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Assessing carers' needs and offering support
Target
a) The CRT offers involved families/carers the opportunity to meet CRT staff separately from the service user to discuss their own support needs.
b) The CRT provides involved carers/families with information about local services for carers (e.g. welfare advice, carers groups).
c) The CRT specifically records (using a structured form or as part of assessment/treatment plans) carers' needs and a support plan and provides the carer with a written copy.
d) The CRT staff demonstrate a clear, shared understanding of how carers may be supported even where service users refuse permission to share information with carers.
Why this is important
Many CRT service users rely heavily on a carer, who may themselves be under a significant amount of strain as a result of the service user's condition. All stakeholders agreed that supporting carers was a central part of the CRT's role, and carers have a right under the Carers Act 1995 to an assessment of their needs. Conducting a comprehensive carer's assessment is a big task which the CRT may not always be best placed to undertake. But that should not prevent CRT staff from talking to involved family about their immediate support needs and agreeing a plan for what help the CRT can provide during the time they are involved.
In the video below, carers and service users discuss the importance of supporting carers, as well as managing confidentiality issues.
Ways of doing this well
Some of the most effective strategies teams are using around the country include:
Ensuring carers' own needs are assessed
The Chichester CRHTT provide carers with their own care plan, outlining how the team will help them support the person they care for, and how the team will support them in turn:
In Wales the local county councils carry out carers' assessments using the form below:
Providing clear information about local services
Carers' support groups and related types of support are found across the country, but many carers may not be aware of their existence. Signposting carers to these sources of support may help the carer both during CRT support and in the long-term beyond their contact with with the CRT.
Sharing information with carers
Brighton and Hove HTT have clear guidelines for staff about how to support carers and provide useful information while maintaining confidentiality of a service users.
Dedicated carers' support workers or carers' champions
The Mental Health Services self-assessment checklist form from Triangle of Care is a really useful tool to help teams make sure they are doing all they can to support carers. You can find the checklist in Appendix 1 of the document below.
Dedicated carers' support workers or carers' champions within the CRT team may help to maintain a focus on supporting carers. Read the case study from Bristol Intensive Team about the work their carer champion does.
Bristol Intensive Team Case Study
The role of the carer' champion was developed through our quality monitoring system in the team. Expressions of interest were made and Simon Smith took the lead in developing this role with the team's support. Simon has worked for AWP for 12 years in various roles and in several different teams, he had been working in the team as a recovery coordinator. Simon is very enthusiastic about and dedicated to this role. He first became interested in the role of working with carers around 6 years ago when he was working with a gentleman who tragically took his own life; when he first heard this news his first reaction was: 'who found him, and please don't let it be his young child who was living with him'.
This had an impact and he began to reflect on his own practice around how we work with families and those close to the people we support. After some supervision talking about the situation and his thoughts and feelings the suggestion was made that he be considered the role of carers' Champion for the team.
His role in the team has changed significantly over the last few months. A year ago he would have been snowed under doing many different carers assessments for any person who was new to mental health services, and offering one to one support for them to look at how we can help with any of their needs.
Over the last 18 months he has been working closely with Senior Management in the Trust to develop a new simpler system to register carers electronically on RIO. It was felt by many clinicians that registering a family member on RIO was so complex it was off putting, and as a result staff were either sat in front of a computer for hours or didn't complete the paperwork correctly, if at all. The new system which comes out in Bristol in the next few weeks will make it very easy to get a significant other registered as a carer, meaning staff can spend more time with the family doing face to face contact and offering support.
Simon has been supported to have four dedicated days to offer families and their significant others time to talk about their experiences, and give them a chance to discuss any fears, concerns and worries they might have. This also provides an opportunity to give them valuable information about different services that can offer them on-going support, whether this is looking at funding for a carers' break, advocacy, education or just a chance to meet and talk to people in a similar circumstance.
Examples of good practice
In our fidelity review survey of 75 crisis teams in 2014, the following teams achieved excellent model fidelity, and can be contacted for advice about how they achieved this:
- Bristol Intensive Team, Avon & Wiltshire Mental Health Partnership NHS Trust
Relevant reading
National Audit Office: Survey of Service Users (2008)
The CRT offers involved families/carers the opportunity to meet CRT staff separately from the service user to discuss their own support needs
"After the fourth day visiting my daughter, a member of staff talked to me in-depth. I was so distressed she took me aside, and I thought, 'Thank God, someone has finally treated me like a human being.'"
Simone (Carer)
Source: NAO carer focus group (p. 7)
Rethink: Under Pressure (2003)
The CRT specifically records carers' needs and a support plan
'Carers have a legal right to have their own needs assessed but few make use of this right and for those who do, many do not receive any extra help as a result' (p.2)
'It is not enough that carers have a right to an assessment, they must also have the right to receive the support they need. Providers must ring fence resources so that recommendations to address identified carers' needs can be financed. We welcome the introduction of carers' assessments, and there are carers who have found the process of 'being assessed' helpful and positive in terms of identifying and talking through their own needs. So many more carers would benefit, however, if some of the mountain of 'unmet need' was also addressed through this supportive process.' (p.7)