Carers

Although there are different types of mental illness and symptoms, family members and friends of those affected share many similar experiences. There is a lot you can do to help your friend or relative. However, you need to look after yourself too.

Don't ignore warning signs of mental illness in a family member or friend. The sooner the person receives treatment, the better the outcome is likely to be. It will help if you:

Encourage the person to see a general practitioner (GP) or other doctor for an assessment.

Make an appointment with the GP yourself to discuss your concerns and what can be done (if the person refuses to see a doctor).

The distress associated with having a family member with a mental illness may lead to feelings of guilt, anger or shame. Acknowledging these feelings is the first step towards resolving them. It is important to understand that neither you nor the person with the mental illness are to blame for it.

Developing a positive attitude will help you to provide better support for a friend or family member with a mental illness. It will help if you:

• Find out as much as you can about mental illness, treatment and what services are available in your area.
  
• Find out if there are any education and training courses for carers that you can attend.
  
• Recognise and accept that symptoms may come and go, and may vary in severity. Varying levels of support will be required at different times.
  
• Develop a sense of balance between your own needs and the needs of the person you care for.
  
• Contact a support group for carers or relatives and friends of people with a mental illness.

You should decide what level of support and care you are realistically able to provide. Explain this to the friend or relative with the mental illness as well as the health professionals involved in their care (for example, the psychiatrist or case manager). This will ensure that the type of support you are unable to provide can be arranged in another way. You should also discuss options for future care with health professionals and other family members and friends. This will ensure continuity of care when you are unable to fulfill your role as a carer.

Plans to cope on a day-to-day basis
It is important to encourage a sense of structure in the life of a person with a mental illness. You can:

• Develop predictable routines - for example, regular times to get up and eat. Introduce gradual changes to prevent boredom.
  
• Break tasks into small steps - for example, encourage someone to shower more by helping them put out towels and choose clean clothes.
  
• Try to overcome a lack of motivation - for example, encourage and include the person in activities.
  
• Allow the person to make decisions - even though it can sometimes be difficult for them to do this and they may keep changing their mind. Try to resist the temptation to make the decision for them.

Try and discuss strategies with the person and health professionals to deal with:

• Suicidal thoughts - talk about the thoughts with the person and discuss why they are having them. Suggest things to distract the person from the suicidal thoughts. If the thoughts persist, especially if the person experiences hallucinatory voices that suggest suicide, inform their doctor.
  
• 'Manipulative' behaviour - for example, where the person with the illness tells one person untrue stories about mistreatment by the others who care for them. Establish whether the behaviour is being used to get extra help and support. Try and involve the person in activities which will make them feel less resentful towards others. Check out the stories before you react.
  
• Aggressive or violent behaviour - this may be associated with psychotic symptoms or alcohol or drug abuse. Involve health professionals promptly. For aggressive behaviour associated with extreme stress, try to develop an atmosphere that is open and relaxed.
  
• Report aggressive behaviour
  If someone is persistently aggressive, you should report actual or threatened violence to the treating health professionals (and the police, if necessary) immediately. If you live with someone who is persistently aggressive, seriously consider ways you can live apart. It is very likely that living apart will work out better for both of you.
  

Mental illness can lead to a variety of emotional effects for brothers and sisters of the affected person. For example, they may feel:

• Confusion about their sibling's changed behaviour.
  
• Embarrassment about being in the affected person's company.
  
• Jealous of their parent's attention.
  
• Resentment about not being like their peers.
  
• Fear of developing the mental illness.
  
  

What you can do:


If your sibling has a mental illness, you can:

• Talk honestly about your feelings and encourage others in the family to do the same.
  
• Be active in improving mental health services - for example, through local mental health support groups.
  
• Avoid making the ill person the axis around which the family revolves.
  
• Maintain your focus on living and enjoying your own life.

What you can't do:

If your sibling has a mental illness, you can't:

• Be totally responsible for their welfare.
  
• Make your sibling behave in a certain way - for example, force them to take their medication.
  
• Solve all their problems or feel you ought to.
  
• Lessen the impact of the illness by pretending that it is not there.

Neither you nor the person affected by the mental illness are responsible for their condition.

It may help to contact a support group for family, friends or carers of people with mental illness.

Firstly , they have the right to an assessment of their own physical and emotional needs and agreement of a Care Plan to meet those needs.

Requesting a carer’s assessment

You may request a carer's assessment at any time. Contact your local social services office, whose address can be found in the telephone directory, or mental health services.

Before your needs are assessed, it is important to think through issues in advance. These may include:

• How willing and how able are you to provide care now and in the future?
  
• How caring affects your social life or your job?
  
• Will you need breaks from caring?
  
• How good is your health?
  
• Are there any relationship or financial problems?
  
• What practical or emotional support do you need?
  
• What other responsibilities do you have, eg bringing up children, caring for elderly parents?
  
• What would happen if you became ill?
  
• Are you able to provide care effectively?
  
• Do you need someone to help you get your views across?
  
• What do you want from the assessment?

