In May 2026 The Department of Health and Social Care launched a survey asking for evidence to inform the mental health strategy for England.
Making Families Count responded. This is a summary of our survey response.
About Making Families Count
Making Families Count is a Community Interest Company operating in England and Wales. We are comprised of families who have been traumatically bereaved and harmed by suicides and mental health homicides/attempted homicides, and experienced health professionals. We work to turn our trauma into helping to improve mental healthcare.
Question on Hospital to community
The suicide prevention strategy does expect all areas to offer postvention services to families bereaved by suicide to reduce the risk of suicide by the bereaved but not all areas have such support. However, the strategy makes scant reference to families/carers who are caring for suicidal adults at home, and there is a huge gap in support to family carers.
Research and guidance show that supporting, training and enabling health professionals to work with family carers as partners in care keeps people with mental illness safer and assists them to live well.
Similarly, investigations following harm show that when families’ concerns are ignored risk increases; when families are sidelined, failures in care are much more likely.
Given the planned shift from hospital to community, working well with family carers and offering them support and information is critically important.
Providing support and information to family carers can reduce burn out and stress and improve caring ability, which can in turn contribute to reducing their family member’s risk of suicide and homicide. Support to enable tailored local carer support groups to function is important.
A standard of care to work with family carers would help. Such a standard should expect the service to involve and support family carers as partners in the care of their loved one, wherever possible. It should state that families will know how to escalate concerns at any time of day and week; that information sharing will be based on a presumption of involvement, with collaborative safety planning, clear explanations of what can be shared, and a duty to listen to family concerns even where consent is absent.
Question on the further support that should be provided to people with severe and enduring mental illness to
- help them stay well
- maintain participation in education, work and community life
- avoid crisis and/or hospital admission
- reduce length of stay in inpatient units
There are an estimated seven million unpaid carers in the UK, 13% of whom support people with mental health conditions. Data is not available about how many people with severe and enduring mental illness (SMI) live with their family/partner/close friends. And even when they do not share a household the family and friends of people with SMI are involved in providing unpaid care, love and support.
Providing consistent high quality support and information to family carers alongside training clinicians to work well with family carers helps earlier identification of deterioration, enables more robust, dynamic risk management and helps contribute to a reduction in crises, detentions and serious incidents, including avoidable admissions. Improved communication with and inclusion of families as partners in care reduces the risk of missing warning signs that lead to harm and to escalation to emergency services.
HSSIB mental health reviews, the recent NHS Resolution Review of Suicide Settlements and the CQC 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 Review of the Mental Health Act recognised that family involvement improves outcomes; guidance from NICE and the Royal College of Psychiatrists also states the value of involving family in care of people with severe mental illness.
The Mental Health Act reforms including higher thresholds for detention and increased emphasis on community-based care make it even more important to work well with family and friends carers. Family carers spot early signs of deterioration, non-compliance with medications, lack of insight or unusual behaviour. Family carers are more alert to efforts to mask deterioration and working with them can reduce risk and keep people well in their community.
Question on the main barriers to continuity of care across transitions between hospital and community services, and between different levels of care, including child to adult services?
A barrier to seamless transitions is the change in levels of family involvement when a young person transitions form CAMHS to adult services; parents are often excluded from care at this point or soon afterwards. Families should be involved in the transition process, which should start long before the actual service changes, to negotiate and agree how they will continue to support their family member and work collaboratively with the adult mental health team when the transition takes place.
Similarly, when adults transition to different services, for example community to inpatient; team to team; catchment area to different catchment and so on, these services should recognise that the family will be the holders of salient information and have to function as care coordinators as someone moves between services. Therefore, information sharing with families is vital to ensuring continuity of care, including of medication.
Queston on using data to improve mental health and wider societal outcomes
There is very limited and out of date data on the numbers of people with SMI and people struggling with suicidality living with their family (including chosen family) or friends in the community. Reliable data on the numbers of family carers of these adults, and their needs, could help inform service provision and development. It could help to raise the profile of these family carers, which could help to reduce the stigma and the belief of so many family carers that they have to cope alone and that somehow their situation is shameful.
Question on preventative approaches which have the strongest evidence for reducing incidence or severity of mental health problems and promoting good mental health
People who have been brought up in the care system (Care experienced people) are much more likely to experience severe mental illness. Therefore, offering universal and targeted family support is vital. This should include supporting parents whose children have a diagnosis of neurodiversity, and where there are safeguarding concerns, helping families to keep children and young people safely with their wider family – using kinship care, Family Group Conferences, and keeping siblings together. We note that much of this now DfE policy.
