First, families and carers (including young carers) ask .... 0. 130. 17. 59. 14. 42. 16. 5. Being heard. 81. 44%. 11. 55%. 92. Involvement in relative's care. 36. 20%. 8. 40% ... âFound it useful to have a named person to put a face to and have as a ...
Families’ views on the familyliaison service on mental health wards in Somerset Sara Gore and Roger Stanbridge 2007; Lakeman, 2008; Walker & Dewar, 2001; Bee et al., 2005). Whilst acknowledging the boundaries of confidentiality, they request specific information concerning the person they support, including diagnosis and their current condition and progress; the treatment options and effects; discharge arrangements; the aim of specific services/care provided and information about who is Research into family and carer views on partnership providing care, e.g. name of the key worker (Hervey & Ramsay, working 2004; Lakeman, 2008; Bee et al., 2005). Families and carers also When relatives are admitted to mental health wards, families need general information, including information about services and carers often report they feel ignored and excluded from their and support mechanisms (Hervey & Ramsay, 2004) and request care; they report they do not always receive adequate information that information should be offered at an early stage, especially to fulfi l their caring role (Hervey & Ramsay, 2004; Bee et al., when their relative is fi rst hospitalised (Lakeman, 2008). 2005); and are given insufficient recognition of what support they need themselves (Bee et al., 2005). Consultation with families Working with carers and families on inpatient wards in Somerset and carers in a number of studies has shown they would welcome In Somerset, as part of the Somerset Partnership’s ‘Strategy to increased partnership-working through a change in culture and Enhance Working Partnerships with Carers and Families’ (2002, att itudes on mental health wards in a number of areas. revised in 2010), a three-day knowledge-and-skills training in First, families and carers (including young carers) ask family inclusive ways of working has been delivered to all inpatient for improved contact and communication with professionals teams working with adults and older people by means of a whole(Walker & Dewar, 2001). Lakeman (2008) found families and team training approach (Stanbridge et al., 2009, 2012). In order carers of people with mental health problems in a hospital sett ing to implement trust practice-guidelines to meet with families wanted more direct lines of communication with physicians and within seven days of an admission, a family-liaison service has respectful engagement with staff. Secondly, families and carers been developed. A member of staff, with a systemic family therapy express a desire to be listened to and supported by inpatient staff training and experience in working with families, is employed through receiving help and advice (Bee et al., 2005; Lakeman, 2008). Bains and Vassilas (1999) report positive experiences when one day per week to work alongside ward staff (especially with the ‘ward champion’ for family liaison) to hold meetings with families families and carers of people with dementia attended the ward round, as they valued the opportunity to meet with staff but would as part of the assessment and admission process. An initial sixmonth (December 2007–June 2008) pilot on one inpatient ward have liked to know more about the purpose and composition (Carter, 2011) found a considerable increase in the number of of the ward round in advance. Carers stated it would have been helpful to receive support at the time of ‘the crisis’ and when their family meetings taking place, and that meetings were positively friend or relative was fi rst admitted to hospital (McKenzie, 2006). received by people who use services and their families/carers. The family-liaison service is now operating on all inpatient mental Th irdly, families and carers would like to be involved in their health wards for adults and older people within the Somerset relative’s care and the decision-making process in treatment and Partnership. For a full description and evaluation of the familydischarge planning (Lakeman, 2008; Walker & Dewar, 2001), liaison service see Stanbridge (2011). For a series of case studies and sharing their perceptions of the situation with professionals describing the content and process of family-liaison meetings, see (Lakeman, 2008). Hervey and Ramsay (2004) highlight that Left wich et al., (2011). families and carers would like increased recognition from professionals for the contribution they make in the care of their relative. Method Families and carers also request a service that is responsive Th is research examines feedback about family-liaison to their needs (Walker & Dewar, 2001). People who use services meetings from people who use services and members of their and their families highlight a need for inpatient staff to help them support network (referred to as “ family members”) including gain personal support through signposting, and informing them relatives, carers and sometimes friends or neighbours, when about carer-support services (Lakeman, 2008; Simpson & Benn, appropriate, who have attended meetings. Feedback forms are 2007). In addition, families and carers require information to provided following each meeting. Although family-feedback forms help them in their role (Hervey & Ramsay, 2004; Samuels et al., are always available, in a high proportion of meetings, feedback Th is article examines feedback from families, carers and people who use services on a newly created family-liaison service designed to create closer working partnerships with families and carers on inpatient mental health wards for adults and older people in Somerset.
