Current Practices and Barriers of Family-focused Care of Patients with Severe Mental Illness and Their Children: A Survey Among Czech Psychologists and Psychiatrists
Published Online: Aug 23, 2025
Page range: 103 - 116
DOI: https://doi.org/10.2478/sjcapp-2025-0010
Keywords
© 2025 Anna Havelková et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
FIGURE 1:
Organizational and systematic barriers in involving children (1 - agree to 5 - disagree)
| Mean | SD | |
| Operational factors at my facility do not allow involving children in treatment. | 3.22 | 1.46 |
| Reimbursement of these services from insurance companies is problematic | 2.89 | 1.48 |
| Insufficient time for inviting children. | 2.64 | 1.29 |
| Insufficient physical space to work with the family. | 3,49 | 1.39 |
| Lack of appropriate programs and procedures for working with families. | 2.62 | 1.37 |
Questionnaire topics
| Topic | Content | Item example | Number of questions |
|---|---|---|---|
| Demographic and work characteristics | Gender, age, profession, type of medical facility (inpatient, outpatient…), length of experience, psychotherapeutic education, parenthood |
In what type of facility do you work with patients with SMI? Are you a parent? |
10 |
| Current practice | Routines of identification of parental status, frequency, and ways of instructing adult patients on how to educate children about SMI, involvement of family members in the treatment, professional awareness of available services, and materials. |
In the following questions, think of your typical practice and select the most suitable option on the following scale: Always – 75 – 100 % of cases Often – 50 – 75 % of cases Sometimes – 25 – 50 % of cases Rarely – 5 – 25 % of cases Never – 0 % of cases - How often do you purposefully ask your clients with SMI if they have children? |
11 |
| Personal attitudes | Attitudes toward the involvement of minor children in treatment, discussing parenting in adult patient’s treatment, the ability to practice a family-oriented approach, family-focused policy |
What do you think of involving minor children in the treatment? (5-point Lickert scale agree/disagree) - It’s helpful. - It’s not appropriate for a child. - It’s not appropriate for the patient. - It can prevent the development of problems in the child. - This increases the likelihood of improvement in the patient’s condition. |
3 |
| Perceived professional, systemic and organizational barriers | Skills and knowledge, concerns about a therapeutic alliance, insecurity, reasons to not invite a child into parent’s treatment, systemic and organisational barriers |
What are the barriers to involving minor children in your work with a client? (5-point Lickert scale agree/disagree) - I don’t have enough experience to involve children. - I don’t have the appropriate training to involve children. - If I involve a patient’s child in my practice, I would be assuming too much responsibility, as it is beyond my role. - I feel uncertain about working with my patients’ children. - Involving children is outside my area of expertise. |
7 |
| Recommendations for practice | Improvement recommendations for provision of support/professional support to COPMI |
Select the level to which you agree with the following statements. (5-point Lickert scale agree/disagree) - The current system is adequate regarding care of psychiatric patient’s children - I would welcome better support for children of parents with SMI |
3 |
Attitude subscales (1 - agree to 5 - disagree)
| Mean | SD | |
|---|---|---|
| Subscale |
||
| Serious mental illness of a parent always has negative psychosocial effects on children | 2.41 | 1.10 |
| Minor children of parents with SMI are at increased risk of developing psychological or other difficulties | 1.80 | 0.81 |
| Subscale |
||
| It’s helpful. | 1.93 | 0.92 |
| It’s not appropriate for a child. | 3.88 | 1.17 |
| It’s not appropriate for the patient. | 3.80 | 1.02 |
| It can prevent the development of problems in the child. | 2.44 | 1.01 |
| This increases the likelihood of improvement in the patient’s condition. | 2.33 | 0.88 |
| Involving children could impair the patient’s condition. | 3.88 | 0.88 |
| I don’t work with my patients’ children because they’re not mature enough. | 3.56 | 1.77 |
Barriers subscales (1 - agree to 5 - disagree)
| Mean | SD | |
|---|---|---|
| Subscale |
||
| I can assess how my patients can provide day-to-day care for children. | 2.16 | 0.86 |
| I can counsel patients on how they can talk to their children about SMI. | 1.83 | 0.84 |
| I can discuss the topic of parenting with patients easily. | 1.41 | 0.71 |
| Subscale |
||
| I don’t bring up parenting issues because it interferes with the therapeutic relationship. | 4.39 | 0.78 |
| Dealing with parental issues would place an additional and excessive burden on the patient. | 4.09 | 0.87 |
| There is not enough time for parenting issues in the session. | 3.97 | 1.15 |
| Involving children could impair the therapeutic rapport with the patient | 3.72 | 1.03 |
| Subscale |
||
| I don’t have enough experience to involve children. | 2.58 | 1.37 |
| I don’t have the appropriate training to involve children. | 3.10 | 1.33 |
| If I involve a patient’s child in my practice, I would be assuming too much responsibility, as it is beyond my role. | 3.19 | 1.93 |
| I feel uncertain about working with my patients’ children. | 3.32 | 1.27 |
| Involving children is outside my area of expertise. | 3.58 | 1.29 |
Descriptive statistics of demographic variables (N = 193)
| N | (% of the sample) | |
|---|---|---|
| Gender | ||
| Female | 145 | (75.1) |
| Male | 48 | (24.9) |
| Profession | ||
| Psychiatrist | 100 | (51.8) |
| Clinical psychologist | 73 | (37.8) |
| Psychologist in healthcare | 20 | (10.4) |
| Age category (years) | ||
| <30 | 14 | (7.3) |
| 31–40 | 40 | (20.7) |
| 41–50 | 72 | (37.3) |
| 51–60 | 42 | (21.8) |
| >60 | 25 | (13.0) |
| Type of medical facility | ||
| Inpatient psychiatry | 49 | (25.4) |
| Outpatient psychiatry | 57 | (29.5) |
| Outpatient Clinical Psychology | 56 | (29.0) |
| Private practice | 18 | (9.3) |
| Other (mental health centres, day-care centres, employed in several facilities) | 13 | (6.8) |
| Years of experience (years) | ||
| 0–5 | 15 | (7.8) |
| 5–10 | 27 | (14.0) |
| 10–20 | 47 | (24.4) |
| 20 and more | 104 | (53.9) |
| Psychotherapeutic training | ||
| Yes | 160 | (82.9) |
| No | 33 | (17.1) |
| Parenthood | ||
| Parent | 149 | (77.2) |
| Non parent | 44 | (22.8) |
Why has the child not been invited to a joint meeting with you? (N=142; multiple choice)
| N | % | |
|---|---|---|
| It is not my area of expertise. | 51 | 35.9% |
| I had not thought of that. | 41 | 28.9% |
| The parents disagreed with my suggestion to bring the child in for counselling. | 27 | 19.0% |
| I am not trained/educated/competent to work with children. | 26 | 18.3% |
| I do not consider it appropriate. | 22 | 15.5% |
| I do not have the time capacity for this. | 20 | 14.1% |
| Due to policies of the organization (workplace). | 16 | 11.3% |
| I am referring the child to a child specialist. | 10 | 7.0% |
| There was no reason/possibility/opportunity. | 10 | 7.0% |
| The initiative should come from the patient. | 9 | 6.3% |
| The child was too young/the offspring was an adult. | 5 | 3.5% |