predominate. Frustration with the limitations evident in this approach has seen the United Nations call for the transformation of mental health service delivery. Recognising paradigmatic influences on mental health social work may lead to a more considered enactment of person centred, recovery and rights-based approaches. This paper compares and contrasts influences of neo-liberalism, critical theory, human rights and post-structuralism on mental health social work practice. In preparing social work practitioners to recognise the influence of, and work more creatively with, intersecting paradigms, social work educators strive to foster a transformative approach to mental health practice that straddles discourses.

Safety for women when accessing mental health services: a scoping review of the link between safety and recovery.

ObjectiveA sense of safety and recovery from mental health issues seem to be interrelated concepts but, to date, there has been no review of studies exploring the links between safety and recovery for women accessing mental health programs. This review aimed to identify current knowledge and knowledge gaps regarding the experiences of women and their personal safety when accessing mixed-gender and women's mental health programs.MethodsA scoping review methodology was used. Four electronic databases (Medline, PsycINFO, AMED, and CINAHL) were searched, covering the period from January 2000 to December 2019, to identify relevant peer-reviewed articles, which were screened for inclusion. Key search terms included ('women' or 'female' or 'gender') and ('recovery' and 'mental health programs') or ('community mental health' or 'community mental health centres/or community mental health centre') and 'safety'.ResultsTwelve studies were identified, 10 of which were from English-speaking countries (five from the UK, three from Australia, two from the US) and two from European countries, indicating there is limited literature directly relevant to women with mental health issues and their personal safety while using mental health services. Safety from assault and harassment and finding safe and supportive connections were commonly reported as crucial to the process of recovery for the women with mental health issues across these studies.ConclusionsBased on the identified knowledge gaps, this paper advances the argument for more research to inform gender-specific service provision.What is known about the topic?Service guidelines identify the need for gender-sensitive practices in mental health services, yet women continue to report experiences of sexual or other forms of harassment while in acute and subacute mental health programs.What does this paper add?This study identified the current knowledge regarding the experiences of women when accessing mental health programs. In particular, a sense of feeling safe in services was crucial to the process of recovery for women with mental health issues.What are the implications for practitioners?This study contributes to the body of knowledge informing health professionals who work within these mental health programs and highlights the need to meet women's needs to feel safe when accessing services.

Peer Worker Perspectives on Their Potential Role in the Success of Implementing Recovery-Oriented Practice in a Clinical Mental Health Setting.

Purpose: Recovery-oriented practice (ROP) is growing internationally in mental health services. The study aimed to examine the perspectives of peer workers about ROP pre-implementation within one service. This is important to improve clinicians' understandings of how service users feel and experience the organization's culture, thereby improving recovery focus.Method: A focus group using semi-structured questions. The research design was a social constructivist exploratory study, utilizing a narrative approach. The data collected were qualitative, and analyzed for meaning units and categories in the data.Results: Eight participants were service user and carer peer workers. Peer workers considered their roles as educating clinicians, representing service users, aiding in cultural/systemic shifts in services, and as leaders. Peer workers add lived experience and can contribute to clinician uptake and fidelity of practice in ROP.Conclusion: The study contributes to the growing evidence that the inclusion of peer workers in mental health services is advantageous in the implementation of ROP to ensure a lived experience grounded perspective underpins practice and policy change.

Heteronormative models of health-care delivery: investigating staff knowledge and confidence to meet the needs of LGBTIQ+ people.

Health services internationally are reconsidering whether current service delivery models are inclusive and responsive to lesbian, gay, bisexual, trans* and gender diverse, intersex, and/or queer (LGBTIQ+) identifying individuals. A survey was conducted to establish a baseline needs analysis, as part of an LGBTIQ+ workforce development program, on perceived staff knowledge and confidence in a multi-site public mental health service in Melbourne, Australia. The survey comprising multiple choice, 5-point Likert scale ratings, and short answer sections was administered to mental health staff attending training at their place of work. Workplaces included: community clinics, residential services, acute inpatient services, service development, and research departments. Perceptions of self-confidence and knowledge, and further support needs expressed, were examined through analyzing quantitative and qualitative responses in feedback following the education sessions. The sample comprised 85 respondents; the majority female (66%), with a good representation of staff across age brackets. While the majority of staff identified as heterosexual (68%), LGBTIQ+ individuals were represented. Though 64% of staff surveyed noted that opportunities exist in the workplace to discuss LGBTIQ+ issues, a desire to increase knowledge was expressed by 94% of staff. Staff attitudes, knowledge, confidence, and support needs should be carefully considered at organizational and leadership levels, to ensure health services foster LGBTIQ+ responsive service delivery models and practices.

