Carers

This factsheet aims to explain caring and will focus on carers looking after people with mental health problems. If you are a carer, you will find details of the types of support available and what services may be able to help. You will find suggestions of things you may find helpful for yourself and the options and support open to you.

Who is a carer?

A carer is a person who provides help and support to someone with a mental health problem. The term “carer” is usually used to describe friends or family who provide voluntary support rather than paid professionals or care workers who are employed to provide a service, though the term is sometimes, confusingly, used to describe these workers too. In the context of this factsheet, a carer may be a relative of the person they care for, or they may be a friend or neighbour. They may live with the person, or live apart. The one uniting factor is that they provide some degree of emotional support or practical help for the person they are caring for

How can a carer help someone with mental health problems?

It is important for a carer to try and gain an understanding of what the mental health problem is, how it affects someone, and how best to help. Carers can provide emotional and practical support and can encourage people to seek appropriate support and treatment, especially if the person has little insight into the fact that they are ill. They can become involved in treatment plans and, above all, make the person feel wanted, needed and loved. A major role for carers can be to monitor the person’s mental state, watching out for any signs of relapse, encouraging them to take their medication and to attend medical appointments etc. If a carer is concerned about any deterioration in a person’s mental state they should alert the doctor, psychiatrist or mental health team as soon as possible in order to prevent the possibility of a relapse.

What can a carer do in an emergency?

A carer may become very concerned about the mental health of the person they are caring for; perhaps as there are major signs of deterioration, or threats of danger to themselves or other people. In these cases, the carer can contact their local Social Services department or Community Mental Health Team and request a Mental Health Assessment, if this has not already taken place. This usually involves two doctors and an Approved Social Worker visiting the person at home to assess their mental health state, and to see whether any other support services need to be put in place. People with severe symptoms may require hospital admission for a period of assessment and treatment. Hospital admission can provide levels of care and attention that would not be possible at home. It can also give medical staff the opportunity to accurately assess a person’s condition over a period of time, and to provide a broader range of treatment than might be possible otherwise. Most people who are admitted to hospital go voluntarily, however, in some extreme situations a person may be admitted to hospital compulsorily under the Mental Health Act 2007, England & Wales (or equivalent in Scotland and Northern Ireland) commonly referred to as sectioning, or detention under section.

Under section 13 (4) of the Mental Health Act 2007 the 'nearest relative' has the power to request the social services department to carry out an assessment. Social services are legally obliged to respond.

'Nearest relative' is a legal term. The relevant person is identified by law in the following order:

husband/wife (this also includes civil partners and people who have been living as man and wife for at least six months)
son/daughter (if aged over 18)
father/mother
brother/sister
grandparent
grandchild
uncle/aunt
nephew/niece

If there is no one in the first category, move to the second category and so on. If there is more than one person in a category, the older one takes priority. (Only those living in England and Wales can be counted.) However, a relative who is actually caring for someone takes priority over all the others. A person who is not a relative, but has been living with the person concerned for at least five years, can also be considered as the 'nearest relative'.

There may be occasions when a carer may feel that the person they are caring for needs urgent psychiatric help, and mental health services are unable to arrange an appointment soon enough. In this situation, if practical, a carer could take the person to their local Accident and Emergency Unit where they can be assessed by the Duty Psychiatrist, or contact the person’s Crisis Team if they have one.

In extreme situations, for example if the person is presenting as an immediate danger to themselves or other people, a carer could call the Police and explain the situation. It is possible for the Police to take someone to a place of safety, either a Police Station or a hospital, where they will be assessed by a Psychiatrist. This option should be seen as an action of last resort as it can be a very distressing situation for the person involved and their carer

What needs may carers have?

Being a carer can be an extremely satisfying role, however, it can also be extremely challenging, physically and emotionally demanding, stressful, exhausting and isolating. Carers can have a variety of needs depending on their individual situation. Some carers may feel they need emotional support while others would like practical assistance. Some may want information and advice while others are looking for financial help. Some people may want recognition of the hard work they do, others may need time off from their caring role. Some carers are desperate to find some type of support service for the person they care for, others would like to become involved further in the planning of care programmes.

What rights do carers have?

Carers have recognised legal rights as set out in the Carers (Recognition and Services) Act 1995, the Carers and Disabled Children Act 2000, and the Carers (Equal Opportunities) Act 2004.

Carers are entitled to have a Carer’s Assessment to have their own support needs assessed by either their local social services or mental health services, but this needs to be viewed realistically as many local authorities do not have the resources to provide for these needs.

Carers can request a referral for a Carer’s Assessment from their own GP, or they can contact the Care Co-ordinator of the person they care for, their local Social Services Department, or if the person they care for is in the care of mental health services, they can request a Carer’s Assessment from the local Community Mental Health Team. Carers can also request a Carer’s Assessment independently of whether the person they care for is receiving services or not.

What does a Carer’s Assessment involve?

Carer’s Assessments aim to identify what support needs you may have, and to arrange ways to meet your needs. The assessment will usually look at how you are coping generally, whether you need emotional or practical support, what social or support networks you may have, whether your health has been affected by your role as a carer, how you might cope in an emergency, and whether you need information about benefits.

After the assessment you should receive a written support plan detailing how any needs that have been identified will be met. If the local authority is unable to provide any or all of the services you have been assessed as needing, they may put you in touch with other local voluntary organisations that can help you.

In certain situations where the local authority has assessed you as being eligible for a particular service they may not provide themselves, they may decide to give you direct payments. This is a means by which you can buy in the support you need from private agencies. This type of arrangement can be complicated, so it may be wise to contact your local social services and ask to speak to a direct payments specialist advisor

What kind of support may be available?

