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Caring for someone who has mental ill health

A guide for carers

Darlington AssociationOn Disability

Introduction

This guide is intended to assist you if you care for (or may have to care for) someone who has mental ill health.

Mental ill health is relatively common; a recent survey showed that in a given year one in four adults have experienced some type of mental ill health.

The number of those experiencing severe mental ill health is fewer, but it is estimated that one in 100 of the population will require in-patient care at some point in their lives.

Whether you are supporting a relative or friend who is living with you or whether you visit someone in his or her home to provide support, we hope the guide will be of assistance when trying to understand:* something of the nature of mental illness* how it can be treated, and* what support you as a carer can expect to receive in

your role as a carer.

Mental ill health is an illness, just as real as a physical illnessIt is nothing for the person experiencing it, or the carer, to be ashamed of. Mental ill health can occur at any time of life and there are a variety of causes, some of which are due to

Revised November 2013

the genes which we inherit or are caused by traumatic experiences.However, most mental ill health results from difficulties experienced by the person in coping with stressful life experiences, such as bereavement, divorce or financial difficulties.

How we respond to these situations and what support we receive from others may possibly influence how the illness develops.Whether the mental ill health is acute, long-term or a milder form which comes and goes, caring can be very demanding and emotionally wearing.

It can also be unpredictable and upsetting, particularly when the person cared for is someone whom you love. You need all the information, advice and support you can get to support your caring role.

Then and nowIn the past, mental illness had a stigma attached to it and people were reluctant to talk about it, especially with reference to their own family. It was considered totally abnormal and unrelated to the physical body, which was said to be possessed by a strange spirit. The language used to describe people with mental ill health reflected this.

Recent initiatives like SHIFT and Time To Change have altered the public attitude to mental illness and the stigma once associated with it. These days many forms of mental illness can be treated by a General Practitioner, who will


know when to refer someone to be seen as an out-patient or to be visited by a Community Psychiatric Nurse (CPN.) or Social Worker at home.

It may be necessary for the person to be admitted to a hospital, but usually not for long and often to a hospital near their home.

In most cases people are admitted into hospital informally. This means that the person agrees to be admitted into hospital and the hospital agrees to have him/her as a patient.

Only in rare instances is it necessary for them to be admitted compulsorily under a section of the Mental Health Act (see section 9 for details).

On discharge from hospital, support should be provided for as long as the person needs it, to enable him/her to participate fully in their community.

The outlook for people with mental illness is improving. Many people make a full recovery, while others can continue their ordinary lives with treatment and support. There are a variety of forms of treatment and support which should make life easier for the person with mental ill health, as well as for you as a carer.

However these services are not always readily available and one of the purposes of this guide is to let you know what you can expect from the Mental Health Services and


what to do if these are not available. You not only have certain rights as a carer or nearest relative, but you should also expect to be consulted, informed and supported with regard to the treatment and care of the person for whom you care, as well as receiving support for yourself.

There is information in other sections about the organisations which you can approach if you are having difficulty getting services – you may need to be persistent. A new NHS directive called the Triangle of Care encourages hospital staff to involve carers when someone is an inpatient in hospital. As a carer you should be persistent in insisting that you are fully involved. You are an important part of your relative’s life and your views and needs should be taken into account.

Above all, you need to take care of yourself and not always put the needs of the person you care for above your own.

At the end of the guide there is further information on the different sources of support and advice and on what rights you have as a carer. There is also an explanation about how to make a complaint and on the different kinds of staff whom you may meet in the course of your relative’s treatment.

* Throughout the guide, where the word ‘relative’ is used, this can also apply to a partner or friend who is carrying out the caring.


Contents

Section

Introduction1 What to do in a crisis2 What are the signs?3 Making contact with Mental Health Services4 Who works in the Mental Health Services?5 Receiving treatment6 Discharge and on-going treatment and care7 Care Co-ordination8 A Carer’s assessment –

Checklist for preparing for an assessment9 Mental Health Act and compulsory admission

to hospital10 Your rights as a carer11 Making a comment or complaint12 Someone to talk to13 Support groups14 How to gain support and information for

yourself and the person you care for15 Carers’ register16 Looking after yourself17 The transition from Mental Health Services for

adults (under 65) to Older Peoples Services (over 65)

18 Young Carers and Young Adult Carers 19 Additional publications


1 What to do in a crisis

If your relative refuses to see his/her General Practitioner (GP) or to discuss the matter with you or anyone else and flatly denies there is any issue, you may need to take some action.