We are aware that the waiting times for CAMHS in some parts of the country are excessively long; if these cannot be improved then at the very least parents should be offered information and strategies to help their child and to cope with the challenges of a child experiencing mental health difficulties
Family-inclusive practice has a good evidence base, particularly for people experiencing severe mental illness, crisis presentations, self-harm, psychosis, and suicide risk. Families often identify early signs of deterioration, support treatment adherence, and provide essential emotional and practical support that promotes recovery and prevents relapse.
Evidence highlighted by Making Families Count demonstrates that involving families and carers as partners in care contributes to earlier identification of risk, more effective safety planning, improved communication, and reductions in crises, emergency interventions, avoidable admissions, and serious incidents. National investigations, coroners’ reports, and patient safety reviews repeatedly identify the exclusion of families as a contributory factor in adverse outcomes, including suicide, self-harm, and mental health-related deaths.
Research also shows that structured family interventions and evidence-based models like Open Dialogue can reduce relapse rates, decrease inpatient admissions, improve treatment engagement, enhance social functioning, and improve quality of life. The Open Dialogue collaborative care approach is recommended internationally for people with severe mental illness and psychosis.
Question on which preventative approaches have the strongest evidence for reducing the numbers of lives lost to suicide
Evidence collected by experts at The Centre for Suicide Research, Dept of Psychiatry, University of Oxford suggests that all of the following are needed:
- Postvention support services for people bereaved by suicide/a self-inflicted death who are at higher risk of suicide and who experience very complex grief
- Public health responses to reduce access to means has proven effectiveness for reducing lives lost to suicide.
- Efforts have been made to translate this population level evidence to individual level principles of care through means restriction counselling and safety planning, with an early but growing evidence base indicating that that effective safety planning can reduce suicidal behaviour. Effective safety planning must be feasible and meaningful and the supporters identified in safety planning, generally family members or friends, must be aware of their role and helped/prepared to provide the support needed. Moreover, as highlighted above, evidence shows that family members can contribute essential information to safety planning such as early warning signs and triggers as well as reduction of access to means.
- Research indicates that when psychosocial assessments following self-harm are of a good quality and seen as an intervention rather than a screening exercise, the likelihood of repetition of self-harm can be reduced. Evidence and best practice stipulate the importance of involving family members wherever possible to ensure a holistic and contextual assessment and optimise patient safety.
- There is a dearth of strong evidence based family interventions for adults and their family members that are specific to suicidality, but current research is investigating the effectiveness of Dialectical Behavioural Therapy ( DBT) informed family interventions to support family and friends who support adults.
- Research with family members of suicidal individuals consistently highlights the need for recognition, collaboration and communication, information and education, support and practical guidance, and tailored peer and individual therapeutic support. It is essential for supportive interventions to be coproduced and evaluated.
Question on what commissioning, funding and oversight or accountability arrangements (nationally and locally) best support safe and integrated mental health services that improve outcomes across mental health, participation in work, education and community life, and social functioning
The new NHS Ten Year Plan envisages not just a shift from hospital to community but also a shift in power, giving more agency to patients, and by extension, to their carers. This will only work if the care provided is relational rather than transactional. Systems can support or impede relational care.
Impediments include
- Seeking consent to information sharing as an immediate system requirement on admission, (and therefore by definition very vulnerable) instead of as part of a wider and ongoing conversation with a patient on admission, as part of a psychosocial assessment, and ongoing as part of care and safety planning and review.
- Failure to build authentic personal relationships with patients and with their family carers, and instead insisting on using systems without any attempt to humanise them. Records need to be completed but they can be done in a relational way. Small gestures make a big difference: asking people what they want to be called, how to pronounce their names, finding out how they understand and follow their religious or spiritual beliefs rather than making assumptions, asking family and friends how they are
- Insistence that Crisis Helplines can only speak to the patient and require the patient’s permission before they can speak to a family carer
- Insisting that staff comply with GDPR without exploring what this means for information sharing, and failing to ensure staff know they will be supported when they decide to break confidentiality because they need to protect the safety of their patients, or their family carer, or the public.
Instead, embracing nuance, building trust and offering management, supervision and training that is reflective, that empowers clinicians to feel safe and supported to use their judgement when working with patients and their family carers.