Delivering family psychoeducation at the mental health acute inpatient service: A practitioner narrative.

WHAT IS KNOWN ON THE SUBJECT?: The admission of a loved one for first episode psychosis can cause considerable distress and confusion for family members. Psychoeducation can enhance family members' knowledge of the disease process and their role in supporting recovery. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: There is limited research on psychoeducation processes within adult inpatient settings. A Practitioner Narrative found that basic assessment questions can help guide the psychoeducation process. The Stress Vulnerability and Phases of Psychosis Models are valuable and efficient educational tools in answering many typical questions. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Psychoeducation sessions should be offered routinely in the early stage of a first episode psychosis, but must be individualized to family needs and concerns. The psychoeducation structure also provides an opportunity for family members to "tell their story" to process the events leading up to a first admission and their emotional reactions to the service user's illness. Abstract Aim To clarify how initial psychoeducation, while typically brief, can best be targeted to the needs of families during the acute treatment phase of a first episode of psychosis, when there is often significant distress and confusion. Method Over 6 months of conducting inpatient psychoeducation meetings, with families of individuals experiencing first-episode psychosis, a senior mental health nurse-as a practice development undertaking-kept a record of needs/issues expressed by families. Thesis The most frequent needs of families during a first episode of psychosis were: 1. Opportunity to discuss events leading to admission; 2. Space to share feelings and fears; 3. Have practical information concerning current care; 4. Education regarding the nature of psychotic symptoms and 5. Information about recovery. Implications for Practice Family members of individuals experiencing a first episode of psychosis often require an opportunity to process the events leading up to the admission, and their emotional reactions to the individual's illness and admission. The psychoeducation process can be individualized and targeted to the needs of families, with active listening to the family's stories. Psychoeducational frameworks that were useful for explaining issues raised were the Stress Vulnerability Model and the Phases of Psychosis.

Vocational support in mental health service delivery in Australia.

BACKGROUND: Individuals experiencing severe and persistent mental illness report a desire to gain and sustain work. Individual Placement and Support (IPS) is an evidence-based approach to vocational rehabilitation to support competitive employment outcomes. AIM/OBJECTIVE: This study aimed to evaluate whether a joint-governance management partnership, between a clinical adult mental health and an employment service, could deliver a sustained IPS program in Australia. MATERIALS AND METHOD: The methodology entailed a Clinical Data Mining approach, to examine records from seven years of implementation of IPS in one setting within an Australian public mental health service context. RESULTS/FINDINGS: Despite the prevalence of schizophrenia spectrum diagnoses and an older mean age (39 years), indicating that a large proportion of the cohort had experienced serious mental illness for over twenty years, findings were that 46.3% of participants achieved employment. CONCLUSIONS: This is an excellent result and is comparable to the only randomised control trial, with adult services, in the Australian context, which found a 42.5% employment rate possible under IPS compared with just 23.5% with referral to external employment services. SIGNIFICANCE: More extensive trialling of IPS across clinical services is required, in Australia and internationally, including fidelity protocols, for knowledge translation to be achieved.

Dual diagnosis competencies: A systematic review of staff training literature.

OBJECTIVE: To conduct a systematic review of the literature regarding approaches to staff training in dual diagnosis competencies. METHODS: A search was conducted using eight databases: Informit, Taylor & Francis, Springer, Proquest, Expand, Sage, Psych info, Elsevier and Cinahl. The year range was 2005 to April 2015. An additional manual search of reference lists was conducted to ensure relevant articles were not overlooked. RESULTS: Of 129 potential results, there were only 11 articles regarding staff training in dual diagnosis. The limited studies included problems: small sample sizes, selection biases, and questions as to validity of some capability instruments, and low inclusion of service user perspectives. Organisational challenges to greater uptake of staff training including agency size, agency willingness to change, and a need to change policies. CONCLUSIONS: There is a pressing need for more research, and quality research, in this important area of knowledge translation, dissemination and implementation of evidence-based practices. In particular there is limited literature regarding the efficacy of dual diagnosis competency resources, and a gap as to use of the mentoring in dual diagnosis capacity building.

