Most commonly, families describe a catalogue of failed attempts before they can engage Mental Health Services in helping with their own concerns about a child. Thus the Mental Health Practitioner may often meet a family which is already exasperated and angry at the amount of time it has taken to get Mental Health Services involved.

However, this is not always so; it is not uncommon to experience the opposite situation, where the family subtly minimises or undermines the seriousness of a diagnosis. One such potential difficulty, specific more often to Psychosis than other conditions (though certainly not exclusive to psychosis), is the situation in which the symptoms are effectively hidden by the young person, whose presentation may be guarded, and particularly so towards the family.

It is not uncommon in the context of an individual meeting with a mental health professional, who may have more confidence in approaching and enquiring about bizarre mental phenomena, that the young person reveals more explicit symptoms than the family has been exposed to. This sets up a dilemma for the mental health professional, who has access to information which has not been granted to the family, and whose own assessment of the problem is significantly divergent (and often less urgent) from the professional's.

In such a situation the family (particularly those without experience of mental health problems in others) finds it difficult to accept the idea of their child/sibling being as ill as professionals say she is.

In such a situation, powerful defences of denial combine with a 'fight-flight' basic assumption (Bion) within the family group to cast the mental health professional as the threat, rather than the mental illness within their ranks. The risk is that the family thus retreats from the encroachment of professionals. In such a situation the workers will need to move slowly, perhaps emphasising the functional disability (not being able to go out of the house, shouting out for no apparent reason, etc.) rather than the aetiology (early onset schizophrenia, etc.). By seeking for common ground - identifying concerns about the young person that they and the family can share - the worker may be able to join with the family to allow them to facilitate the beginnings of treatment. "We know from experience that many people who are finding it difficult to go out, or become stressed and shout out unexpectedly, benefit from..."

Further work on introducing notions of diagnosis, management, and prognosis is discussed under FamilyWork in the section on Specific interventions.

The issue of Confidentiality is important in the context of a young person who has withheld the extent and nature of their symptoms from the family. In this instance (depending somewhat upon the exact age and the perceived risks), it may be appropriate to keep the particular content of a young person's delusions or hallucinations confidential, whilst one's duty of care does require some discussion of the fact that the young person is unwell with their parents.