Table 6.

Theme three: How organisations can promote effective family involvement

Subtheme	Data extract number	Quotations
Offering flexible appointments	16	‘You’ve got family members who’ve got to take time off work to support individuals who have struggled with crisis and obviously you’ve got the loss of income from that then and it’s like a snowball effect with some people isn’t it, like family involvement, it's what their involvement is, the knock on effect of that, you know’ (H4S2 – staff)
	17	‘I mean I wouldn’t necessarily change the times of the visit so that the family could be present because of the nature of what we’re doing and the risk for that patient but I would certainly speak to them’ (H1S1 – staff)
Improving communication between crisis services and carers	18	‘Even when the lady came I thought she might speak to me, but she didn't speak to me. She just saw my husband, then she left. [Interviewer: “OK, do you know if they left any information about if you needed to get back in touch with them at all or…”] I don’t know if they have left it with [patient] but I didn't see any. He told me that “I am discharged now”, he only told me’ (F2S1 – carer, partner)
	19	‘I felt shut out actually and I didn’t know what was going on and even though it was so hard to hear what she was saying and it was upsetting, I was aware of what she was thinking whereas I didn't know what she was thinking when she went on her own, do you know what I mean’ (F2S2 – carer, mother)
	20	‘Yeah, I mean like they do say to call the urgent care hub, but from like my experience they don't take referrals from family members, like they kind of talk to them on the phone and say like we're not taking referrals until we speak to the patient and get their consent, but then it adds to anxiety on discharge – if something were to happen what would I do then?’ (H5S2 – staff)
	21	‘Just a bit more how we could support her more, in whatever way that is, you know. Because if I saw her a bit quiet, I would talk more, but sometimes you just need not to talk as well to her, so there's that as well but it's just, for us to help her cope and how to help her, you know we can think ourselves a little bit, but are we saying the right things because I think that's the most important thing, because I know I wouldn't say anything negative to her, because I know that wouldn't be what you should do, but it's what, how or even how to say or what to say that would be best for her, that's what I felt. We were struggling with things of how we can do it’ (F6S1 – carer, mother)
	22	‘If I hadn’t have been with my family or if I hadn’t been mentally where I am at the moment then do I think my chances are of still being here, I doubt it. You know what, that would have been blood on my hands. I've always said I take responsibility for things but I don't take responsibility for a system that is just, there are so many people who have lost their lives and even [nurse] said it, she said “I've seen people fall through these cracks” – it's not even a crack. There's no net or anything’ (P2S2 – patient)
	23	‘I’ve noticed a lot more calls from family members actually ringing us for updates or saying “Can I discuss this with you?” or “Can you make a note of this?” and I don't think there's been prior to COVID that many calls from family members trying to actively link in with us in between visits’ (H2S2 – staff)
Improve information provision and signposting for carers	24	‘When I started in crisis resolution and home treatment [CRHT] I had absolutely no idea on what services and our role is signposting on to other services because our main role is prevention, um, so actually when I first started I took time in my day to research what services were near me and to find out about the befriending service, and [name] and some of the service users I come across will tell me about groups they go to and I try to keep that information. Some information has come through other colleagues that have been community-based for 20 years and I have a little app on my phone which I share with all the service users which tells you about what's on in the local area’ (H7S2 – staff)
	25	‘They left me a leaflet to go to these once every few weeks on a Wednesday. I can't remember what it's called now, it's just for people, like the partners, who have been through or going through. It just gives you a bit of an hour, you know, coffee, to speak to some other people’ (F4S1 – carer, partner)
	26	‘I would tend to just go online and find some easy-to-understand information, ’cause everybody Googles don't they, and it makes it worse ’cause then I'll get a family member who'll say “I looked online last night about this and have they got that as well, why you giving them that medication?”’ (H1S1 – staff)
Train and support staff to effectively involve families	27	‘I think it’s harder if there’s conflict and they’re saying “Don’t tell my mum about this”, so I think there is always benefit in training around conflict in families and confidentiality because it's a minefield isn't it? I suppose it would be helpful to have an idea how to manage that and what solutions can be found because to be honest I think most of us, like, wing it’ (H3S2 – staff)
	28	‘It’s kind of talked about as a bit of a buzz word isn’t it, like family involvement and carer involvement, but I don't feel like there's ever any actual training in it, you just like learn it on the job. I don't think there's any specific training on, like, when it's a good idea to, when it's not a good idea to engage people, you know, family members and stuff. I remember when I went on the ward I was like a champion for carers like. [I] had only been qualified about 6 months. It was just like they need a name to put on the board for like the champion – you didn't have any specific training or anything’ (H5S2 – staff)
	29	‘A monthly meeting where the community staff get together with a psychologist, because that used to be really beneficial because you'd come away from that meeting and go, yeah, next time she does that I'm not going to react the way I did because we're all human aren't we?… Well, actually being able to break it down and understand why they're doing it, you then respond to them better’ (H1S1 – staff)

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