Motivations and benefits for supporting carers
A range of motivations were reported to have encouraged forensic mental health services to provide support to carers, including responding to demand from carers, implementing policy guidelines and known best practice, increasing understanding and improving relationships. This development was perceived to have a positive impact on inpatient services as well as a range of other benefits, demonstrating that at least in principle, many forensic mental health services staff understand the importance of involving carers:
Carers play a very important role in the support of forensic clients. They provide valuable information on clients’ mental health and can highlight concerns quickly to staff.
For some, the decision to provide such support was primarily driven by the need to implement legal and best practice requirements. These might include: implementing the national carers strategy, nursing delivery plans or standards for schizophrenia care, risk management, inclusion, and overall minimum standards for secure services:
…we have legal responsibilities to work professionally with our carers as set out in the Mental Health Act.
Other respondents reported a value-based commitment to carer support, making the case that positive efforts in this regard are part of giving out a message about what the NHS stands for. This might be in tandem with instrumental motivations about the worth and impact of effective support for carers in terms of patient benefit and overall satisfaction.
Carer support was clearly well developed in some forensic mental health services, based on an understanding of the needs and views of forensic carers, and perhaps implying some level of collaboration. Only one service, however, commented that support initiatives had been developed organically in response to discussion with carers. There was little mention in the responses of any wider consultation exercises with either carers or service users.
Around two-thirds of services explicitly acknowledged the benefits of providing carer support. These included potential direct benefits to the person in forensic mental health services as well as to carers. Staff emphasised how supporting carers improved communications in the care team, including gaining information from family members about patient history, as well as enabling staff to give information and support reciprocally. This collaborative approach could be assumed to have indirect benefits for patients:
If carers have a better understanding of their relative’s mental health they will hopefully understand care packages being provided and support them, ultimately impacting positively upon their relative’s mental health stability.
Carers provide ongoing support for our patients. When a patient is first admitted the carers are extremely important in helping the clinical team develop an understanding of our patients’ backgrounds and recent histories. At the same time chatting to and supporting carers allows us to alleviate their distress and anxieties.
Qualitative responses were replete with language indicative of perceived benefits to patients, carers and the service provision as a whole – with an emphasis on ‘improved communication’, collaborative ‘exchange of information’, reciprocal extension of ‘understanding’ of each other’s perspectives, developing ‘insights’ into ‘user perspectives and greater engagement with carers/patients’. There was a sense from some comments that provision of support to carers facilitated better engagement and ‘buy-in’ to packages of care. Similarly, carers were reported as well placed to provide advocacy for patients in CPAs and other meetings.