Around six million carers in the UK provide regular and substantial support to a relative, partner or friend who has a mental health problem or both mental and physical illness. Up to two million of these are children providing care in their family home.
Many of these people put their own lives on standby, missing out on career opportunities and personal relationships and incurring extra costs as a direct result of the role they assume. If they did not sacrifice their time and energies to support their loved ones, the burden would fall on the NHS. The economic value of the contribution made by all carers in the UK has been calculated at £87bn each year.
The government recognises the value of carers and has introduced an extensive range of legislation, policies and guidelines. It is clear there is a statutory requirement that mental health staff should fully consider and address the needs of carers. But despite this, carers frequently feel unsupported and frustrated by a lack of information and inadequate involvement in care planning.
Studies show that relatives and friends closely involved in supporting a patient can experience prolonged psychological distress – and also that comprehensive support can mitigate any resulting mental and physical health problems. Nurses are in the best position to provide this support.
I would attribute the reasons nurses fail to support carers to three main factors. First, mental health nursing is a busy profession and nurses are occupied working with patients. Second, nurses do not always fully appreciate the magnitude of the burden placed on family and friends. And third, they are not necessarily in a position to provide that support directly.
Caring for a loved one is very different from caring for a patient. Nurses don’t necessarily know how to support carers instinctively. I’m not suggesting nurses are failing to be empathic but next time you look at one of your patients who doesn’t recognise you or has forgotten how to feed themselves, imagine the person is your mother or your child. Then you’ll be part way to understanding how it feels to be a carer.
But recognising carers’ needs is just the start. Nurses need to feel confident in knowing how best to work with relatives or close friends, provide advice and information, and access additional support when necessary. To facilitate this, there is a need for an education and training programme that will enable mental health nurses to inform, involve and support carers.
Researchers at City University London were recently commissioned by the Supporting Carers Better Network, a project of the national charity Together: Working for Well-being, to identify the content and design of an education and training programme.
We conducted focus groups and listened to the views of carers, support workers, nurses, service users and managers.
We found the importance of working in partnership with families should be an integral part of training to become a mental health nurse. This should be provided to all mental health students throughout their pre-registration professional training. This education should be supplemented with visits to and placements with families, carer support workers, centres and organisations.
CPD and post-registration training should be exploited to ensure the existing mental health workforce provides services that are family friendly and sensitive to the needs of families and carers. Smaller numbers of nurses could then be trained to provide specialist interventions.
To be successful, there must be an organisational strategy that includes explicit support throughout all levels of health and social care.
Most importantly, this strategy needs the support of nurses. Nurses must see supporting carers as their responsibility. Then, with a well-designed education and training package, they will be able to understand the burden placed on families or friends, identify the signs of distress, and offer appropriate support.
Alan Simpson is research fellow and lecturer in mental health at City University London’s School of Community and Health Sciences
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