You may find it helpful to talk to a relative or friend, or to someone else whom you trust, perhaps someone who has themselves had experience of having a relative or friend with mental ill health, or you may like to approach one of the mental health organisations (listed at the end) for advice.

If you are seriously concerned for your relative and think that they may be a danger to themselves or others, possibly suicidal or paranoid, then the GP should be contacted for advice and possibly a visit.

If the GP thinks that your relative should be admitted urgently, he or she will arrange with the hospital for this to take place as soon as possible. She/He may ask the Crisis Resolution Team and/or Home Treatment Team to get involved.

However, if the GP can not persuade your relative that support is needed, then he or she can ask the Social Services Department to have an Approved Social Worker apply to the hospital to have your relative admitted


compulsorily for assessment under Section 2 or 3 of The Mental Health Act. This is done only in more extreme cases.

If the GP is not willing to take any action unless approached directly by your relative, you can approach Social Services yourself. Either you or the Approved Social Worker can then make the application for an assessment.

Alternatively, in an emergency you could ring the hospital or take your relative to the Accident and Emergency Department.

Before you request such an assessment you should consider whether this will affect your relationship with your relative. Causing him/her to be detained compulsorily, even for a short period, could be regarded by him/her as a breach of trust or a betrayal on your part. For this reason if it is necessary for him/her to be compulsorily admitted, it may be better for an Approved Social Worker to make the application rather than you.

It can be difficult to decide what is best to do. However, if you feel that you need to take action, you need to be reassured that what you are doing is the best for everyone.

Darlington Social Services Department can be contacted on 01325 346200 or out of hours on 0870 2402994. If you do not have this number with you, you can telephone the police on 101 and ask for contact details.


2 What are the signs to look for?

You may have a relative who is behaving uncharacteristically or even strangely. Examples of uncharacteristic behaviour will vary but may include: periods of depression or moroseness in a person not

usually given to low spirits. sudden outbursts of unwarranted anger in a normally

even tempered person or difficulty in getting out of bed in the morning in someone

who usually gets up in good time.

It may be that your relative is experiencing a passing mood or going through a bad patch in his/her life. However if the behaviour persists or is strange or bizarre, it may be that your relative is experiencing something more serious. There are certain signs which may indicate specific types of mental ill health. The following symptoms are taken from the Health of the Nation booklet: “Mental Health: Towards a Better Understanding”, published by the Department of Health.

Anxiety and phobiasSymptoms may include: faster heartbeat and taking quick, short breaths sweating giddiness and/or fainting tension/aches and pains dry mouth


These symptoms may also be caused by a physical illness and should be discussed with a GP.

DepressionSymptoms may include: having low moods for a long time loss of appetite or weight feeling tired being unable to sleep or waking up early losing interest in usual hobbies, activities or sex avoiding other people and being irritable poor concentration feeling persecuted feeling guilty – even suicidal

When a number of these symptoms are present, depression may be the cause.

Manic depressive illness (bi-polar disorder)Symptoms of the manic phase may include: being over active and very excitable poor judgement, such as spending more money than you

can afford not thinking straight believing yourself to be someone you’re not and over

estimating what you can do disinhibited behaviour, such as being over-familiar with a

strangerSchizophrenia


Symptoms may include: hearing critical or abusive voices excessive pre-occupation with religious ideas believing that someone is following or persecuting you believing your thoughts and actions are known or

controlled by someone else excessive fear and disturbed behaviour

What to doIn the first place, you can talk with your relative to get an idea how he or she is feeling. Try to find out: how long have he/she has had these feelings? has he or she felt like this before? has something happened to cause these feelings? Is this

cause still present?

If your relative does not wish to discuss the matter with you, you could suggest that he/she talk with someone else whom they can trust, such as another relative, friend, work colleague or a minister of religion. There are also voluntary organisations which have people trained to listen, such as the Samaritans or Mind (see section 12).

If your relative is willing to discuss things with you and you decide, through talking with them and through observing their behaviour, that there is a mental health issue, you can suggest a visit to his or her GP or offer to make an appointment.


3 Making contact with MentalHealth Services

Seeing the General Practitioner (GP)If your relative has agreed to see his/her GP, you can check that an appointment has actually been made and offer to accompany him/her.

