NAMI Extends Education Program To Families of Mentally Ill Vets

Family members of veterans with mental illness are helping researchers to measure the impact of the Family to Family Education Program (FFEP), which provides family members with the communication skills, coping mechanisms, and crisis- management skills necessary to deal with their loved one's mental illness and its impact on the family.

Developed by the National Alliance of the Mentally Ill (NAMI) in 1991, the FFEP seeks to empower family members by teaching them about mental illness (see story at left).

The course is offered to the public, but in 1997 NAMI-Metro Cleveland brought family members of veterans with mental illness into the fold by offering the course at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center in Brecksville, Ohio.

Due to the popularity of the course, in 1999 the VA Healthcare System of Ohio and NAMI-Ohio entered into a contract to offer FFEP at VA facilities, including medical centers and outpatient clinics, throughout the state.

Susan McCutcheon, R.N., Ed.D., the network telemedicine coordinator for the VA Healthcare System of Ohio, led the effort to enter into the contract with NAMIOhio. She told Psychiatric News th at it was her experience in psychiatric administration at the VA facility combined with an interest in family education that inspired her to bring FFEP to family members of veterans.

Outside the Buckeye State, the course has been gaining popularity and is now taught in half of the nation's 21 Veterans Integrated Service Networks, of which the VA Healthcare System of Ohio is one.

McCutcheon said that each FFEP class is also open to the public and draws family members of veterans and nonveterans alike. In addition, while the courses held at the VA are not tailored specifically to the needs of veterans, they educate family members about posttraumatic stress disorder, one of the common psychiatric disorders affecting veterans.

Only one study to date has examined the impact of the FFEP program on family members. Lisa Dixon, M.D., led a pilot study using measurements such as the Family Empowerment Scale and the Family Experience Interview Schedule to assess family members' perceptions about themselves and their relatives with mental illness.

Dixon is an associate professor of psychiatry at the University of Maryland School of Medicine in Baltimore and associate director for research at the Mental Illness Research Education and Clinical Center at the VA Capitol Healthcare Network.

According to the findings, the course enhanced family members' feelings of empowerment and reduced their "subjective burden of mental illness" by diminishing their feelings of worry and displeasure about their relative with mental illness-benefits that stayed with them six months after the end of the course.

The results appear in the July 2001 issue of Psychiatric Services.

Dixon said she was encouraged by the findings and emphasized the need for additional research on family education programs such as FFEP. "As with many other consumer and peer-based programs, there are many people participating in them, yet we have limited information about their effectiveness."

Dixon, who has a sibling with schizophrenia, joined NAMI while in medical school and said that her status as a family member provided her with an intimate knowledge of the issues at stake in her research.

Another study of the FFEP is under way. When McCutcheon received the Robert Wood Johnson Executive Nurse Fellowship in 2001, she set out to replicate Dixon's study and decided to use the fellowship money to examine the impact of the FFEP program on family members of veterans, and, indirectly, their veteran relatives with mental illness. McCutcheon is currently recruiting participants from FFEP courses at Ohio-based VA facilities.

"By measuring outcomes on the family members and veterans, I hope to further the process of establishing the FFEP program as an evidence-based practice and part of a continuum of services we offer to our veterans," she said.

An abstract of the report, "Pilot Study of the Effectiveness of the Family to Family Education Program," is posted on the Web at <http://ps.psychiatryonline.org/cgi/content/full/52/7/965?> ▪

Psychiatric Services 2003 52 965