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forms were given but not returned. In a small number of cases, family members were not asked to complete a form due to the emotional intensity of the meetings. The forms ask two questions: 1) What did you fi nd helpful about today’s meeting? 2) What did you fi nd unhelpful? Responses from families, who attended family-liaison meetings on wards for adults and older people between December 2007 and June 2010, were collated and summarised into key themes using thematic analysis (Braun & Clarke, 2006).
Results Two hundred and sixty-eight feedback forms were returned by June 2010 from family members (N=204) and people who use services (N=64) who had attended 153 meetings (just under 40% of the meetings held). The majority of returns (247) were from adult wards, with a small number (21) from older-people’s wards,
where the service had only recently been started. Table 1 shows the start date for the family-liaison service on each ward. Table 1: Start dates for each ward Adult wards
Older-people’s wards
Ward 1: December 2007
Ward 4: August 2009
Ward 2: March 2008
Ward 5: October 2009
Ward 3: September 2008
All family members and people using services (268) highlighted helpful aspects of the meetings with thirty-four family members (17%) and thirteen people who use services (20%), giving a total of forty-seven (17.5% , 47/268), also commenting on unhelpful aspects. Table 2 shows the number of people who gave feedback on each ward, bearing in mind that the service was running for different lengths of time on each ward.
Table 2: Number of returns/comments from family members and people using services
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Type of ward
Family members
People using services
Number of Number of forms returned people who gave positive feedback
Number of people who gave negative feedback
Number of Number of forms returned people who gave positive feedback
Number of people who gave negative feedback
Adult
184
184 (100%)
32 (17%)
63
63 (100%)
12 (19%)
Older people’s
20
20 (100%)
2 (10%)
1
1 (100%)
1 (100%)
TOTAL
204
204
34 (17%)
64
64
13 (20%)
What did you find helpful about today’s meeting? Feedback from family members Table 3: Number of family members (FMs) who mentioned each helpful aspect/theme No of FMs (Adult)
%
No of FMs (Older people’s)
%
TOTAL
Receiving information (total) (N.B where FMs mentioned more than one type this is included once in total) General Support Advice Care Ward/system Resources (e.g. leaflets)
115
63%
15
75%
130
17 53 13 34 16 5
9% 29% 7% 18% 9% 3%
0 6 1 8 0 0
0 30% 5% 40% 0 0
17 59 14 42 16 5
Being heard
81
44%
11
55%
92
Involvement in relative’s care
36
20%
8
40%
44
Communicating with each other
40
22%
0
0
40
Making contact
22
12%
2
10%
24
Atmosphere/approach
16
9%
5
25%
21
Questions answered
14
8%
2
10%
16
Presence of facilitator
5
3%
1
5%
6
General
3
2%
0
0
3
Practicalities of meeting
0
0
1
5%
1
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Below are examples of quotes for each theme that emerged from the helpful aspects highlighted by family members. Receiving information The points made include receiving advice; information about their relative’s care and well-being; information about ward/system/processes; information about support for carers and receiving-information resources. • “It was rewarding to have you and (staff member’s name) give us such positive advice and I would like you both to accept my thanks for this.” • “The most helpful thing is to be reassured that my mum is in caring environment where her health and well being are important instead of perhaps in a place where she is just kept fed and clean. The meeting has ‘personalised’ the situation for me and made me feel less anxious about her welfare.” • “I also find helpful the way information about treatment is shared openly with me. Whether the news is welcome or unwelcome, it must ultimately be helpful to know quite fully what the position is.” • “As a mother found it very helpful to understand how things work within hospital” • “Having information about the service, as it was all completely new to me.” • “Very useful being able to discuss what help and assistance is available to carers. I previously had no idea what resources were available in particular help for younger ‘carers’.” • “Finding out that I can get support for myself and not feel so alone with it all.” • “Leaflets given to us should be useful.”
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understanding of the situation.” • “To coin a phrase ‘there’s strength in number’ and I feel more involved in procedures.” • “Good to be part of planning (relative’s name’s) care.” • “Having the chance to input to the assessment process.” Communicating with each other The points made include a chance to talk/meet together (all family members); the sharing of views and improving communication and relationship issues. • “Being able to hear something definite about her (relative’s) point of view.” • “Sharing our experiences with all family members present.” • “Certain suggestions on how to cope with our problems in communicating with each other.”