During the appointment, the GP will want to know as much as possible about how your relative is and what may have brought about his/her present symptoms. You should encourage your relative to be as open as possible. All information will be treated in strict confidence, although it may be passed onto other Health and Social Service staff, unless your relative asks for this not to happen. If your relative is happy for you to be present, you can give your comments on his/her health. If they are not happy for you to be there, you should be offered another opportunity for you to speak with the GP.

At the end of the consultation the GP may decide on one or more courses of action:

1. Prescribe medication

It will be useful if you can learn what this is, what it does and what side affects to look for so that you can assist your relative in remembering to take it and to observe any affects


2. Refer to someone else in the practice, for example a counsellor

If the GP refers your relative to a counsellor, it will be an opportunity for him/her to talk about his/her issues. The counsellor will listen and may suggest ways of dealing with them.

3. Refer to a member of the Community Mental Health Team (CMHT)

A specialist Mental Health Social Worker or Community Psychiatric Nurse (CPN) working in the CMHT may also advise your relative. The CPN may advise on taking medication. They may also give medication by injection.

If the GP thinks that your relative may need a referral to a support group or day service, or needs advice and support with work or accommodation, the Social Worker will carry out an assessment to work out with him/her how best to meet his/her needs.

4. Refer to a voluntary organisation

There are a number of organisations which can provide advice, information, counselling and activities such as relaxation classes (see sections 12, 13 and 14).

5. Refer to an outpatient clinic to be seen by a Psychiatrist ( see also section 4)


6. A combination of the above

7. Admission to hospital

After the initial consultation the GP will want to see your relative again at some point to see how he/she is doing. You can support your relative in keeping their appointment, as well as encouraging him/her to do the other things which the GP recommends.

Seeing a Psychiatrist (See also section 4)If your relative’s GP decides to refer him/her to a Psychiatrist, she/he will receive an appointment from the Psychiatric Out-patient Department. If the GP considers that this is urgent, the appointment should be within a few days; if not, it should still be not more than a few weeks. The Psychiatrist will probably talk with your relative in more detail than the GP. As with the GP’s appointment, you can be present if your relative wishes and you can tell the Psychiatrist how you see your relative’s concerns/issues.

There are a variety of treatments which the psychiatrist may suggest for your relative; these can include: medication treatment by a clinical psychologist treatment by a psychotherapist counselling ECT


It is quite likely that the Psychiatrist will refer your relative to the Community Mental Health Team (See also section 4). They are a group of professionals who will assess your relative’s condition and suggest what course of action would be best. They will then review progress from time to time.

If the Psychiatrist considers that your relative’s condition needs assessment and treatment under close supervision, he or she will ask your relative to go into hospital as an in-patient. If your relative is not willing to go voluntarily as an informal patient and the Psychiatrist considers that assessment and treatment are needed urgently, they can recommend that your relative be admitted compulsorily. (see section 9).

Whether your relative is admitted to hospital or not, his/her needs will be assessed using something called the Care Co-ordination approach (see also section 7). This means that they will be given a copy of a personal care plan which details what treatment or care he/she should receive. Your relative will also be given the name of someone who is expected to co-ordinate all the care and support. This person is called a Care Co-ordinator (see also section 4).

Information and advice for youYou may find the Mental Health Services system confusing. If there are things which you do not understand, you should ask your relative’s GP, the hospital staff, or the Care Co-ordinator. They will not be able to give you details of your relative’s diagnosis and treatment without permission, but


you should be told in general terms what is being recommended for your relative and you should be allowed to be present during the assessment if your relative agrees.

If either you or your relative are not happy with what is proposed, you can ask to see another GP in the practice.If you or your relative are not happy with the Psychiatrist’s diagnosis or treatment proposal, you can ask the GP for a second opinion.

If you are still not clear about what is happening or disagree with the diagnosis or treatment, you can get more information, advice or support from the Patient Experience Team Service on 0800 0520219 or one of the mental health organisations listed in section 14.

If your relative needs advice or support, he or she, or you on his/her behalf, can contact one of the advocacy organisations listed at the back.

Out of hoursTo contact a GP, telephone your surgery. You will be transferred to a GP on call. He or she will offer advice or your relative may be asked to go to the hospital. If you are not able to leave the house, a home visit will be arranged.

Darlington Social Services Department can be contacted on 01325 346200 or out of hours on 0870 2402994. If you do not have this number with you, you can telephone the police on 101 and ask for contact details.