Respite care
This is designed to give you a break away from caring for a time. It might be a one-off break, or a regular service depending both on your needs and the needs of the person you are caring for. This often involves the person you support staying in a mental health respite centre to give you a break or allow you to go away for a holiday.

Domiciliary care
This usually involves a paid care worker taking over caring responsibilities for an agreed time each week, giving you a break from caring and allowing you space and time for yourself or to look after other responsibilities. Domiciliary workers can also help with tasks you might find difficult to do yourself, for example helping bathe someone.

Befriending services
Befrienders can visit people with mental health problems in their own homes, or go out with them. This can give the service user the opportunity for more social interaction, and allow you to have time off from caring. Befriending services are often offered by local voluntary organisations.

Day care services
There are a range of day centres, drop-in centres and day hospitals that service users can be referred to. These can offer a variety of services including social groups and therapeutic activities. These can be offered for anything between a few hours and a few days per week depending on assessed needs.

What financial support may be available?

Carer's Allowance is the main state benefit for carers so it's important to find out if you can receive it. Carer's Allowance is currently worth *£48.65 a week. To qualify you need to meet all the rules:

You must be 16 years old or over
You must look after someone for at least 35 hours a week
The person you look after must receive a qualifying disability benefit
If you work you must not earn more than *£87
You must not get one of a list of other benefits, contact your local CAB for details
You must be living in the UK when you claim Carer's Allowance
You must not be a full-time student

You may also be able to get the Carer Premium - an extra amount of money (up to *£27.15 a week) included in the calculation of Income Support, income-based Job Seekers' Allowance, Housing Benefit and Council Tax Benefit (Rent Rebate in Northern Ireland). An amount equivalent to the Carer Premium is used to calculate Pension Credit.

*NB: SANE will endeavour to keep the amount up to date, but to be sure of the latest details of these payments, check http://www.directgov.gov.uk/ or contact the Citizens Advice Bureau.

What can I do to help myself?

Support groups
Many people find it helpful to meet with others in a similar position. It can be very useful to share experiences with those who may be going through the same thing you are. There are opportunities for mutual support, and you may get ideas of what things other people have found helpful to them. Above all, it is an opportunity to help you realise that you are not alone in your situation.

Care for yourself
When you are caring for someone else it is extremely important that you look after yourself too. You will feel better if you are able to rest, eat properly, pay attention to your physical appearance, and don’t abuse alcohol or drugs. Be kind to yourself, allow yourself treats, and try to keep up a social life of your own.

Counselling
It can be very stressful caring for someone with mental health problems, indeed carers may be service users themselves. Sometimes it may help for you to have someone to talk things over with. A referral for counselling can be arranged by your doctor. However, frequently there are long waiting lists for treatment on the NHS. Free or low-cost counselling is also provided by a number of charities and voluntary organisations and, for those who can afford to pay, there are many private practitioners.

Where can I find help and support?

There is a wide a range of services available that can help provide support, advice and information to carers. You may find some of the following useful:

SANEline / SANEmail
1st Floor Cityside House, 40 Adler Street, London, E1 1EE
helpline:0845 767 8000
email: sanemail@sane.org.uk
web: www.sane.org.uk
SANEline and SANEmail offer emotional support and information to those experiencing mental health problems, their families and carers.

British Association for Counselling and Psychotherapy (BACP)
BACP House, 15 St John’s Business Park, Lutterworth, Leicestershire, LE17 4HB
tel. 0870 443 5252
email: bacp@bacp.co.uk
web: www.bacp.co.uk
See website or send A5 SAE for details of local practitioners.

Carers UK
20–25 Glasshouse Yard, London EC1A 4JT
carers line: 0808 808 7777, tel. 020 7490 8818
minicom: 020 7251 8969, fax: 020 7490 8824
email: info@ukcarers.org
web: www.carersonline.org.uk
Information and advice on all aspects of caring.

Citizens Advice Bureaux
Check the phonebook for details of your local office, or search the online database on the CAB website
web: www.adviceguide.org.uk
web: www.citizensadvice.org.uk
Helps people resolve their legal, money and other problems by providing free information and advice.

Crossroads Association
10 Regent Place, Rugby, Warwickshire CV21 2PN
tel: 0845 450 0350
email: mailto:help@crossroads.org
web: www.crossroads.org.uk
Can provide respite to carers. Trained carer support workers can provide practical support in the home.

Princess Royal Trust for Carers
142 Minories, London EC3N 1LB
tel: (020) 7480 7788
email: mailto:help@carers.org
web: www.carers.org
Provides information, advice and support services, and a network of 129 independent carers' centres.

Rethink
28 Castle Street, Kingston-upon-Thames, Surrey KT1 1SS
tel. 0845 456 0455 advice line: 020 8974 6814
email: advice@rethink.org / info@rethink.org
web: www.rethink.org
Working to help everyone affected by severe mental illness, including carers.

Samaritans
The Upper Mill, Kingston Road, Ewell, Surrey KT17 2AF
helpline: 08457 90 90 90, fax: 020 8394 8301
email: jo@samaritans.org
web: www.samaritans.org
24 hour telephone helpline offering emotional support for people who are experiencing feelings of distress or despair, including those that may lead to suicide.

Together – working for wellbeing (formerly MACA)
12 Old StreetLondon EC1V 9BE
tel: 020 7780 7300
email: contactus@together-uk.org
web: www.together-uk.org
Provides community services, including respite support for carers.

About Mental Illness