[Contextual psychiatry: a re-evaluation focusing on family system therapy]

Mental health services are currently in a state of flux and psychiatry is being affected by cost-cutting measures and is seeking a new direction. In this article we advocate the re-evaluation of contextual psychiatry. We focus primarily on the position of caregivers in view of the Dutch government's political decision that mental health care problems should, if at all possible, be solved in the intimacy of the family, involving care givers and family members. This decision has put these people, who are already over-burdened, under extra pressure if they do not receive additional support.

To analyse the causes of the restricted influence of systemic insights in psychiatry and to make recommendations regarding the need for the re-evaluation of contextual psychiatry, in order to further the dialogue between the triad professional, patient and caregiver.

Our article consists of a qualitative review and our analysis, opinions and recommendations.

Caregivers feel that they do not receive enough attention. Professionals feel uncomfortable in dialogues with patients and caregivers because of issues such as loyalty, divided allegiance and the need for privacy. There are sufficient arguments to support the integration of systemic therapy into general psychiatric practice.

Caregivers are essential partners for supplying information and support during the process of change. They deserve to be supported so that they do not become even more over-burdened. We advocate the re-unification of psychiatry, family policy and family therapy, more collaboration between the Dutch Association of Psychiatry and the Dutch Association of Family therapy and the introduction of new sections into existing teaching courses.