4 Who works in the mental health services?

Community Mental Health TeamThere are two community Mental Health Teams in Darlington both now based at West Park Hospital. These teams include a Psychiatrist, a Senior House Officer, Social Workers, Community Psychiatric Nurses (CPN’s), Support Workers, a Psychologist and a Cognitive Behaviour Therapist. Together they provide a comprehensive service in the community for those experiencing mental ill-health and their families. They may offer counselling and education as well as administering and monitoring medication. They will be able to assist you with day to day difficulties which may arise. A CPN may also work as a Care Co-ordinator (see section 7).

PsychiatristPsychiatrists are doctors specially trained to diagnose and treat mental illness. A Consultant Psychiatrist is the most senior and leads the medical team. Junior Medics are qualified doctors who work in psychiatry under the supervision of a Consultant Psychiatrist; some will eventually become Psychiatrists.

Social WorkerSocial Workers provide care and support in dealing with difficulties surrounding everyday living. They also have skills in assessing people’s needs in the community and ensuring


that these needs are met. Approved Social Workers are especially trained in dealing with people experiencing mental ill health. They are authorised to apply to have people compulsorily admitted to hospital. A Social Worker may also work as a Care Co-ordinator (see section 7)

Hospital nursing staffHospital nursing staff on psychiatric wards may be called Psychiatric Nurses. The more senior nurses have a particular qualification in nursing people with mental ill health. People admitted to hospital are allocated a Named Nurse who has specific responsibility for them.

Clinical PsychologistClinical Psychologists are Psychologists who are trained to work with people towards understanding their feelings, behaviour and thoughts and how these affect their daily lives. They normally work in a hospital setting and offer medium term treatment over 16 or so sessions.

PsychotherapistPsychotherapists are professionals who work with people with severe mental ill health by supporting people to understand their feelings, behaviour and thoughts. They offer long term treatment over 2-4 years.

Occupational TherapistOccupational Therapists are trained to assist people in developing confidence and skills that they need to live independently.


5 Receiving treatment

The kinds of treatment which your relative’s GP can recommend have already been described in section 3. The hospital medical staff can prescribe similar kinds of treatment for your relative, whether they are seen as an out-patient or treated as an in-patient. There are two main categories of treatment: medication and talking treatments.

MedicationAnti-depressant drugs are used to treat the symptoms of depression and assist people experiencing depression in becoming more motivated. Anti-psychotic drugs, or neuroleptics, are used to treat people with schizophrenia and manic depression. These are used to reduce agitation, assist sleep and ease symptoms, such as hearing voices and paranoia. Tranquillisers are also sometimes prescribed to calm patients, but they are used less now than previously. It may take time to discover the right medication and dosage.

Talking treatmentsTalking treatments are used to enable people to discover the causes of their ill health and find means of dealing with it: psychotherapy involves helping a patient talk about

his/her concerns and their causes in some depth and can be a lengthy form of treatment.


clinical psychology concerns people’s behaviour and involves assisting people understand it and how it can be changed.

counselling involves allowing people to talk about their concerns, come to terms with them and find ways of dealing with them.

In all these three forms of talking treatment, the therapist listens to the person, does not pass judgement and will not rush into a conclusion or suggestion for action.

Electoconvulsive therapy (ECT)Electroconvulsive therapy is sometimes prescribed for people with severe depression who have not responded to other forms of treatment such as anti-depressants. Some people are unhappy with it, because they fear that it will cause lasting damage to the person treated. Most doctors, however, are confident that it is safe and that it is useful for certain people. It is always given under strictly controlled conditions.

Your relative and treatmentUsually your relative must consent to any treatment which is prescribed. In some cases where a person is considered unable to make a judgement, treatment can be given without his/her consent under the Mental Health Act (see section 9). In some cases a second doctor’s opinion is required before treatment can be given. The person concerned must always be told about any treatment he/she is to receive.


6 Discharge and on-going treatment and care

Discharge from hospitalWhen your relative is ready to be discharged from hospital, a plan for further treatment and care should be drawn up by the hospital and you should be consulted about it.

The plan should include: details of further treatment while your relative is living at

home arrangements for any support which he/she will need, and details of the assistance he/she will require to find

accommodation and work, if this is necessary.

If your relative is returning to live with you, it is important that you are happy with the arrangements. If you are not, you should let the hospital staff know.