I felt that our questions were really ! heard and responded to
Involvement in relative’s care The points made include the giving of information; sharing views/perspectives; working together; planning care and involvement in assessments. • “The opportunity to elaborate on the background to his illness, what had happened prior to being admitted to hospital, events in past, contributing factors.” • “Talking over my point of view, and suggesting what I feel would be helpful/beneficial to (relative’s name) was very important to me.” • “It was extremely helpful to compare my direct experience of (relative’s name’s) condition with others who have a professional Context !"#$%&'(&
Making contact • “Meeting a great team of support for both (relative’s name) as a patient and for myself as a carer.” • “Found it useful to have a named person to put a face to and have as a contact.” Atmosphere/approach within the meeting • “The relaxed, un-defensive approach to answering the questions that we posed.” • “(Family-liaison worker’s name) was very kind and caring without being condescending.” • “Professional but relaxed atmosphere created by hosts… Listening and empathy ability. Open, honest and straightforward approach.” • “Conducted in friendly, patient manner.” • “Informal informative approach.” Questions answered • “I felt that our questions were really heard and responded to.” • “All questions answered in a manner which was not patronising but was inclusive and made me feel part of the discussion process.” Presence of facilitator • “Having someone else there to help direct the meeting and make suggestions.” • “Also useful to have somebody to act as mediator between parties.” • “(Family-liaison worker’s name) really helped us to open up to each other and support discussion.” General: (where no other comments were made): “Very positive feedback; excellent service; a must for families.” There was one other helpful aspect highlighted by one family member: Practicalities of meeting: “Meeting started promptly. Offer of refreshments.” !"
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Being heard The points made include being listened to; the opportunity to voice concerns/worries/feelings and experiences of reassurance and support. • “It is nice to talk to caring people who understand what you have been through looking after some one who is ill.” • “Being able to freely discuss how I am feeling and the problems leading up to the point of admission without being judged.” • “It has been so helpful to have some support. To know that we are not on our own with our problems.”
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Feedback from people who use services Table 4: Number of people who mentioned each helpful aspect/theme No (Adult wards)
%
No (Older-people’s wards)
%
TOTAL
Receiving information (total) (N.B where people mentioned more than one type this is included once in total) General Support Advice Care
26
41%
1
100%
27
2 15 3 7
3% 24% 5% 11%
1 0 1 0
100%
3 15 4 7
Communicating with each other
17
27%
0
17
Being heard
16
25%
0
16
Involvement of friends and family
6
10%
0
6
Planning care
5
8%
0
5
Atmosphere/approach
3
5%
1
Everything
4
6%
0
4
Presence of facilitator
2
3%
0
2
Making contact
2
3%
0
2
Questions answered
1
2%
0
1
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Below are examples of quotes for each theme that emerged from the helpful aspects highlighted by people who use services. Receiving information The points made include receiving advice; general information; information about their care on the ward; and information about available support (for family and self). • “Finding out what support is available for (family member’s name), as he has supported me throughout my illness, particularly during my admissions to hospital. Extremely helpful.” • “Knowing that there is more care in the community out there – so there are different channels you can go through.” • “Ideas for how to approach situations.” • “I found the meeting useful to know where I am in the unit and what is allowed or not and how much involvement I have to do. About sessions and ward rounds that my husband can come as I forget what to say.” Communicating with each other The points made include talking to each other and improving communication and relationship issues. • “100% better talking.” • “Being able to talk amongst each other to explain how the large amount of problems has affected one another. Talking about the problems helps release the tensions.” • “Discussing things that we may not have spoken about otherwise.”
100%
100%
4
• “It’s helpful to know that somebody is listening and willing to help.” Involvement of friends and family • “Opportunity to let (friend’s name) know she can be as informed and involved as she wants, but don’t want her to feel responsible.” • “The meeting was quite helpful because it gave a chance for my parents to talk about their concerns and views about my recovery and time being spent in hospital.” Planning care: “Talking about care plan and future.” Atmosphere/approach within meeting • “I really enjoyed the meeting and found (family-liaison worker’s name) very friendly and easy to talk to. (Staff member’s name) was also helpful and kind. I really enjoyed the meeting and can’t thank (family-liaison worker’s name) enough for his help and friendly attitude. I really want to go home and feel positive I can get on better. Everything was explained very clearly.” • “Friendly and relaxed atmosphere.” Everything: “The whole meeting was good.” Presence of facilitator • “Being able to talk with some one there to stop things going astray or getting out of hand.” • “Being on neutral ground and with (family-liaison worker’s name) in the room made it much easier to have a conversation with my mum and to begin to appreciate that she has needs too.”
