Impact Training

Focus on…Carers

    By Robert Corteen, Associate Trainer 

It is an unarguable truism that those people who care for another individual with a mental health problem, whether in a formal or informal capacity, at some stage, if not constantly, experience varying levels of anxiety concerning the role that they perform. That can range from relatively minor and contained anxiety amongst some professional carers and health care providers (nurses, doctors, psychologists etc….sometimes even to the extent of complacency and regardless of geographical location) to anxiety of major significance amongst family-carers which interferes to some degree with the conduct of normal everyday life.

It is not uncommon to see these higher levels of anxiety in the lives of those individuals who are thrust into the caring role by virtue of a relative becoming mentally unwell – particularly if that relative is part of the nuclear family (mother, father, husband, wife, son, daughter etc….).

Such anxiety is, in my view, completely understandable. Unfortunately, however, it is often reinforced by the very care system which seeks to 'fix' the problems that the mentally unwell individual has.

When illness strikes

When illness strikes (however we choose to define that concept), all attention (maybe inevitably so) suddenly becomes focused on the individual who is unwell – particularly if they are hospitalised as a result. Such focus often has the unfortunate consequence of increasing carer / relative anxiety as they strive to discover what the nature of the problem is with their loved one. This quest for understanding often meets with little success as mental health professionals invoke an almost 'Chinese wall' like attitude to protect the confidentiality and 'rights' of 'their' patient / service user. As a mental health nurse myself, I am convinced that this is not intentional, but more a result of not always viewing the unwell individual and any family connections as a unit and 'treating' that family unit holistically. There are, of course, always exceptions and I would not like to be accused of over-generalisation!

Getting a balance

Now, before everyone shouts at me that the rights of the individual reign supreme and they may not want others becoming involved in their struggles with mental health (an argument with which I do not disagree and in fact respect), let me just make a plea for balance, good communication and openness to be displayed by professionals as well as lay carers. As professionals, I would expect health care workers to take a lead here as theoretically at least they are able to take up a more objective position. I believe passionately that it is possible to achieve this - even in extreme cases where the individual wants to virtually 'cut off' all contact with family, without alienating those same people who until illness struck were possibly providing food, shelter and family life for that same individual.. However, back to the main focus of this article……!  

At the point of 'illness', as a family carer many describe their world as falling apart. Concern leads to anxiety which can spiral (usually downwards!) into despair, isolation and often anger and depression. If I could have a pound for every carer that has said to me 'if ONLY I could understand and be given information as to what's wrong with X' I would be very wealthy!

It seems to me that in many cases it is the lack of knowledge of the specific mental health problem in particular and its treatment / prognosis that is the cause of much carer anxiety. Relationships between family members, including the mentally ill person, often become strained as a result and everyone walks on proverbial 'eggshells' for fear of upsetting everyone else and provoking unnecessary and undesirable confrontation. This often continues once the person has been discharged and is back with the family. Life as was previously experienced by the family unit has changed sometimes dramatically. This 'thing' called mental illness permeates the very fabric of the family. If only this was a broken leg we were dealing with and not a broken mind! At least we could SEE the problem! This is for many a venture into the complete unknown, and a very steep learning curve! 

Impact's work with a carers' organisation

For the past year or so Impact as a company, and I as an Associate Trainer with Impact, have had the privilege of working with the Oxford Health NHS Foundation Trust Buckinghamshire Directorate Carer Support Team in an effort to address some of the issues that I have identified above, as well as a number of others that seem to arise perhaps more spontaneously!

The programme that we have been running has involved sessions on Carer anxiety; Dealing with difficult behaviours; Dealing with poor motivation and resistance; How to support someone with a mental illness; Dealing with Risk; Dealing with suicidal behaviour; Cognitive Behaviour Therapy and Working with the Recovery Model in Mental Health. Future sessions as this article is published will address Depression and Bi-Polar Affective Disorder. The Carer Support Team has yet to finalise the full programme for the upcoming months but this will be based as always on offering the maximum support to family-carers.

The challenge for me and the Carer Support Team has been in providing a forum for both education as well as the sharing of sometimes raw emotions without turning the event into a therapy session. Each session is attended by approximately 10-15 carers as well as staff from the team and many meaningful relationships have been developed over the months as carers find a natural source of empathy amongst carer colleagues and realise – often for the first time – that they are not alone in the difficulties and emotions they face on a daily basis. This can be very liberating.

Feedback

The overwhelming majority of people have expressed extreme satisfaction with the sessions we have held and for me certainly it has been very humbling to share in the lives of people who are often hurting and desperate to find a way forward. The team members too have been hugely supportive and encouraging and I am eagerly looking forward to future programmes!