On leaving hospital, your relative may be under his/her GP’s care again. The GP will receive a report from the hospital and any further issues should be taken up with him or her. Your relative may require on-going treatment.

On-going treatmentWhether your relative has been admitted to hospital or just seen as an out-patient by a Psychiatrist, some form of on-going treatment will probably be needed.


If the illness is not too serious and your relative is expected to recover quickly, the treatment may take the form of some form of medication, talking treatment or both; these will gradually be reduced as improvements occur.

If the illness is more serious or chronic ( a condition which your relative is likely to have throughout his/her life), the treatment will probably continue for some time and will be adjusted.

According to how the illness responds to treatment, your relative: will need to return to the hospital for checks and possibly further treatment will probably be supervised by the Community Mental Health Team may be asked to attend a day hospital, which provides various forms of occupational activity, as well as treatment is quite likely be visited at home by a CPN to assess progress and possibly administer injections.

On-going care and supportThe Social Services Department will be responsible for any continuing care and support which your relative needs. A Social Worker from the Community Mental Health Team (see section 4) will discuss with your relative what support is needed and will draw up a plan of action which may include: assistance finding accommodation or a job assistance sorting out welfare benefit entitlement


various day services to occupy and assist him or her during the day and possibly provide support at home. Your relative may be asked to contribute to the cost of these services.

What to do if you are not happy with your relative’s treatment or care

If you are not happy with the treatment that your relative is receiving through the Health Service, you should take it up with the hospital staff, if he or she is being treated there, or with the GP, if he or she is being treated at the GP practice. If you are still not happy with the hospital treatment received, you should take it up with your relative’s GP. If these routes fail, you can ask for advice from one of the mental health organisations listed in section 14 or the Patient Experience Team Service on 0800 0520219, who can also advise you on how to make a complaint (see section 11).

If you are not happy with the care which your relative is receiving from social or voluntary services, you should take it up with the Social Services Department or the voluntary organisations concerned. If this fails, then you could contact one of the mental health organisations listed in section 14 of this guide.

Section 14 also gives details of two advocacy organisations which can assist and support either your relative or yourself.


What to do if your relative becomes seriously ill again

Your relative may develop worrying signs or symptoms, such as those experienced previously and detailed in section 2.or when he/she was ill before. If you are concerned you can suggest to your relative that he or she asks to see his/her GP, urgently if necessary. If he or she does not want to do this, you can approach the GP yourself and express your concern.In an emergency you can ring the hospital or dial 999.


7 Care Co-ordination

The following section has been written for people experiencing mental ill health by Darlington and County Durham Priority Services Trust. . It explains the procedure required to arrange the services and care needed by someone experiencing mental ill health

Services to support people with a mental health need in Darlington.

The staff involved in the care of people with mental health needs from Health and Social Services have joined together to form Community Mental Health Teams (CMHT’s). This includes Social Workers, Community Psychiatric Nurses, Doctors, Occupational Therapists and Support Workers.

The way Health and Social Services work with people with mental health needs to identify what problems they have and what support we can arrange for them has changed. Instead of providing services separately, from now on anyone who needs the support of Health or Social Services will find they have:- one assessment one care package one person making sure that they receive the right care.

We want to make it easier for you to see the right professional at the right time without having to have more than one assessment of need. This should mean that you Revised November 2013

won’t have to be asked the same questions more than once. This way of arranging the services you need is called Care Co-ordination.

What does Care Co-ordination mean for you?The reason for the change is to organise services in a way that makes them work together more closely. We are doing this to make the service: easier to understand easier to ask for information, advice, help and support able to provide more choice in the help available to you able to give the person being cared for more involvement

in how the service is planned and delivered.

We want to make it easier for you to get the service you need.We want to manage the service in partnership to ensure we help people to move through services easily.We want to make sure that you and your carers have a say in how services are developed and provided.

Who can contact the Community Mental Health Team?Anyone can contact the Community Mental Health Services if they have mental health concerns. You can telephone or write to the Community Mental Health Team Ask a relative, friend, carer or professional to make contact for you

Usually people see their G.P. if they are unwell. GPs will contact the Mental Health Service on your behalf to request


specialist workers to look at your needs with you and help decide what services are best for you

How will Care Co-ordination work?

What happens when someone first contacts the Community Mental Health Team?When you contact us you will be asked some basic questions by a member of Health or Social Services staff to identify how best they can help. The member of staff can: give you the advice and information you need redirect you to someone else who can offer more appropriate help and/or arrange for you to have an assessment to find out what support you need.