Challenges in implementing individual placement and support in the Australian mental health service and policy context.

Objective Although Australia's service and policy context differs from that of the US, studies have highlighted potential for individual placement and support (IPS) to support competitive employment outcomes for people with severe and persistent mental illness. The aim of the present study was to explore why the model is not yet widely available. Methods A document analysis was conducted to discern reasons for challenges in implementation of IPS practice principles within the Australian service context. Results The document analysis illustrated that although policy acknowledges the importance of increasing employment rates for people with severe and persistent mental illness, consistent measures, change indicators, direction and time frames are lacking in policy and strategy documentation. Further, IPS principles are not consistently evident in guiding operational documentation that government-funded Disability Employment Services (DES) programs are mandated to adhere to. Conclusions For IPS to be readily implemented, it is necessary for government to offer support to agencies to partner and formal endorsement of the model as a preferred approach in tendering processes. Obligations and processes must be reviewed to ensure that model fidelity is achievable within the Australian Commonwealth policy and service context for programs to achieve competitive employment rates comparable to the most successful international programs. What is known about the topic? The IPS model has been established as the most efficacious approach to support people with severe and persistent mental ill health to gain and sustain employment internationally, yet little is known as to why this model has had very limited uptake in the Australian adult mental health service and policy context. What does this paper add? This paper provides an investigation into the achievability of IPS within DES philosophical and contractual arrangements. What are the implications for practitioners? Mental health practitioners are typically skilled in their understanding of individual or micro-level challenges faced by consumers in achieving vocational goals: working with symptoms, medication side effects, motivation and anxiety. The present study was designed to offer practitioners an increased understanding of service-level factors, because these present considerable challenges to achieving sustained employment. This paper is a call for greater advocacy towards better integration of employment and mental health service delivery in the Australian policy and practice context.

Early Intervention in Psychosis: Health of the Nation Outcome Scales (HoNOS) Outcomes From a Five-Year Prospective Study.

INTRODUCTION: Over the last two decades, mental health services internationally have shifted towards intervening early in psychosis. The critical period for intervention is estimated to be five-years and many specialised programs target early psychosis. AIM/QUESTION: This prospective cohort study aimed to evaluate five-year outcomes from an early psychosis program (EPP) that adopted an integrated model, providing nursing and multidisciplinary community mental healthcare to clients aged 16-65years, beyond the typical age range of 16-25years. METHOD: We examined one routine outcome measure, the Health of the Nation Outcome Scales (HoNOS) across episodes of care for clients receiving EPP over a 5year period (n=239), comparing these results with HoNOS outcomes in an Australian national dataset for all public mental health clients. RESULTS: HoNOS improvements were highly significant from intake to discharge and from review to discharge for EPP clients, and these compared well with national outcome performance. CONCLUSION: There is potential for mental health nurses and other clinicians to significantly improve client symptoms and functioning, in a model of early psychosis treatment beyond a youth focus.

Family group interventions in an early psychosis program: A re-evaluation of practice after 10 years of service delivery.

INTRODUCTION: The role of family in supporting service users in coping with illness and engaging in relapse prevention in early psychosis is important. Taking on this caring though is stressful and challenging, and it has been found that support and information for carers assists in their coping and reduces isolation. AIMS: To evaluate the current utility of a psychoeducation group program in a public adult mental health service, for the families of people experiencing early psychosis. METHODS: A purpose-designed pre- and post-intervention questionnaire was administered to quantitatively measure group participants' changes in perceptions of their understanding of mental illness and its treatment through attending the group. Additional qualitative items were used to determine other knowledge, benefits and any critical feedback. RESULTS: The group program continues to result in highly significant improvements in family members' understanding of psychosis, recovery, medications, relapse prevention and substance co-morbidities. Additional feedback reaffirmed previous findings that family members find group peer support valuable and that this reduces isolation and the experience of stigma. CONCLUSION: The current evaluation, conducted following 10 years of early psychosis group work, found there to be efficacy in family peer support groups and that it is important to provide family interventions in public early psychosis mental health services.