The important roles of families in the lives of adults with serious mental illnesses are well documented. In fulfilling care-giving roles, families are typical of people coping with stressful circumstances in that they need information and support. When clinical services failed to meet the needs of families, peer- and community-based programs emerged. These programs incorporate elements of self-help, empowerment, trauma recovery, stress and coping theories, as well as mutual assistance models and are primarily focused on helping family members, not improving consumer outcomes. Family self-help programs are widely disseminated, are very popular among their participants and receive modest financial support from state and municipal mental health authorities. But this dissemination was not preceded by scientific evidence that they achieve their goals. It is this gap in knowledge that our project is proposing to remedy. By far the most common such program is the National Alliance for the Mentally Ill's Family-to-Family Education Program (often abbreviated FTP): a 12-week class with a highly-structured standardized curriculum, developed and conducted by trained family members. It provides education about mental illness, emotional and practical support, and problem solving and communication skills. In collaboration with FTP creator, Joyce Burland, we have conducted two independent pilot studies demonstrating that FTP is effective for reducing participants' self-reported subjective burden and depression and increasing their empowerment. We now propose a randomized trial comparing individuals who completed a three-month FTP class to individuals referred to the usual community resources. At the same time that we are evaluating family member outcomes, this study provides an opportunity to evaluate the potential benefit that FTP has for consumers. Guided by a stress-coping framework, we hypothesize that FTP participants will have increased problem- and emotion-focused coping activities, reduced depression, distress, and subjective illness burden and that FTP benefits will be retained six months after FTP program completion. Secondarily, we hypothesize that consumers in families of FTP participants will have improved outcomes. A total of 392 family member participants will be recruited in four Maryland counties over 28 different classes, producing approximately 150 persons in each study condition after accounting for study attrition. In the course of creating a randomized trial evaluation of the FTP program, we have had to balance scientific rigor with real-life practical and ethical concerns on a number of issues, creating certain methodological limitations. Nevertheless, the academic/consumer partnership represented by this study is critical to creating a health care system that is both consumer and family driven, and also based on scientific evidence.
