Visions Journal

Isabella Mori, MEd, MPCC

Reprinted from the "Families and Crisis" issue of Visions Journal, 2017, 12 (4), p. 34

Vancouver Coastal Health (VCH) has a Family Support and Involvement (FSI) team. This team assists families with resources, education, information and support, as well as with facilitating the inclusion of family in the care of their loved ones. The team also works on including families in important decisions taken by Vancouver Coastal Health, including, for example, the design and planning of the new VCH mental health hospital, the Joseph and Rosalie Segal Family Health Centre. We work in the community, alongside Vancouver mental health teams; in acute care, which includes shorter stays at Vancouver General Hospital or UBC Hospital; and in tertiary care, which involves longer stays in regional mental health facilities, from Richmond up to Whistler and the Sunshine Coast.

How does the FSI team help?

The FSI team assists families and individuals in various ways. We use the acronym “IRIS” to explain how we work. IRIS grew out of the VCH Policy for Family Involvement in Mental Health and Addiction, which has been in place since 2013.

Involve family in the care team. The FSI team encourages health care providers to include family as part of the decision-making care team. “Family” may include blood relatives, relatives by marriage or any other individuals whom the client views as “family.” Depending on the client’s wishes, and his or her clinical needs, families are involved as people who know about the client’s history and who can help make informed care decisions.

Family members are often a patient’s main support, and their insight and information can be an invaluable resource. A nurse caring for an agitated client once told me about how she took the time to listen to the client’s father’s experiences. The client’s father pointed out that the client had autism. He explained some of her idiosyncrasies and how to de-escalate problems. The nurse followed the father’s recommendations and was able to help the client feel less agitated. The nurse felt that if she had not taken into account the father’s insights, a stressful situation could have turned into a traumatic seclusion-room experience.

Receive information from family. Even though family members often know important information about the client, sometimes health care providers are reluctant to listen to it. The FSI team reminds health care providers that families are not bound by the Freedom of Information and Privacy Protection Act (FIPPA) in the way that providers are. Families can give as much information as they wish. It is up to providers to reflect on how much information is useful for the client’s care, and what can be set aside.

In a crisis, listening to information from family can be vital, especially when a client is momentarily confused and does not remember details that may be important. Certain medical conditions can affect mental health episodes, treatment and outcomes (diabetes can worsen psychotic symptoms, for example). It is important that health information is not forgotten or overlooked. Family members can help ensure that important information gets passed on to the care providers.

Inform families. Health care providers often need guidance on how to inform families appropriately. Often a provider’s respect for the client’s privacy can clash with the family’s desire or need to know what is going on with the client’s health care.¹

But families need other types of information as well, especially when they encounter the crisis of their loved one hospitalized for the first time. They have questions about the hospital (When and how often will my loved one see the doctor? Why can’t my loved one listen to music on his cell phone? Why is he in a seclusion room?) and the system (Why is my loved one suddenly in a different ward? Will she get support after she leaves the hospital? What about housing?). Families may also have questions about mental health or substance use (When will my loved one be cured? Is there any hope? Can she go back to work?).

The FSI team works with health care staff to answer these questions. For example, we make sure that care staff has information and program pamphlets, and we remind staff members that we are available to answer the family’s questions when they don’t have the time to answer them themselves.

Support family. We have observed that simply when an FSI team member is in the hospital as a family champion, health care staff members pay more attention to supporting families. Since the FSI team began providing support services, we have heard reports of more nurses, doctors and social workers incorporating a family’s experiences into health care planning, listening to families and supporting families in times of crisis.

The FSI team is also always available generally to provide support to families. Our telephone numbers and email can be found on our website (see below). We make sure there is coverage when one of us is absent. We are available for short-term coaching and counselling, or just to listen when it all gets too overwhelming. We also facilitate support and educational groups.

The FSI team works to ensure that the voices of families are heard in all parts of the system, from staff education and hiring to policy writing and the building of VCH’s new mental health facility. Of course, our efforts do not always achieve a perfect outcome. But we are grateful that VCH has opened up the opportunity for families to be involved, and to be supported in times of crisis.