Discuss the issues and policies surrounding support for carers in contemporary society.
The aim of this assignment will be discuss the issues and policies surrounding support for carers in contemporary society. For the purpose of this essay the term 'carer' refers to someone of any age whose life is restricted because they are looking after a friend, relative, partner or person who cannot manage without help because of illness, age or a disability of any kind (Department of Health 2002) The essay will attempt to explore the origins of relevant policies related to the subject area, discuss current local initiatives, and outline examples from practice to reinforce the impact which any policy may have had on Mental Health Services. For reasons of confidentiality (NMC 2002) pseudonyms will be used when referring to any client or location within this assignment.
It was only a few decades ago when families and relatives were given the blame for experiences of their family member with severe mental illness. Even though today times have changed, and carers are not deemed as the cause of the problems, it is still very common for them to be excluded from the process of recovery of their loved ones from severe mental illness, or to be classed as 'interfering' if questions are raised about the delivery of care of their family member. Inspite of this, over the past 20 years, carers have become increasingly recognised by government. According to Henwood (1998) 1 in 8 persons is an informal carer to either a relative or family member, which has led this group of people to becoming more recognised for the support they give to clients and also for their own needs. Supporting carers not surprisingly has proved increasingly popular with the government, because it helps to reduce the demand of local authority funded services, reasserting the responsibility onto families and individuals. However, as straightforward as this may seem, it amounted to the difficult task of translating the support into actual rights and benefits, the task was given to the backbench politicians.
The first piece of legislation to materialise was the Carers (Recognition and Services) Act (1995). This Act was an important step towards recognising carers, and the supporting role that they play in looking after their family members, and the difficulties, which they face. They were given the right to an assessment both physical and mental, this would be carried out on an annual basis. This would be in addition to the person being cared for. However, if the person being cared for refused an assessment, then the carers would not be entitled to an assessment, this resulted in low numbers of assessments being undertaken by local authorities, as there was no extra funding available for this service. In the same year Department of Health's (DoH) publication Building Bridges (1998) also provides the legislative framework recognising the caring role. More recently, the Carers and Disabled Children's Act (2000) primarily strengthened the rights of carers to an assessment of their needs with regard to an assessment of their needs regarding their role; this is irrespective of whether the person whom they are caring for receives services or even is in acceptance of their own illness. These services were defined as anything that promoted the health and wellbeing of the carers. The help can range from driving lessons, counselling or even money to replace a broken washing machine. There is however no guarantee that services will be provided - the legislation did not come with any new money for implementation. And councils are able to charge carers for the services they receive.
The problem of funding was recognised in the government's National Strategy for Carers called Caring for Carers (1999) and a grant was introduced which was specific to carers, it led to an increasing influx of carers taking breaks. It was hoped that this strategy would be reinforced by a bill to consolidate the rights of carers to assessment and services in their own right. The requirement that health authorities and local authorities bring together the organisations in their locality which assist carers to assess carer's needs and how local support services, should best be provided. The strategy outlines ...
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The problem of funding was recognised in the government's National Strategy for Carers called Caring for Carers (1999) and a grant was introduced which was specific to carers, it led to an increasing influx of carers taking breaks. It was hoped that this strategy would be reinforced by a bill to consolidate the rights of carers to assessment and services in their own right. The requirement that health authorities and local authorities bring together the organisations in their locality which assist carers to assess carer's needs and how local support services, should best be provided. The strategy outlines a number of measures to improve the conditions of carers, including:
- Measures to engage carers as partners in planning services and assistance for carers.
- More funding for carers to take a break from caring.
- The requirement that health authorities and local authorities bring together the organisations in their locality which assist carers to assess carers' needs and how local support services should best be provided
Further evidence indicates that carers of people with severe mental illness are not always receiving the services they need to support them, or to maintain their own good health. In a Social Services Inspectorate report, carers of people with mental health problems were especially critical of how little they were consulted about care plans for service users, how their own needs were not assessed, and how little support they received. In addition, few authorities had implemented the Carers Act within their mental health services when inspected in 1999 by the Social Services Inspectorate (Social Services Inspectorate 1999, cited in DoH 1999b).
In 1999, Standard 6 of the National Service Framework for Mental Health (MHNSF) Caring for Carers (1999) made it a requirement that professionals assess the needs of the carer of an individual with an enhanced CPA. Other policies also have promoted the inclusion of carers. Under Section 11 of the Health and Social Care Act (2001), health authorities, primary care trusts and NHS trusts are now required to make arrangements to involve and include patients and carers. In the MHNSF there are good practice guides for each standard included, however little is said with regards to good practice around carers. To achieve standard 6 of the MHNSF local services need to pay attention to the needs of people caring for someone with a mental health problem, this may include an assessment for the carer and perhaps a care plan for the carer themselves. Nevertheless, locally it has become clear that initiatives are beginning to alter the balance of power in relation to the care system supporting an individual patient. (Derbyshire Mental Health Services NHS Trust 2002)
Whilst on practice placement, evidence of initiatives for carers of people with mental health problems have been evident, but only to a minimum. Apart from making the carer aware of their rights to an assessment, it appears that practitioners are themselves only just coming to terms with the utilisation of the provision. (Santa Maria, Daldry, Stevens (1999) One example observed of support for carers was in the community setting. Tony (pseudonym) was offered respite from his wife Carol (pseudonym) who suffered with bipolar disorder. Carol was given access to a day services resource centre, which she attended for 3 days per week, to allow Tony adequate periods to time to pursue his own interests and genuinely have a rest from caring.
