In the evolving landscape of mental health care, involving relatives has gained recognition as a vital component of holistic treatment. Yet, a novel qualitative study published in BMC Psychiatry reveals an intricate web of ambivalence and tension within this collaborative dynamic. Conducted in The Netherlands, researchers have delved into the perspectives of the so-called triad—relatives, patients, and professionals—uncovering a complex interplay that challenges the implementation of recovery-based approaches. This investigation illuminates why, despite widespread advocacy, meaningful engagement of relatives often remains elusive in practice.
The study employed semi-structured interviews with 24 participants spanning the triad: seven relatives, seven patients, and ten professionals affiliated with various mental health organizations. By focusing on direct narratives, the researchers sought to transcend quantitative assessments and instead capture the nuanced realities experienced by each stakeholder group. Employing rigorous thematic analysis, the team meticulously decoded recurring themes and tensions pivotal to understanding the triadic collaboration.
Central to the findings is the recognition of five critical aspects influencing the involvement of relatives in mental health care. Foremost is the inherent significance attributed to relatives’ participation—acknowledged as a source of support and enrichment in the recovery process. However, this value is tempered by the shifting nature of their roles, as relatives frequently find themselves transitioning from familial support figures to quasi-caregivers, a boundary laden with emotional and practical challenges.
Perhaps one of the most striking revelations is the intermediary role relatives often assume between patients and professionals. This position places them as vital conduits of information, advocates, and at times, buffers in tense interactions. Yet, this role is fraught with complexities; relatives report feeling burdened and overlooked, their contributions underacknowledged within clinical frameworks predominantly structured around patient autonomy and professional authority.
Tensions surface acutely when examining the dynamic interplay between patients’ autonomy and relatives’ involvement. While contemporary recovery models emphasize patient self-determination, both patients and relatives express ambivalence about the balance of influence and control. Patients may perceive relatives’ involvement as supportive or intrusive, and relatives struggle to reconcile their desire to assist with respect for patient independence. These conflicting sentiments underscore the delicate equilibrium necessary to foster collaboration without encroaching upon personal agency.
The study also unveils instances where relatives’ negative experiences within this triad exacerbate difficulties in collaboration. Feelings of invisibility, being unheard, and marginalization by professionals contribute to strains not only between relatives and clinicians but ripple through familial relationships. Such strains can erode trust, impede communication, and ultimately detract from the intended benefits of involving relatives.
One of the more unexpected findings pertains to the limited representation of relatives’ intermediary role within recovery-oriented literature and practice. Despite their pivotal position, relatives remain a surprisingly underexamined and undervalued component in scholarly discourse, reflecting a gap between policy advocacy and clinical reality. This discrepancy signals an urgent need for frameworks that better incorporate and support relatives’ perspectives and contributions.
The researchers articulate the notion of an "uneven triad" to encapsulate these divergent perspectives and power imbalances. While the triad is deemed essential to recovery-based paradigms, the practical integration of relatives is marked by inconsistencies and systemic challenges. Professionals often face organizational constraints and cultural norms that complicate efforts to fully engage relatives, while relatives themselves navigate ambiguous roles without clear guidance or support.
This study’s insights hold profound implications for mental health care policy and practice. It calls for more deliberate, structured approaches to involve relatives—not merely as adjuncts but as integral collaborators whose voices and needs warrant recognition. Training programs for professionals might address communicative strategies and cultural competencies to bridge existing gaps and mitigate tensions.
Moreover, the findings suggest that interventions should account for the emotional complexities relatives endure as they traverse the delicate spaces between caregiving and personal relationships. Offering support mechanisms tailored to relatives may alleviate feelings of burden and foster more sustainable involvement aligned with patients’ recovery journeys.
In implementing recovery-oriented models, mental health services must reconcile the competing values of autonomy, support, and collaboration inherent in the triad. Achieving this requires adaptive practices that recognize the diversity of relational contexts and the fluidity of roles over time. The uneven triad serves as a conceptual framework to guide such adaptations, emphasizing that one-size-fits-all approaches are inadequate.
The qualitative scope of this study, while rich in depth, also signals the need for broader research exploring diverse cultural, organizational, and diagnostic contexts. Understanding how these factors modulate relatives’ involvement can inform more inclusive policies that transcend localized challenges.
Ultimately, this study sheds light on an underexplored yet critical dimension of mental health care—the intricate interdependencies among relatives, patients, and professionals. By confronting the ambivalence, tensions, and unmet needs embedded within these relationships, the research paves the way for more empathetic, equitable, and effective collaborative care frameworks.
As mental health care continues to evolve, integrating the voices of all triad members will be essential to realizing the full promise of recovery-oriented approaches. This study’s revelations underscore the urgency of transforming proclaimed ideals into practice, bridging the gap between policy and lived experience for the benefit of patients and their support networks alike.
Subject of Research: Perspectives on involving relatives in mental health care from the viewpoints of relatives, patients, and professionals, within the framework of collaborative, recovery-oriented mental health approaches.
Article Title: The uneven triad: a qualitative study of perspectives of relatives, patients, and professionals on (not) involving relatives in mental health.
Article References:
Kroon, S.J., van der Krieke, L., Bruggeman, R. et al. The uneven triad: a qualitative study of perspectives of relatives, patients, and professionals on (not) involving relatives in mental health. BMC Psychiatry 25, 384 (2025). https://doi.org/10.1186/s12888-025-06814-3
Image Credits: AI Generated