What is an assessment?An assessment is carried out with you to identify what your needs are and to determine what services are suitable to support your needs.This assessment will be carried out by the most appropriate person for you. These people are called Care Co-ordinators.

What happens during an assessment?The Care Co-ordinator will meet with you to: ask questions about any difficulties you are having find out what you would like to do discuss what support is available to you Identify any carers and ensure that they are given an opportunity to have their needs assessed.


The Care Co-ordinator will also talk to other workers involved in your care, e.g. GP’s, Occupational Therapists and Support Workers. A report is then written to say what your needs are and what is going to be done to support you. This is called a Care Plan.

You will receive a written care plan which will provide information about which services you will receive and who is responsible for making sure you receive these services.

Who is involved in an assessment?You will be involved in planning your care with your Care Co-ordinator, and other members of the team who are supporting you. This may involve the Consultant Psychiatrist, your Support Worker, Occupational Therapist, ward/day hospital staff and you may wish to involve a carer, family member or an independent advocate.

The review meetingsWe will look at your care plan at meetings. These meetings are called “Reviews” or “Care Co-ordination meetings”. They are held so that we can discuss with you any areas of concern you are having and the progress you are making. If, following a review, a change is made to the services you receive you will be provided with an up-to-date care plan.

There are two levels of care co-ordination provided

Standard level – is for people whose needs can be met with the support or help of one professional person or where you need only low level support from one agency or professional.


Enhanced level – this will apply when more than one agency or mental health professional needs to be involved in planning and providing care.

Care Co-ordination standards you can expect:- we will provide people receiving care co-ordination with a copy of a written care plan- the care plan will be regularly reviewed by the person’s care co-ordinator- you will receive a copy of a written care plan that will be agreed on your discharge from hospital. This will set out the care to be provided and identify the care co-ordinator- we will offer all carers who provide regular and substantial care an assessment of their needs and a support plan, which will be reviewed every year.

What if you are not happy with the assessment or the services you receive?

You have a right to complain at any time if you are not satisfied with the assessment you are given; or you are unhappy with the kind of help you are offered following your assessment.

For further information about the complaints procedure, contact the Care Co-ordinator. The team want to be able to make sure people get the support they need in an organised and sensible way.


8 Checklist for preparing for a carers assessment

Anyone who provides or intends to provide a substantial amount of care on a regular basis can have a carer’s assessment. It's not just the amount of time you spend doing practical tasks. Caring for someone with mental ill health may require a lot of supervision and emotional support. It is important to consider the impact it has on your life - such as your health, your work, your relationships with family and friends - and what caring prevents you from doing.

You can have a carer’s assessment if you: live with the person you care for live away from the person you care for care for someone full time care for someone as well as working full or part time.

You can ask your GP, Social Services or someone from the Community Mental Health Team or for an assessment


The following checklist gives you some things to think about when getting ready for assessment.

1. About your caring roleDo you and the person you look after live in the same house or do they live in their own home?

2. What sort of support/assistance do you provide?This might include:

shopping

dealing with money (collecting pensions, paying bills)

talking to GP’s/hospital appointments

housework/cleaning

providing meals

laundry

bathing

toileting

dressing, washing or other personal care

keeping an eye on the person you support

emotional support


3. Do you provide support during the night?

4. Approximately how many hours a week do you provide care for someone?

5. Does the person you care for receive any other type of help e.g. domiciliary care?

6. Do you receive any support from family/friends?

7. How does it affect you?

When was the last time you had a whole day to yourself?

Has your own health been affected as a result of caring for someone?

Has your work been affected as a result of caring for someone?

If the last question is yes, how has it been affected?

I am unable to do the job I would like

I am unable to change my present job

I am unable to work as many hours as I would like

I have to work to support the person I care for


8. Do you feel able to continue with your present level of care?

9. Do you feel you need support to continue to care?

If yes, what support do you think you need?

10 Do you need time out from your caring responsibilities?

Possible outcomes from a carer’s assessment

Please don’t be put off by the word ‘assessment’. This is not about judging you as a carer. It is about making sure that your views are listened to and are about both your own needs and the needs of the person you care for. This is to ensure that both of you receive the most appropriate type of assistance available.

