Table 1.

Topics/strategies recommended to be addressed with persons with SMI and/or their family members to prevent family conflict and violence

Mutual understanding •Support family members and persons with SMI sharing with each other (as they feel comfortable) their perceptions & experiences regarding incidents of conflict and aggression •Support parties in considering each other’s perspectives/experiences, possibly utilizing role-plays and/or mental imagery Resource for additional information: Substance Abuse and Mental Health Services Administration ([SAMHSA] 2009)

Positive communication •Educate family members on enhanced sensitivity to verbal stimulation among many persons with SMI •Reframe possible hostility, criticism, and emotional overinvolvement as feelings of frustration and helplessness •Support parties in conveying warmth, positive regard, and appreciation •Support parties in communicating in a calm manner; expressing feelings with “I messages”; providing brief explanations as to why feelings are experienced; describing observations matter-of-factly; and making clear, specific requests focused on desired actions Resources for additional information: Kolko et al. (2011); Interpersonal Effectiveness modules of Linehan (2014); SAMHSA (2009); Wexler (2020)

Effective problem-solving •Educate parties on structured problem-solving process •Assist family members in classifying problem behaviors as “annoying” vs. “dangerous” and, possibly, reevaluating expectations of their relative with SMI •Supporting family members in rewarding desired behaviors and calibrating punishments in response to severity of the problem •Engage parties in participating in the structured problem-solving process related to family concerns, in and outside of treatment services Resource for additional information: Kolko et al. (2011); SAMHSA (2009)

Psychiatric symptoms and crises •Educate parties on common psychiatric and other illness-related symptoms •Support parties in accessing local treatment services, especially those corresponding to specific symptoms present in persons with SMI that may increase risk of violence (e.g. substance use treatment, Social Cognition Training, Cognitive Behavioral Therapy for psychosis) •Aid parties in identifying early warning signs of psychiatric crises •Assist parties in creating a psychiatric crisis management plan, possibly including a psychiatric advance directive Resources for additional information: SAMHSA, 2009, 2019

Triggers and early warning signs of anger and conflict •Educate parties on the cognitive-behavioral model of problematic behaviors (including role of cues and cognitions) •Solicit perceptions from parties regarding triggers and early warning signs of anger and conflict •Educate parties on common triggers and warning signs of anger and conflict Resources for additional information: Kolko et al. (2011); Chain Analysis of Problem Behaviors modules of Linehan (2014); Reilly et al. (2019); Wexler (2020)

De-escalating conflict and managing violent behavior •Solicit perceptions from parties regarding effective de-escalation strategies within the cognitive-behavioral model of problematic behaviors •Reinforce opportunities for de-escalation •Educate parties on strategies commonly recommended for preventing and de-escalating conflict •Inform parties of local resources to manage violent behavior (e.g. CIT trained officers and mobile crisis and domestic violence advocate services) •Assist parties in creating a written conflict management plan, including -Coping strategies to be used to remain calm when experiencing triggers to anger and violence -Support persons to contact to help manage conflict/violence -Support persons to NOT contact, who may enflame conflict/violence -When to contact the police vs. alternative professionals (e.g. crisis psychiatric services) -Agreement of consequences to future violence Resources for additional information: Kolko et al. (2011); Chain Analysis of Problem Behaviors modules of Linehan (2014); Reilly et al. (2019); Wexler (2020)