Table 4 Value and barriers of involving a relative in relapse prevention for relatives, service users and care coordinators

Value

• Increases understanding of bipolar disorder, triggers and EWS

• Gives relatives a role - empowering

• Recognize need to seek help earlier - important in a crisis

• Improves relationship with service users

• Improves relationship with mental health services

• Provide insight into triggers and EWS

• Another 'pair of eyes' to recognize EWS and triggers

• Increased support during a crisis

• Improves relationship with relative

• Provide insight into triggers and EWS

• Another 'pair of eyes' to monitor service user

• Improves contact during a crisis

• Improves relationship with relative

Barriers

• Conflict with work and other commitments

• No suitable relative to take part

• Not wanting to intrude on relationship between Service User and Care coordinator

• Want to keep illness and issues private from family

• Want to keep family issues private from CC

• Did not want to burden family members

• Fear increased monitoring will lead to increase misattribution of normal emotions and behaviors

• Concern over placing relatives in position of power

• Families were a source of stress and trigger to relapse

• Relationship with CC is exclusive from relatives

• Takes longer

• Informal increase of caseload

• Have to maintain confidentiality of service user

• Difficulty dealing with family dynamic within sessions

• Unconfident as therapists