In addition it may open the door to: the possibility of increased services for the person you care for, either to increase his/her independence or to take the pressure off you, or to enable you to take a break.

the opportunity for you to receive advice on how to care for the person you care for e.g. moving and handling, how to respond to mental health needs/presenting behaviours you may find difficult to manage.

in some instances, the possibility of services in your own right (carers services).Revised November 2013

9 Mental Health Act and compulsory admission to hospital

If your relative has to be compulsorily admitted to hospital, the following provides a summary of the statutory arrangements under the 2007 Mental Health Act:

AdmissionAn application for admission for assessment has to be made either by an Approved Social Worker or the nearest relative. It has to be supported by the recommendations of two Doctors, or, in the case of an emergency, of just one Doctor.In any case, the hospital to which application is made must be satisfied that: your relative is sufficiently ill to need to be detained for

assessment, and he or she needs to be detained in the interests of his or

her own health or safety or of the protection of others.

DetentionYour relative can then be detained for up to 28 days, or in the case of an emergency assessment, for up to 72 hours. Your relative can be further detained for treatment on the recommendations of two Doctors for up to six months.Also, if your relative has been admitted to hospital informally and wants to be discharged, but the Hospital Doctor considers this is not in his/her best interests, then they can be kept in hospital for up to 72 hours.


In addition a nurse can recommend that your relative be detained for up to six hours, if there is no immediate access to a Hospital Doctor and the nurse considers it to be in the best interest of the patient. The Health Trust should write to the legally defined nearest relative to formally tell him/her of his/her relative’s detention.A Consultant Psychiatrist can assess a person detained via the Mental Health Act and remove the detention order. A person may continue in hospital ‘informally’ at this point.

Right of appealYour relative has the right to appeal to the hospital to be discharged and, if this is not successful, he/she has the right to appeal to the Mental Health Review Tribunal (see contact details below). The Act also provides for your relative to be entitled to an Independent Advocate.Similarly the nearest relative has the right to appeal to the hospital and then to the Mental Health Review Tribunal.

You can discuss these statutory arrangements with medical or nursing staff in order to get a fuller understanding of them. You can contact the Mental Health Action Office within the County Durham and Darlington Priority Services NHS Trust on 0191 3336573 or 0191 3336557. They can assist with your appeal application and give you some information with regard to appeals.

Mental Health Review TribunalSpur Q North, Government Buildings, Honeypot LaneStanmore, Middlesex, HA7 1AY


10 Your rights as a carer

Carers have a legal right to have their own needs assessed.

The Carers (Recognition and Services) Act 1995, gives people who provide substantial care on a regular basis the right to request an assessment of their needs when the needs of the person for whom they are caring are being assessed or reviewed.

In addition, following implementation of the Carers and Disabled Children Act in 2000, people aged 16 and over who provide substantial care on a regular basis are also entitled to an assessment of their own needs, even if the person for whom they are caring has refused an assessment or the provision of services. This right only applies where the local authority is satisfied that the person cared for is someone for whom it may provide or arrange for the provision of community care services.

Following implementation of the Carers (Equal Opportunities) Act in April 2005, all carers should be informed of their right to an assessment and there is a duty placed on Councils to consider a carer’s outside interests (work, study or leisure) when carrying out an assessment. Better joint working between Councils and the Health Service will also be promoted to ensure that support for carers is delivered in a coherent manner.


Although a carer’s assessment does not guarantee that the carer’s needs will be met, the evidence in an assessment will place a pressure on Health and Social Services to try and meet them.

Your needs as a carer can be assessed either as part of the assessment of the person you care for, or through a separate carer’s assessment. See Darlington Adult Social Care Departments leaflet, ‘Helping Carers to Care’ for more detailed information.

National StandardsIn addition, the Department of Health has set out certain national standards for the treatment and care of people with mental ill health.

These standards state that all individuals who provide regular and substantial care for a person on Care Co-ordination Approach should:

have an assessment of their caring, physical and mental health needs, repeated at least annually

have their own written care plan given to them and implemented in discussion with them

The Department of Health says that a carer’s plan should include information on the following:


the mental health needs of the person for whom they are caring, including information about medication and any side effects which can be predicted

the services available to support the mentally ill person

the action needed to meet defined contingencies or emergencies

what to do and who to contact in a crisis

what will be provided to meet their own mental and physical health needs, and how it will be provided

the action needed to secure advice on income, housing, educational and employment matters

arrangements for short term breaks

arrangements for social support, including access to carers’ support groups

information about appeals or complaints procedures

Nearest relative

Nearest relatives of people with mental ill health who are compulsorily admitted to hospital also have certain legal rights. Since these are fairly detailed, they are not included here, but the information can be obtained either from the


hospital or from one of the mental health organisations listed in section 14.

