The importance of supporting informal carers and using their knowledge and experiences to increase the effectiveness of mental health care and treatment is implicit in Scottish law and policy: specifically in the Mental Health (Care & Treatment) (Scotland) Act 2003 (MHCT Act) and the national Carers Strategyfor Scotland 2010-2015 Caring Together (Scottish Government, 2010).
Recent UK-wide developments such as the Triangle of Care, carer peer support, implementation of a recovery agenda for informal carers (Worthington et al, 2013; Machin and Repper, 2013), and the Royal College of Psychiatrists’ Partners in Care campaign, serve to further underline the importance of engaging mental health carers across the UK. That said, it is recognised that research is urgently needed to provide a more secure evidence base for developing carer-centred services generally (Samele et al, 2007). Particularly lacking is research that examines the perspectives and experiences of mental health carers, and especially that of family carers supporting people in forensic mental health services.
Evidence from early implementation of the MHCT Act, however, suggested that mental health carers were not always treated as ‘partners in care’ (Ridley, Hunter and Rosengard, 2010). Dissatisfaction among carers generally with levels of involvement with services and frustrated access to information is recognised in international literature (Mental Health Council of Australia and Carers Association of Australia, 2000; Marshall and Solomon, 2000; Scottish Intercollegiate Guidelines Network, 2013).
In the Scottish context, the Moffatt Report (Kelly et al, 2010) pointed to shortcomings including low numbers of carers in receipt of carer assessments and appropriate information. Initiatives such as Equal Partners in Care (EPiC), a joint project between NHS Education for Scotland (NES) and the Scottish Social Services Council (SSSC) focussing on workforce education and learning from sharing best practice, have subsequently sought to address some of these concerns.
Analysis of consultations during 2012 and two major forensic mental health services conferences held in 2010 and 2011 identified ‘significant gaps and inconsistencies’ in respect of forensic carers’ experiences and levels of existing support reported by professionals (Forensic Network Advisory Board, 2012).
While generally acknowledged that there have been improvements over the past decade, these recent consultations concluded that forensic carers in Scotland felt uninformed, traumatised, bewildered, and did not understand what was happening to their relative, or what they could do to help them or manage their own distress. Support in Mind Scotland and the Forensic Network commissioned this independent study to examine these discrepancies, focusing on the experiences and views of this neglected group of carers.