A survey of the use of family therapy in medium secure units in England and Wales

The majority of patients within medium secure units in England and Wales su ffer from schizophrenia. Family interventions are of proven benefit in the management of this illness. A telephone survey was undertaken to gain an un derstanding of the use of this technique in medium secure facilities, what limited its availability and what problems were encountered in its use in a secure setting. Family therapy was used relatively infrequently, with several services not convinced of its benefits. In services that did undertake such work there w ere no set criteria and little reference was made to the importance of the level of expressed emotion within the family. The type of work undertaken a lso varied considerably. The work was not routinely supervised by trained t herapists and this may explain its poor focus. Most services reported a lac k of appropriately trained staff as a factor limiting the availability of f amily work. There is strong evidence for the need to train staff in this te chnique for use in medium security. Working with families in a systemic way , whilst also focusing on reducing expressed emotion, should fit easily int o the working of most multi-disciplinary teams in forensic psychiatry.