Carers’ Evaluation of Support
Just short of half of survey respondents rated the quality of support received from forensic mental health services as either good or very good. However, a fifth felt this was poor or very poor. Carers report different and inconsistent experiences of support from various forensic units, and the staff within them, which they contrast with each other. Encounters with key staff coloured the whole impression formed of a particular service or discipline. There was an apparent demarcation of responsibility for attending to carers’ interests between ward-based personnel and specialist workers situated in centres away from main ward areas. It might be unfair to overgeneralise, but carers quite often identified positive contributions from a range of specialist personnel, but were typically critical of those ward nurses who appeared to them as indifferent or uncaring, and concerned more with a custodial rather than a supportive role.
Identifying and accessing support appeared to be a struggle for a significant proportion of carers in the study. This is not always the fault of services per se. It could just as easily reflect difficulties in targeting support on a group of carers with complex and divergent needs grounded in their geographical location, individual circumstances and particular experiences. From the survey, around 33% of carers had found it either easy or very easy to access support when they needed it, in comparison with 31% who had found this difficult or very difficult.
Only 53% of carers completing the survey reported receiving any form of advice, information or support on first admission to forensic mental health services. For some this might reflect an historical state of affairs, and levels of support may have subsequently improved. For others, a perception of lack of support has persisted such that they stated they have ‘never at any time felt supported’ (survey respondent).
Carers felt supported when they were confident their relative was getting the best care and treatment possible:
They have undoubtedly helped my daughter in a way that I would never have believed possible. Always with compassion and understanding, what more could any carer want? (survey respondent)
This also intersects with the service’s disposition towards information exchange and involvement in care pathways. Carers needed to share their personal experiences and stress, hence being listened to was immensely important:
I needed at the time to get a hellova lot of things off my chest and we did have… a Community Mental Health Nurse who in a very informal way `oh I was just passing’ would come in and he’d sit down by you know where I’m sitting here now, and I would babble on for an hour or so about my latest frustrations and he’d just sit and nod and occasionally say `oh crikey’” (father)
Although there were only a few comments about the Mental Welfare Commission for Scotland’s (MWCS) role in supporting carers, it had mixed reviews, with some forensic carers feeling it was more likely to support ‘the system’ than the carer or their relative.