For families with a loved one living with schizophrenia or another serious mental health issue, navigating support and finding the right care can be challenging. CMHA Toronto is piloting a new approach to help families tackle what is most often a long-term and complex situation that can affect every area of family life. Family Intervention Therapy (FIT) includes the client and their immediate loved ones in a process that teaches new ways of communicating and relating that help people move forward together.  

FIT is a good fit at CMHA Toronto. Not only does it align with Ontario Health’s initiative to improve outcomes for individuals living with schizophrenia, but it also meets the agency’s goal to expand family work across different programs, says Dimple Mehta, Manager of Family Outreach and Response and the Healthy Families program. Dimple, along with Antonio Gordinho, clinical lead of CMHA Toronto’s Transitional Rehabilitation Housing Program Site 1, have been trained in the FIT methodology. Each is currently working with a family to test drive FIT and determine how to introduce it to the rest of CMHA Toronto’s clinical team.  

The core premise of Family Intervention Therapy is that the mental health and behaviour of one family member can have profound implications for the entire family system and vice versa. FIT, developed in the U.K., involves a range of strategies and techniques designed to enhance communication, resolve conflicts, and foster a healthier family environment.  

Highly structured and psycho-educational, group sessions take place weekly over 12 to 14 weeks. FIT’s goal is to help improve communication in the family system, says Dimple. The therapy focuses on teaching four practical communication skills: expressing pleasant feelings, making a positive request, active listening, and expressing difficult feelings. It also covers problem-solving and wellness planning, giving families tools to identify early signs of mental health crises and strategies to manage them together.  

FIT sessions help families recognize and break down entrenched dynamics that may have developed over years. “This is not a family that had a difficult time last week,” Antonio explains. “This is a family that probably has navigated these patterns for years.”   

Even so, unlike some other therapeutic approaches, FIT is not used to raise or hash out past resentments or difficulties. “It's very ‘in-the-present’,” says Antonio. “Part of the finesse for people who provide [this therapy] is how to support people to come into the here-and-now and continue to move forward. If we can improve communication, then we're more likely to have better outcomes in terms of family dynamics and functions.” 

For Antonio, who has an extensive background working with families in the area of addictions, he values the way the program de-emphasizes the individual with the mental health issue as the central figure in the family dynamic. “Quite often, the person in question is the focal point of everything. They live with the illness, the behaviours are manifested by them, the impact on [others] is a result of that. It can feel really daunting and overwhelming, like it's the responsibility that they carry on their own. One of the beauties of this approach is that it de-emphasizes the individual as the problem,” Antonio says. 

Taking the focus off the person who is directly experiencing the mental health issue allows each member of the family to forge new ways forward both individually and as a team. Each person is having their own mental health experience – stress, fatigue, exhaustion, hopelessness, depression – which affects how they function in the family. “Without interruption, that'll just continue to create division and make what was already stuck perhaps even more stuck,” says Antonio. FIT helps promote connection and helps every member of the family “consider, reconsider, seek new perspectives, give things a try. It really balances the recovery journey,” he adds. 

Dimple and Antonio were trained by the U.K.-based Meriden Family Program in collaboration with Ontario Shores.  

While initially designed for families of people with schizophrenia, FIT’s communication skills training, problem-solving focus, and wellness planning can benefit any family managing mental health issues. 

Dimple says that when identifying families who might be eligible to participate, they cast a wide net. “Because it’s such a unique population being targeted, within our agency we're expanding to other individuals who have mental health concerns, but not necessarily psychosis or schizophrenia,” she explains. The family she is working with has a loved one experiencing schizophrenia; Antonio is working with a family where the issue is depression, anxiety, and ADHD.   

Both families are about half-way through the program. When we spoke with Antonio, he reported that the family he was working with had been assigned the task of having their own independent family meeting to practice some of the skills they had learned. Since then, the family has “made an effort to communicate more and with more mindfulness [and said that] their overall communication was less stressful. It’s really interesting that the three of them are all eager and excited to continue, they’re invested,” Antonio says. 

The aim is for Dimple and Antonio to train other CMHA Toronto staff following a train-the-trainer model, so that FIT can be available across many different program areas. An information session is planned for December, and once training materials are prepared, Dimple is hopeful they’ll be able to begin training staff in February 2025.   

Clinicians seeking FIT training must be professionals registered with an accrediting college such the College of Social Workers, the College of Registered Psychotherapists of Ontario, or the College of Nurses of Ontario.  

Stay tuned for more as the roll-out progresses or feel free to contact us at info@cmhato.org.