Comment on: Family engagement as part of managing patients with mental illness in primary care

Dear Sir,

I read with great interest the article ‘Family engagement as part of managing patients with mental illness in primary care’ by Ong et al.(1)

First, I would like to congratulate the authors for raising awareness of a crucial challenge regarding implementation in current informal caregiver practice. Despite substantial evidence showing the effectiveness of family engagement and family intervention, these are often not sufficiently nor routinely implemented in mental health services such as primary care, psychiatric hospitals or local community services. In the last couple of years, more researchers have reconfirmed commonly known barriers, challenges and the inherent complexity of family engagement.(2) Research has also revealed differences in stakeholder perspectives regarding the barriers experienced and the reasons behind the barriers, such as different conceptions, presuppositions, interests, motives and expectations regarding caregiver engagement.(3) Further, a recent promising study has presented a justified fidelity scale as one of the first instruments of its kind to measure the level of actual family involvement in terms of national guidelines and practices.(4)

In the light of extensive existing quality research on family engagement and the effectiveness of family interventions, I call on the health community to also draw urgent attention to the implementation task and implementation research such as research questions, outcome variables, affecting factors and implementation strategies.(5) I would like to emphasise that explicit and comprehensive identification of all barriers, challenges and facilitators to implementing informal caregiver involvement should be scrutinised. This will hopefully foster more critical reflection, discussions and investigations in the future, and improve decision-making regarding health policies, quality work and clinical practices for family engagement within mental health services.