However, after further research into the area, it was evident that there are resources available, and carers are made aware of their availabilities at point of contact. The most reknown support group for carers of people with mental health problems is Rethink (formerly known as National Schizophrenia Fellowship). This is both a national and local initiative that offers support to carers by supporting the person being cared for back into the community, accommodation, occupation with day services or employment. This service is rated very highly among carers, perhaps because of its focus on community interventions as opposed to the medical type. (Rethink 2003) Rethink also offers a family education, training programme in Derby that provides information to carers about illness, treatments and local resources, supporting them through difficulties they may face as a carer. The programme includes 6 sessions, one a week lasting for two hours. A team of professionals including a nurse, social worker, occupational therapist and a local carer runs the programme. Other support groups include Derby Mental Health Carers Forum, Derbyshire Carers' Association and Crossroads - Caring for carers.
The most important factor that evolves from these findings, what provision is in place for allowing the carer information in relation to these resources? The MHNSF Standard 6 states the Health and Social Care have a duty to let a carer know that they have a right to request a carers assessment, and agree a care plan with the care co-ordinator, this should be reviewed at least once a year, this should enable the carer to care effectively as their personal needs are also being addressed. To care effectively, the carer also needs adequate information from the health professionals in relation to the cared for person, and certain rights to be involved in their care and treatment. (Santa Maria et al 1999) If the person being cared for has to go into hospital because of a mental health problem, or if it is necessary for more than one organisation to provide services, the Care Programme Approach (CPA) applies. This is a way of getting everyone involved to work together, including GPs and consultant doctors. This happens through regular meetings, by appointing a key worker and by writing down decisions made in a care plan. The key worker is a crucial link between the cared for and the carer on the one hand and the professionals on the other.
However, a known barrier to effective carer involvement is patient confidentiality, this seems to be a bone of contention. The underlying reason then that so few carers are involved with professionals in care planning is not the relationship between the carer and service user, but that between carer and professional. (Szmukler 2001) Research published by Rethink shows that support for carers is limited and information is still being denied them, they are still excluded from decision making and are generally left to cope on their own (Rethink 2003)
In conclusion, there are an estimated 1.3 million people who care for someone with a mental illness. The Carers Act 1995, the Caring for Carers Strategy, The NSFMH and the NHS Plan have all acknowledged the case of supporting carers. Standard 6 of the NSFMH stipulates that carers of people with mental health problems should be assessed annually and given their own care plan, yet according to White (2001) these carers are the forgotten army.
In relation to confidentiality of information, improving communication channels for carers is intrinsic in order for them to have access to the information they need to support their relative. If the carer and health professionals are able to work in partnership, a clearer picture can be gained of the service users needs (Santa Maria et al 1999). Ultimately carers want their voice to result in a positive change in their relatives quality of life, but when the system that controls that care fails them, then the role of caring becomes harder.
References
Code of Professional Practice (2002) Nursing and Midwifery Council: London.
Carers & Disabled Children Act [online] 2000 Available at http://www.hmso.gov./acts/acts2000/20000016.htm. [Accessed on 12.1.05.]
Carers (Recognition and Services) Act [online] 1995 Available at http://www.hmso.uk/Acts/acts1995/ukpgs. [Accessed on 19.11.04.]
Department of Health (1995) Building Bridges: A Guide for Arrangements for Interagency working for the care and protection of severely mentally ill people. HMSO: London.
Department of Health (1999) National Service Framework for Mental Health. HMSO: London.
Department of Health (1999) National Strategy for Carers: Caring about Carers. HMSO: London.
Department of Health (1999a) Caring about Carers: A National Strategy for Carers.HMSO: London.
Department of Health (2001) Who Cares? Information and Support for Carers of Confused People. HMSO: London.
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Derbyshire Mental Health Services NHS Trust (2002) A Strategy for Carer Participation in Mental Health Services in Derbyshire 2002-2004. UK
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Henwood, M. (2002) Ignored and Invisible? Carers' experience of the NHS. Carers UK: London
Rethink (2003) Who Cares? UK
Santa Maria, C., Daldry, I., and Stevens, S. (1999) Partnerships: A joint approach to supporting Carers. Mental Health Nursing. Vol 9. No. 5. pp 10-14.
Szmukler, K (2001) Mental Illness: A Handbook for Carers. Jessica Kingsley: UK
White, M. Forgotten Army [online] 2001. Available at http://www.societyguardian.co.uk. [Accessed on 11.1.05.]
