Table 5.

Theme two: Challenges of involving families when delivering a home-based service

Subtheme	Data extract number	Quotations
Absence of a supportive family environment	8	‘I don’t know, there's the dysfunctional families, the drug and alcohol situations, what families are up to, are they getting wasted around. There can be a language barrier as well sometimes when English isn't their first language, and mum or dad are trying to interject but there's a language barrier, err, I don't know, I think we do OK really, there are obviously like I say, it's the dynamics when you walk in the room, and then if it's right I'm getting a bad vibe about this or, and then you respond accordingly’ (H3S1 – staff)
Navigating consent	9	‘Husband met us at the door and showed us to the living room where patient and daughter was. Nothing was explicitly discussed about consent for them to be involved and info sharing, but patient probably didn't have much capacity anyway. Also, this was probably dealt with on earlier calls. They are clearly very involved’ (Observation of routine appointment with staff – H1S1)
	10	‘Both yeah, the HTT [home treatment team] asked first and then my mum and dad were like “Yeah, I literally was just going to say that” and then they asked me as well, ’cause first I wasn't actually sure but then if I say yeah then obviously there's gonna be certain things I'm not going to want to talk about and I'm not going to get the right help, so, yeah, the HTT did ask first and then my parents asked me’ (P6S1 – patient)
	11	‘So I suppose for a lot of people it may be that the family are present before they’re even referred to us. For the people that go to A&E [accident and emergency department] a lot of the time they're actually brought there by their family, a lot of the history is taken from the family and then the contact numbers and the details and in terms of how involved they are and the consent gained at that point, so when they then get referred to us we've got a bit of an idea then’ (H6S1 – staff)
Creating space for patients to disclose	12	‘Patient had come to the centre with her boyfriend but chose to come to the consultation alone. Her thoughts changed from not wanting to be here to actual thoughts of killing herself. This was the first time she had experienced these types of thoughts and they distressed her…. We talked about keeping safe and how to distract using mindfulness techniques and activity’ (P6S1 – case notes)
	13	‘Wife answered door and showed us to living room where children was, staff asked if we could talk away from children – which meant that wife could not attend. […] During assessment staff asked if the patient was happy for her to share info with wife – so, if she wants to call the service and ask’ (Observation assessment appointment with staff – H2S1)
	14	‘And I think at the beginning I think it should be, well I don't know if it should be, but I feel it would've been good for us and for her really. Maybe have time out so she can say things without us, which obviously she might not want to say in front of us so that's important but also I think it's important that you can help her say it is, how she's feeling, or give examples of situations that’ (F6S1 – carer, mother)
	15	‘When I’ve been assessed like alone in the crisis team it’s resulted in a better outcome because I’m like more honest and I think sometimes like my mum might take that the wrong way sometimes coming from me so it’s better to come from the staff I feel like. Then it doesn't put the pressure on me to be like ‘‘oh can you not be here for this’ (P1S2 – patient)

F, family member; H, healthcare professional; P, patient; S1, research site one; S2, research site two.