Juliana Onwumere, David Shiers and Carolyn Chew-Graham
A couple you have known for years consult with you; they are in despair. Their son’s new psychiatric team has just advised them that, as he is now an adult, he will be able to make his own decisions without his parents attending routine appointments. They have watched their son’s prospects for a normal life disintegrate over the last 2 years — rarely leaving his room, losing his friends, and spending most days without structure or purpose.
Many individuals diagnosed with psychotic conditions live with, or remain in close contact with, informal caregivers, typically close relatives such as their parents, partners, siblings, and children. As in the scenario above, the experience of a family member developing psychosis leaves family members bewildered and frightened, working through high levels of distress and often unsupported or even excluded by healthcare providers. Moreover, this often heralds a long-term commitment by families to support and advocate for an individual while feeling unsupported. As ‘family practitioners’ GPs are in a unique position within the NHS to engage with and support both the individual with psychosis and their family carers.
Psychotic disorders, such as schizophrenia, are severe and disabling mental health conditions that affect several million people worldwide and rank among the top global contributors to years lived with disability. The onset typically emerges in adolescence and young adulthood, and often during a period when a young person is establishing their independence. The hallmark symptoms include hallucinations and delusions, often persecutory, that can be focused on other people, including relatives and carers. These will often occur alongside marked disturbances in affect, cognition, and social functioning.