Being heard Making contact: “about the contacts available.” The points made include being listened to; not being judged; being able to speak; and feeling supported/reassured. There was one other helpful aspect highlighted by one • “Being able to voice my own concerns and things worrying to me.” person: • “Freedom to talk without feeling under any pressure.” Questions answered: “That staff could answer any questions.” !"
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What did you find unhelpful about today’s meeting? Feedback from family members Table 5: Number of family members who mentioned each unhelpful aspect/theme No of FMs (Adult) %
No of FMs (Older people’s)
%
TOTAL
Person using the service
6
19%
6
Not meeting key people
5
16%
5
Comments on the service – not the meeting itself 4
13%
4
Not knowing what to expect
3
9%
Request for more information
2
6%
Lack of knowledge about relative
2
6%
2
Only a one-off
2
6%
2
Time of meeting
1
3%
Atmosphere of meeting/environment
2
6%
2
Refreshments
1
3%
1
Length of visit
1
3%
1
Talking about own feelings
1
3%
1
Lack of solution to problems
1
3%
1
Conflict
1
3%
1
Repetition
1
3%
1
Person using the service Th is includes the presence/absence of their relative in the meeting and communication in the meeting. • “Because (relative’s name) isn’t communicating we weren’t able to think more about the future.” • “It was unhelpful not to be able to see (relative’s name) herself.” • “(Relative’s name) very upset.”
1
50% 3
50% 2
Request for more information • “It would have been good to know more re (relative’s name’s) condition and how I could better support him.” • “Not unhelpful – just a suggestion: it would be nice to have a contact card to give people with key worker name and contact info to take away.” • “Nothing really, though as I mentioned, at some time I’d like to be told more about the possible physical causes of her condition.” Lack of knowledge about relative • “There seems to be no communication between anybody about previous treatments.” • “Lack of understanding about (relative’s name’s) behaviour outside of (ward name).”
Not meeting key people • “Talking about key worker, etc, but not being able to put face to name Only a one-off: “The fact that this was a one-off meeting, surely or know what they’re doing in regard to (relative’s name’s) care.” a representative is responsible for this.” • “No doctor to chat around medical facts.” Comments on the service – not the meeting itself • “Felt (relative’s name’s) care wasn’t as I’d hoped for and I did speak to the nurse on the ward about it. When I rang the first night, felt I shouldn’t have rung, said to me ‘what time is this’.” • “The carer support option very limited in regard to what can be offered and feel carers are very private in what goes on at home.” • “Not keen on idea of (relative’s name) being on medication too long, but will support him whatever.” • “Lack of information given to all concerned when a patient is admitted to this unit (how it is run, rules etc).” Not knowing what to expect: “I didn’t realise at all what it was going to be for or about. Perhaps a short information leaflet given out in advance of the first meeting would have taken the ‘unknown’ out of the equation.” Context !"#$%&'(&
Time of meeting • “I am not sure at what point the family meeting take’s place, in my opinion it should be at the beginning of a patient’s stay.” – Case where one family member was away on holiday – offered before the holiday, then re-offered on return. • “It could have happened sooner.” – arranged day after admission but delayed by transfer to general hospital. Atmosphere of meeting/environment • “A feeling that, in spite of the informality, there was nevertheless a bit of ‘stiffness’ and ‘politeness’ about the meeting.” • “I feel the environment could be a bit warmer; something about the physical space is a bit bare and austere.” !"
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Nine common themes (subject mentioned more than once) emerged from feedback received from family members from four of the wards (no negative feedback was received from family members or people using services on one of the older-people’s wards). They are detailed below with examples for each:
3 1
There were six other comments, each highlighted by only one family member. • Refreshments – “Cup of tea might have been nice!” • Length of visit – “The ward being closed due to virus therefore not being able to extend visit but client asleep anyway.” • Talking about own feelings – “What sometimes felt like interview into how I felt about what was happening. Personally, I did not feel the need to discuss that. I appreciate that it was intended to be helpful to me but I was more interested in how we could help the patient.” • Lack of solution to problems – “The meeting itself was very useful the only problem is that there is no immediate solution, but to be honest I don’t think there will be.” • Confl ict – “The opportunity to start arguments.” • Repetition – “Having to go over the same issues as before that have not been resolved.”
