Original Article Informal caregivers in early psychosis: evaluation of need for psychosocial intervention and unresolved grief John Mulligan, 1 William Sellwood, 2 Graeme S. Reid, 3 Suzanne Riddell 4 and Natasha Andy 5 1 Greater Manchester West NHS Trust, Manchester, 2 Institute of Psychology, Health and Society, University of Liverpool, Liverpool, 3 Lancashire Care NHS Foundation Trust/University of Lancaster, 4 Cheshire and Wirral Partnership NHS Foundation Trust, Chester, and 5 Calderstones Partnership NHS Foundation Trust, Lancashire, UK Corresponding author: Dr John Mulligan, Psychosis Research Unit, Greater Manchester West NHS Trust, Harrop House, Bury New Road, Prestwich, Manchester M25 3BL, UK. Email: john.mulligan@gmw.nhs.uk Received 4 August 2011; accepted 3 March 2012 Abstract Aim: Relatives of service users involved with Early Intervention in Psychosis services often experience substantial distress and need associ- ated with their role as caregivers. This study adapted versions of the Rela- tives Cardinal Needs Schedule and the Texas Inventory of Grief and tested their utility for use among rela- tives of service users experiencing a first episode of psychosis. Methods: Staff, service users and rela- tives were consulted and a pilot took place which facilitated the creation of the Relatives’ Urgent Needs Schedule – Early Intervention version (RUNS- EI) and the Texas Inventory of Grief – Early Intervention version (TIG-EI). Thirty service user-caregiver dyads were recruited for the evaluation of reliability and validity. Results: The level of ‘urgent need’ identified by the RUNS-EI demonstrated good concurrent valid- ity with measures of service user social and global functioning as well as measures assessing relatives’ dis- tress, expressed emotion and grief. The measure demonstrated accept- able interrater and test–retest reliabil- ity. The profile of need is reported. The TIG-EI demonstrated ‘excellent’ internal consistency. It also demon- strated good concurrent validity with increased TIG-EI scores correlated with reduced service user social and global functioning as well as increased scores on measures assess- ing relatives’ distress, expressed emotion and caregiving needs. Conclusions: Results appear to support these assessments’ utility as measures of need for psychosocial intervention and grief among rela- tives supporting service users experi- encing a first episode of psychosis. Key words: early intervention in psychosis, informal caregiver, need, relative, unresolved grief. INTRODUCTION Caregivers play a crucial role within mental health systems, but their contribution is often underval- ued. 1 Unpaid caregivers save the Australian, British and American health and social care systems approximately $30.5, 2 £119 3 and $375 4 billion per annum, respectively. Proximity to and familiarity with service users ensure relatives are often best placed to facilitate early assistance and support sus- tained engagement, greater accommodation stabil- ity, improved social role functioning and use of medication. 5–10 Such proximity is not without cost as 29–60% of relatives have been demonstrated to suffer from significant psychological distress. 11 The consequences of excessive burden and stress can impact on the psychological well-being of both service users and relatives. 12 The link between stress and deterioration in mental health has been exam- ined extensively within the context of the family atmosphere, with particular focus on the concept of ‘Expressed Emotion’ (EE). 13 Incorporating critical comments (CCs), emotional over-involvement (EOI) and hostility, EE is commonly used as a Early Intervention in Psychiatry 2012; ••: ••–•• doi:10.1111/j.1751-7893.2012.00369.x First Impact Factor released in June 2010 and now listed in MEDLINE! © 2012 Blackwell Publishing Asia Pty Ltd 1