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Family meetings and integrated patient care commentary: medical family therapy in an inpatient setting.

Article Excerpt
The incorporation of MFTs into a psychiatric inpatient unit is an intriguing idea. As a previous chief of a 29 bedded psychiatric acute care unit, and with intimate knowledge of the functioning of several other inpatient units, I (AH) can comment on how family involvement occurs on most psychiatric inpatient units. The social worker is expected to contact the family to gain collateral patient information and discuss disposition. On occasion, the social worker will "get an earful" from a distraught family member. In these cases, the social worker may be on the telephone for an extended period of time, which is often seen as interfering with the real work of the day. However, good social workers who are invested in providing optimal care will arrange to meet with the families during visiting time or at another time during the day During this meeting the social worker will take a good family history of the current difficulties and will provide education and emotional support. The social worker will also provide referral to community support groups, such as the National Alliance for the Mentally Ill (NAMI), if indicated. During team meetings, if there are any specific family concerns, the social worker will let the rest of the team know. The physician (who usually had not seen the family) then gives direction to the team and specifically the social worker, taking account of the useful information, from or about, the family. This information rarely includes family strengths and rarely draws on the family's long history with the patient and their, perhaps insightful, understanding of the patient.

The attending physician and resident do not meet with family members unless under pressure from the social worker who finds the family too difficult to manage. The social worker will relay that the family has specific questions about the illness and treatment and wants to speak with the physician. The family, of course, sometimes calls the physician directly and asks for a meeting. In these cases, the meetings usually consist of angry family members venting at the physician or tired and worn out family members looking for direction...

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