Feedback from people who use services Table 6: Number of people who mentioned each unhelpful aspect/theme
No (Adult wards)
No % (Olderpeople’s wards)
TOTAL
Too much information • “I found it a bit confusing; a bit too much information given. • “Felt a bit confused at the end of the meeting – too much to take in.” There were six other unhelpful aspects, each highlighted by only one person. • Difficulty of planning ahead – “Not being able to look ahead for a specific time frame (impossible, I know).” • Differences in opinion – “Please be aware that families tend to view their ill member in a way, which the ill member does not recognise.” • Should have happened earlier in life – “I think this meeting would have been helpful at the beginning of my illness (35 years ago). Our relationship has become rather ‘established’ regarding my illness.” • Length of meeting – “Shortened by time! 2-3pm.” • Attendees – “Nothing; just wish my husband had been able to attend too (he couldn’t make it).” • Comments on the service not the meeting itself – “Not being able to get prescriptions straight away.”
Discussion
Feedback from people who use services and their family members shows that they all found the meetings a positive experience. Th is fi nding is consistent with previous research in Atmosphere 2 17% 2 showing that family members and carers value being involved in of meeting/ environment their relative’s care, including in decision making around treatment planning; they appreciate having contact with professionals, being Too much 2 17% 2 information heard (listened to and supported) and receiving information, including being signposted to carer-support services. These Difficulty of 1 8% 1 planning ahead common themes were highlighted as helpful aspects of the meetings by both people using services and their family members Differences in 1 8% 1 on adult wards and by family members on wards for older people. opinion Due to the low attendance of people using services in meetings on Should have 1 8% 1 wards for older people (where attendance is decided on a casehappened earlier in life by-case basis for clinical reasons), feedback was only received from one individual; therefore a comparison cannot be made. Length of 1 8% 1 meeting Consistent with previous research, feedback from both family members and people using services showed they valued having the Attendees 1 8% 1 opportunity to ask questions and have their questions answered, Comments on 1% 1 100% 1 and that people using services appreciated the opportunity for the service family members to be involved in their care as well as valuing being – not meeting itself involved in the care-planning process themselves. Family members and their relatives on adult wards also valued Only three common themes emerged from feedback received the opportunity to talk together as a family, sharing views and from people who use services from four of the wards (no feedback receiving help with communication and relationship issues. was given on one older-people’s ward) regarding unhelpful aspects Th is builds on previous research, which has focused more on of the meeting. They are detailed below with examples for each: families and carers having contact and receiving information from professionals, and points to the value of meetings that can include Not knowing what to expect the whole family and are facilitated by staff with the appropriate • “A little more information before hand about purpose – nature of skills in managing interactions as well as exchanging information. discussion would help one feel less insecure at the start of the It is important to note that the potential for families and people session.” using services to be seen both separately and together during • “I would have liked to have had more advance idea of what the group an admission is likely to offer the most comprehensive way of was about so I could have had more questions ready.” meeting the range of needs and assessing issues of risk. Not knowing what to expect
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%
Atmosphere/environment • “Found it difficult to relax and also upsett ing at times.” • “Very uncomfortable chairs.”
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4
33%
4
Context !"#$%&'(&
Context !"#$%&'(&
said that focusing on their own feelings was unhelpful, whereas a large number of family members highlighted “being heard” as being a helpful aspect of the meeting. Some family members and people using services referred to negative features of the atmosphere or environment of the meeting in contrast to other people’s views that the atmosphere created was a positive aspect of the meeting. These comments are also a reminder of the need for a suitable environment on wards to meet with families. There were also some differences in comments from family members and people who use services. Some family members asked for more information and more meetings, which could be an understandable next step from the initial meeting and therefore an important message for ward staff. One person using services also wanted more information, feeling the meeting was too short. However, comments from two people using services reported there was too much information. These confl icting comments are a helpful reminder that not everyone fi nds the same aspects of the meetings useful, and families and family members are likely to have differing beliefs and needs, requiring a flexible and ‘family needs’ led approach to meetings by staff.