As a result of the assessment, services may be provided for you and/or the person you care for. In some areas local authorities will charge for them and should inform you about this. Also, money may be provided to enable you to buy the services you need. assessment.

and

Secondly , they have the right to information to enable them to access services and provide the best possible care and support to the person they are caring for.

You should be recognised and listened to as a partner in providing care.

You should be valued as someone dedicated to helping the person you care for and who knows them well.

You should be treated with courtesy and respected for your skills e.g. overseeing their medication.

You should be able to work with staff who understand the effects of mental illness on yourself and your family.

You should be able to request an appointment with the consultant psychiatrist or another mental health professional.

You should receive help and information when it first becomes evident that you are providing care for someone with a mental health problem.

You should have the chance to discuss your concerns about the person’s illness and how it is affecting you.

You should receive prompt and positive responses to your requests for help.

You should be able to get immediate help in a crisis.

You should have your needs assessed as well as those of the person you care for and have them reviewed periodically.

You should be able to have breaks from caring.

You should be given access to help in communicating with staff e.g. interpreter, signer.

You should be given an explanation of the mental health problem affecting the person you care for and be told where you can go to get more information.

You should be told what treatments the person is receiving, what other treatments are available, how they work and what the potential side-effects might be.

You should be told what services are available for the person you care for such as day care and employment services.

You should be told how to recognise signs of a relapse.

You should be told who to contact in an emergency and be given a 24 hour phone number.

You should be given advice on how you can best cope with the effects of the mental health problems at critical times such as home leave and the period following discharge.

You should be given information about what support will be provided when you are no longer able to provide care yourself.

• How to obtain a second opinion.
  
• Mutual support carers groups.
  
• How to get help with any financial problems.
  
• How to claim benefits that you and the person you care for are entitled to such as Disability Living Allowance and Invalid Care Allowance.
  
• Your right to make a complaint and the procedure for doing so.

Involvement

You should expect that mental health staff will encourage the person to allow their carer to be involved unless that person has clearly expressed the wish to exclude you.

You should be able to give your views and have your questions answered about the care plan.

You should be able to have someone with you at meetings to help you put your views across.

You should have the opportunity to be involved in the planning and development of services in your area.

You should be able to choose whether you are prepared to accept the role of carer.

You and the person you care for have the right to expect that information either of you provide for mental health services will not be shared with other people without your consent. This includes information provided by you as a carer not being shared with the person you care for and vice versa. This can only be over-ridden if justified through risk or if this is required by law.

Confidentiality should not be accepted as an excuse for not listening to you. You should be given sufficient information by mental health services, in a way that you can readily understand, to help you provide care effectively.

From time to time, a person being cared for may not be able to deal with their own financial and other affairs personally. In these circumstances a Carer could become an Appointee to deal with these issues on the person’s behalf. Application to become an Appointee must be made to the local Benefits Office and your GP will also be able to help in this matter.

You may wish to involve the person’s legal representative to arrange a Power of Attorney giving the legal right to another person to manage the affairs of someone they may be caring for. There are different types of Power of Attorney and ultimately dependent on a person’s assets the Court of Protection may become involved in the management of a person’s affairs when they are mentally incapable of such management. In these circumstances the Carer should consult the person’s legal representative for independent advice and arrangement.

If a person is subject to a section of The Mental Health Act then application can be made for a review of this before a Mental Health Review Tribunal even if they are living in the Community.

The Department of Health recognises the vital role played by carers. This recognition has increased in recent years through -

Caring for Carers : a national strategy for carers, which announced proposals to give support to carers. The Prime Minister said that caring for carers is a vital element in caring for those who need care.

The National Service Framework for Mental Health , which was published in 1999, sets out seven standards, one of which, Standard 6: Caring about carers, says “All individuals who provide regular and substantial care for a person on the Care Programme Approach should have:

an assessment of their caring, physical and mental health needs, repeated at least on an annual basis.

their own written care plan which is given to them and implemented in discussion with them”

The Framework also enables people to become involved in planning care locally through the Local Implementation Team: each team should have a carer representative.

The Care Programme Approach . Everyone in touch with mental health services should have a thorough assessment of their needs and there should be a clear plan for their care and treatment. People with a severe illness and/or multiple needs may be cared for under “enhanced CPA” and they and their carers should be given a written copy of their care plan.

The Carers and Disabled Children Act, 2000 , which enables carers who provide, or intend to provide, a substantial amount of care on a regular basis to someone aged 18 or over to apply for a carer’s assessment. This applies whether or not the person they care for has had an assessment under the Care Programme Approach (CPA) or is in receipt of services from a local authority.

Whether you are a carer providing a substantial amount of care on a regular basis depends upon the impact of caring upon the carer. It does not depend on whether the carer lives with the person or is providing a set number of hours of care per week.

The 1983 Mental Health Act. The “nearest relative” has a number of rights under the Act which enables him/her to:

• Require an approved social worker to assess someone who might need to be admitted to hospital.
  
• Apply to the hospital managers for a compulsory admission.
  
• Prevent a compulsory admission from taking place.
  
• Express his/her point of view when the patient’s detention is reviewed by tribunal or hospital managers.

 

      www.mentalhealthcarers.org/