Soc Psychiatry Psychiatr Epidemiol (1995) 30:261-268 9 Springer-Verlag 1995 A.N. Karanci Caregivers of Turkish schizophrenic patients: causal attributions, burdens and attitudes to help from the health professionals Accepted: 10 January 1995 Abstract The purpose of this study was to examine the causal attributions, difficulties, perceived and expected help behaviour of health care professionals, and hope for the future well-being of the caregivers of Turkish schizophrenic patients in order to form guidelines for forming a collaboration with the families of schizo- phrenic patients. Sixty caregivers were interviewed by using a semi-structured interview schedule. The re- sponses of the caregivers were categorize d within the guidelines of the literature in this area. The caregivers attributed schizophrenia mainly to psychosocial causes, namely stressful events (50%), family conflicts (40%) and patients' characteristics (28%). The most frequently reported difficulties were family conflicts and disruptions of family life (57%), subjective burden (48%) and financial costs due to the patient (27%). The number of difficulties reported by caregivers was re- lated to the duration of the patient's illness. Caregivers perceived pharmacological treatment (42%), interest and support given to the caregiver (28%), and the hospitalization of the patient (20%) as helpful. Their expectations of help were in similar areas. About half of the caregivers were optimistic about the future well- being of their relatives. Optimistic and pessimistic caregivers differed in the educational level of the caregiver and the duration of the patient's illness. The results suggested that the families of schizophrenics need the support of professionals and the establishment of networks focusing on the caregivers and their rela- tionships with their ill relatives and with health care institutions. A.N. Karanci Department of Psychology, Middle East Technical University ODTU, Ankara 06531, Turkey Introduction In recent years, due to the trend towards community- based mental health services, collaboration between mental health professionals and the caregivers of schizophrenic patients on the basis of equity and part- nership has been emphasized (Hathfield 1987; Kuipers 1992; Zipple and Spaniol 1987). In order to form con- structive alliances between families and the profes- sionals we need to understand the needs and burdens of the relatives, their expectations from mental health professionals and their conceptualizations of the illness. Smith and Birchwood (1990) have stressed that an effective service for families should be led by need and should ensure that family needs are understood and responded to sympathetically. It has been shown that the families and the professionals do not agree on the educational needs of families and on perceptions of behaviours of the mentally ill relative that are bother- some for the families (McElroy 1987). McElroy (1987) has reported that families want information on psycho- tropic drugs, education on management techniques to promote independence and self-esteem in their relative, and information on research on major mental illness, housing options and "'burnout" among themselves. MacCarthy et al. (1989) have examined the needs and burdens of the relatives of schizophrenic patients and have found that the relatives' needs for information and advice, emotional support, and respite holiday care are the areas showing the greatest unmet needs. Spaniol et al. (1987) have also found that families are dissatis- fied with the services provided and that family dissatis- faction seems to be related to the fact that services are not based on families' perceived needs. Families have been found to be primarily dissatisfied with treatment coordination, practical advice, information about the illness, emotional support and referral assistance. Caregivers of schizophrenics are faced with substan- tial amounts of burden (Bernheim 1989; Hoenig and