The Evidence
There are an estimated seven million unpaid carers in the UK, 13% of whom support people with mental health conditions. Working with family carers as partners in care, instead of bystander, supports earlier identification of deterioration, enables more robust, dynamic risk management and helps to contribute to a reduction in crises, detentions and serious incidents, including avoidable admissions. Improved communication with and inclusion of families reduces the risk of missing warning signs that can lead to harm and to escalation to emergency services.
Of course family relationships can sometimes be complex and not all involvement from everyone in the family is always appropriate or beneficial; however, national investigations repeatedly identify failures to work collaboratively with supportive family members as a significant patient safety issue
Evidence includes findings from bereaved families, patient safety investigations, Coroners’ Prevention of Future Death reports, and national inquiries which consistently identify failures of communication, relational practice, decision-making about confidentiality and sharing information, and lack of collaborative safety planning and family involvement as significant contributory factors in suicide and self-inflicted deaths, mental health homicides and serious harm.
Similarly, the CQC Special Reviews HSSIB mental health reviews and NHSE Independent Investigation into the care and treatment of Valdo Calocane, consistently find that families are excluded from care planning conversations, and left unsupported – leading to missed early warning signs, poor risk management and people “falling through the gaps”. The Wessely Review recognised that family involvement improves outcomes and guidance from NICE and the Royal College of Psychiatrists also states the value of involving family in care of people with severe mental illness.
Some of the evidence includes:
Making Families Count: Listening to Families Report, May 2026
Self-harm: assessment, management and preventing recurrence, NICE guideline, Reference number:NG225, Published: 07 September 2022
https://www.nice.org.uk/guidance/ng225/chapter/Recommendations#involving-family-members-and-carers
‘Assessment of suicide risk in mental health practice: shifting from prediction to therapeutic assessment, formulation, and risk management’,
Prof Keith Hawton, FMedSci Karen Lascelles, MSc∙ Alexandra Pitman, PhDc, ∙ Steve Gilbert, MAe ∙ Morton Silverman, MDf
The Lancet Psychiatry, Personal View Volume 9, Issue 11p922-928November 2022
Independent Review of the Menal Health Act 2018
https://www.gov.uk/government/groups/independent-review-of-the-mental-health-act
NHS England Independent mental health homicide report into the treatment of Valdo Colocane, Feb 2025
CQC final part of special review of mental health services at Nottinghamshire Healthcare NHS Foundation Trust, Aug 2025
HSSIB Investigation report Mental health inpatient settings: overarching report of investigations directed by the Secretary of State for Health and Social Care, May 2025
HSSIB Investigation Report 1 Mental health crisis care: legislative challenges in emergency departments, April 2026
Making Families Count work
Free eLearning resources
Life Beyond the Cubicle is a free to use, evidence-informed eLearning intervention developed by Making Families Count and Oxford NHS Foundation Trust. The intervention improves how clinicians in mental health and emergency care settings work with families, carers and friends during periods of acute mental health crisis.
The resources consist of a set of six interactive digital learning modules and a practical training guide designed for clinicians working in emergency departments, liaison psychiatry, crisis services, inpatient care and community mental health services. The programme encourages professionals to move “beyond the cubicle” model of isolated clinician-patient interaction and adopt a relational, family-inclusive, curious, compassionate and safety-focused approach to care.
The learning focuses on:
- improving understanding and lawful application of confidentiality and information sharing;
- involving families and carers as partners in care and safety planning where possible;
- recognising family and carer insight as clinically valuable information;
- strengthening compassionate communication during crisis presentations;
The learning is grounded in lived experience, co-production and patient safety principles. It integrates testimony from bereaved families, clinicians and experts by experience/service users alongside practical case scenarios and reflective exercises.
The intervention aligns strongly with current NHS priorities on patient safety, suicide prevention, person-centred care, reduction of restrictive practice and continuity of care.
This learning helps clinicians to readdress the power imbalance when family carers are seen as external to the team and formal decision-making processes. Family carers hold unique insights and information into their loved one which are crucial to support safety, personalised care and recovery from crisis.
Access the resources here
‹https://learninghub.nhs.uk/catalogue/lifebeyondthecubicle
Bespoke Consultancy and Training
We work with organisations to address the blocks to involving family carers as partners in care, and to learn from investigations into harm, including Coroners Prevention of Deaths reports and HSSIB findings and recommendations.
We work with harmed families, clinicians and leaders of organisations to address the significant but frequently overlooked patient safety issue within mental health care: the exclusion of families and carers from crisis response and safety planning due to cultural, systemic and organisational barriers.
We work with organisations to support them to shift from transactional crisis management toward compassionate, collaborative and preventative care. We support organisational culture change and the reduction of avoidable harm in mental healthcare services.
We understand that family-inclusive practice requires cultural as well as procedural change. Training alone is insufficient unless supported by leadership, reflective supervision and psychologically safe organisational cultures. We help organisations to embed these dimensions into their structures and culture.
Contact us to discuss how we might help.