Conclusion Whilst family-liaison meetings are not intended as therapy, it is clear from this feedback that, in addition to valuing exchanging information and being heard, families also often value the opportunity for communication with their relatives in the presence of staff who are non-judgemental, empathic and able to be genuine in their answering of family members’ questions. Th is requires that all staff members are able to be available to families in this way and therefore has implications for training. That meetings may also involve staff managing family interactions, differences of opinion and highly charged situations also points to the value of the presence of a systemically-trained therapist, who has experience in working with families, working alongside ward staff to hold meetings. Our experience is that this also provides confidence in the process for less-experienced staff and a helpful link to specialist family-based approaches should this be required. Being admitted to a mental health ward is a major and often traumatic event, both for the person concerned and also for their family. We are grateful to everyone who took the trouble to give us feedback on their experience of attending family-liaison meetings and their own needs during this difficult time. We are encouraged by the positive feedback from both families and from people using services in relation to their experience of family meetings in this newly created service. Th is feedback remains an essential part of shaping and developing the future of the family-liaison service. References Bains, J. & Vassilas, C. A. (1999) Carers of people with dementia: Their experience of ward rounds. Aging & Mental Health, 3: 184-187. Bee, P., Lovell, K., Playle, J., Barnes, P., Gray, R. & Keeley, P. (2005) Service User and Carer Views of UK NHS Registered Mental Health Nurses: A Review of the Literature. www.nursing.manchester.ac.uk/projects/mentalhealthreview/ usercarerviewsfinalreport.pdf/URL (Accessed: 16th December 2010). Braun, V. & Clarke, V. (2006) Using thematic analysis in psychology. Qualitative Research in Psychology, 3: 77-101. Carter, K. (2011) Family liaison in an adult acute inpatient ward. Mental Health Practice, 14 (8), 24-27. Hervey, N. & Ramsay, R. (2004) Carers as partners in care. Advances in Psychiatric Treatment, 10: 81-84. Lakeman, R. (2008) Family and carer participation in mental health care: Perspectives of consumers and carers in hospital and home care settings. Journal of Psychiatric and Mental Health Nursing, 15: 203–211.
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Feedback about how family-liaison meetings were held showed family members and their relatives found the approach of the meeting and presence of a facilitator to be helpful, valuing qualities of warmth, openness, empathy and respect. Some family members also reported fi nding certain practicalities of the meeting (e.g. prompt start and the offer of refreshments) helpful. A relatively small proportion of people highlighted unhelpful aspects of the meeting. It is also worth noting that a number of comments made related to the service as a whole rather than the meeting itself. Feedback was only received from one person using services and two family members on one ward for older people; therefore, a comparison between comments received on adult wards and wards for older people has not been made. The themes relating to unhelpful aspects were mentioned by both family members and people who use services. First, one family member and one person using services identified the meeting had provided an opportunity for confl ict and differences of opinion. Th is provides an important message for the skills required by the staff facilitator in managing differing views within the meeting and for the availability of specialist family services to refer on to if required. Secondly, both family members and their relatives said they did not know what to expect from the meeting. Th is is consistent with Bains and Vassilas (1999) who found that, although families found ward rounds to be a positive experience, they would have liked to know more about the purpose and composition of the ward round in advance. Th is has led to the family-liaison team developing a leaflet explaining the purpose and nature of the meetings, which will be made available, on admission, for all people on the ward and their families. Also, the training programme in working with families continues to be provided to ward staff (including ‘top-up’ training for those who have already received it), which should help increase their knowledge of the family-liaison service, hopefully increasing staff confidence in explaining its purpose to families. There were some comments only mentioned by family members. First, two family members commented that not being able to meet key people had been unhelpful. In relation to this, it is helpful if the key worker is able to join the meeting; however, due to the shift system and the staffi ng levels of professionally registered staff, this was not always possible. In these circumstances, the meeting is able to signpost family members to further opportunities to meet staff and receive more information through invitations to review meetings (ward rounds) together with facilitating medical appointments. Secondly, although two family members commented that the meeting did not take place early enough, they could not have taken place sooner due to family unavailability in these cases. Th irdly, two family members commented on the staff ’s lack of knowledge about their relative’s previous treatment and behaviour outside of the ward. Th is shows the potential of the meeting to enable family and people close to the person on the ward to provide this kind of information, and many family members highlighted being involved and sharing information with staff as being helpful. It is interesting that a number of the comments show confl icting points of view between individuals. Sometimes, family members showed differences in opinions regarding their relative’s attendance at the meeting with one person feeling their relative’s presence had been difficult, whilst another mentioned their relative’s absence was unhelpful. Similarly, one family member
