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In my last article, writes Drew Lindon, policy and development officer, The Princess Royal Trust for Carers, I wrote about the challenges facing mental health services, and how working effectively with carers should form part of the future of health and social care as a whole. Since then, the national Carers Strategy, Carers at the heart of 21st– century families and communities has been released.
The national Carers Strategy and mental health carers
The Strategy offers a number of key commitments to support carers nationally, though these will apply mostly to England and Wales. This article will assess how this strategy might change the mental health services’ approach to carers.
Positive steps
The Carers Strategy’s commitments include:
- additional funds for flexible carers breaks – £150m over two years to Primary Care Trusts [PCTs], plus £4m for pilot schemes,
- future reform of Carers Benefits,
- piloting of annual health checks for carers,
- expansion of training for staff on working with carers.
These are positive steps, and are likely to have positive impacts for carers looking after people with mental health needs. We are pleased to see that ‘teams within adult mental health and substance misuse services will be particularly targeted’ for training on carers issues and whole family working [p137]. If implemented positively, this should better support both young and adult carers within these families.
Lack of focus on specialist groups
 However, as a whole, the Strategy largely fails to take forward progress made on the key challenges faced by mental health carers. Carers for people with a mental health problem are barely mentioned by the Strategy. Overall, there is little acknowledgement in the Strategy of how to best meet the needs of carers from many ‘hard–to–reach’ groups, which would include carers from black and minority ethnic backgrounds, carers looking after someone with a substance misuse problem or dual diagnosis, or lesbian, gay, bisexual or transgender carers.
A missed opportunity? Not yet
However, the Strategy’s encouraging initiatives are likely to significantly improve the wellbeing of mental health carers if they are applied to mental health services with diligence and drive. If ‘carers must be treated by professionals as partners in care’ [p101], carers’ expertise must be respected in these services as well. We would recommend several areas in which this Strategy could fulfil its potential:
- staff training: The promised training for staff on carers must include mental health carers’ issues. The Partners in Care materials from The Royal College of Psychiatrists/Princess Royal Trust for Carers are an excellent starting point for mental health carers issues and staff training [see www.partnersincare.co.uk],
- helpline and website: The Strategy’s helpline and website information service is aimed to ‘ensure that the needs of those [carers] who have traditionally had disproportionately less support than carers as a whole or who may be more isolated in the community receive greater focus’ [p64]. Mental health carers are a clear example of this group. As such, they should be key targets for the helpline and website, which should offer specialised information around mental health and substance misuse caring issues in addition to other carer resources,
- breaks: We welcome the extra funding to PCTs offered for carers breaks. However, breaks services are often unavailable or inappropriate for mental health carers, particularly those looking after someone with a functional condition. This tends to be due to a lack of recognition by local services of the unpredictability of caring for someone with a mental illness, and therefore the need for greater flexibility in providing breaks. Similarly, there is often a lack of understanding of how to adequately and respectfully support and empower mental health services users while carers are enabled to take a break, and a lack of trained staff that are able to provide this service. To avoid mental health carers being left out of the new breaks services, these issues must be addressed,
- carers benefits: It is a great disappointment that the Strategy does not offer immediate action to rectify the low level of Carers Allowance or the difficulties in claiming it. Urgent review is needed. Particularly for mental health carers, we would highlight the need for the system to be flexible to carers’ specific needs. For example, we would wish to increase the ease of restarting Carers Allowance if a service user has returned from hospital after a section. Likewise, for some carers, the time spent on caring tasks does not drop below 35–hours a week when a person is in hospital on a section three, despite that person’s Disability Allowance being stopped after four weeks in hospital. In this way, there is an argument for Carers Allowance to be less closely aligned with the needs of the person being cared for, and more focused on the individual responsibilities and tasks of the carer,
- information and confidentiality: The Strategy states that work will be done ‘to establish the legislative or other requirements needed to enable carers to receive appropriate information especially in cases where mental capacity is an issue’ [p120]. This commitment is warmly welcomed. This aim must be applied to dealing with confidentiality issues around treatment for mental illnesses. One solution to some of these issues would include implementing information–sharing protocols and agreements between service users, carers and staff at an early stage in diagnosis and treatment. Rather than confidentiality becoming a barrier to joint working, an agreement on what can be shared, with who, how and when, allows all parties to work for the best outcomes for the service user and best support for the carer. Once again, the Partners in Care materials are good starting points on these issues.
If the Strategy’s aspiration is to involve ‘carers in all care planning from diagnosis to discharge and beyond’ [p117], this must be realised within mental health services as well. We look forward to helping make this a reality.
• All quotes are taken from Department of Health [2008] Carers at the heart of 21st–century families and communities, available at: www.dh.gov.uk.
Email Drew Lindon at: dlindon@carers.org. Telephone: 07732 645069.
Infolink: The Princess Royal Trust for Carers, Unit 14, Bourne Court, Southend Road, Woodford Green, Essex IG8 8HD. Telephone: 0844 800 4361. Website: www.carers.org. Website: www.youngcarers.net.
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