The legal definition of nearest relative is complicated, but it is similar to next of kin. A person who is not a relative, but has been living with the person concerned for at least five years, or as husband or wife for at least six months, can be considered as nearest relative. Also the nearest relative can nominate someone else to act in his or her place.

It is the nearest relative whom the Approved Social Worker has to consult about compulsory admission of a person to hospital – this may not in some cases be the carer.

Legal and money matters

Power of AttorneyIt may be useful for the carer to make arrangements to have power of attorney. This is a legal document which gives the carer the right to act on behalf of his/her relative and is drawn up by a solicitor. Power of Attorney needs to be arranged when the relative is able and willing to agree to it.

Trust FundA solicitor may also advise about the possibility of setting up a trust fund to deal with money matters on behalf of the relative, if he or she is not able to deal with them properly.


11 Making a comment or complaint

If you are not happy with the service you or your relative are receiving, you have the right to comment or complain. The following points may be useful:

1. If what you wish to complain about concerns your relative and not you personally, it is best if they make the complaint themselves. If they are not able to do this you can complain on your relative’s behalf. Make sure that you have accurate details about the issue or incident, for example time and place, who was involved and a description of what took place.

2. Make the complaint as soon as possible after the incident occurred. There are usually time limits within which complaints should be made.

3. Begin by speaking to an appropriate member of staff about the service you or your relative are receiving. If you do not feel this is appropriate ask to speak to someone else such as a manager or consultant. For complaints about Health Services you could begin by speaking to a Patient Experience Team officer. They will try to resolve the problem at a local level.

4. Sometimes you may not want to make a complaint but just tell someone about the service you or your relative


has received. You can make comments about services to any member of staff or write directly to a senior member of staff such as a ward manager or consultant.

Making a formal complaintBy speaking to someone you have effectively started the complaints process. If your complaint is not resolved after speaking to staff you can make a formal complaint.

If you want a complaint to be dealt with formally or the complaint is serious you can write directly to a senior member of staff, the complaints manager of the relevant hospital, Chief Executive of the Health Trust or to its Complaints Manager. Their contact details should be on leaflets you have about services. For Health Services this is called Local Resolution.

There is a separate procedure for complaints about Social Care Services. In Darlington you can ask to speak to a manager or write to their Complaints officer. Darlington Borough Council has a Compliments, Comments and Complaints leaflet which gives details of how to complain about a service.

There are timescales within which complaints should be managed. You should be kept informed about what has happened to your complaint. You should also receive a letter with details of the outcome of your complaint.


If you need support to make a complaint, information on who to complain to, or how to start the process you can contact one of the organisations listed in section 14. .

Taking your complaint further

The OmbudsmanIf you are dissatisfied with the outcome of a complaint there may be further steps that you can take. You can ask the Ombudsman to investigate. The Ombudsman is independent of Health or Social Care Services. He/She can consider a complaint only if it has gone through all the earlier stages.

ICASThe local Independent Complaints Advocacy Service (ICAS) is an independent organisation providing advice, assistance and support to people in Tees, Esk and Wear Valleys who have a concern or complaint about the National Health Service. It is not part of the NHS and is completely confidential. ICAS can offer you experienced advocates and case workers to help you make a complaint about a service provided by the NHS. You can contact your regional ICAS on 0300 456 8348


12 Someone to talk to

Carers often say that, where possible, it helps to share your concerns with a close friend or member of your family.

Alzheimer’s Society family support worker. The Alzheimer's Society has a Dementia Support Worker in Darlington who can provide one-to-one support for people with dementia and their family and carers. The support worker can provide ongoing practical and emotional support and can assist with issues such as obtaining a diagnosis, effective care planning, information, and advice. They also run a support group (see also section 13)

Unit 1,Suite 40, Evans Business Centre, 10, Stephenson Court, Skippers Lane Industrial Estate, Middlesbrough TS6 6UT Telephone: 01642 442030

Carers UK Darlington BranchA Drop-in, organised by carers is available on a Tuesday from 10.00am to 12:00pm and on a Friday from 12:00pm to 2.00pm. You will be made welcome and can chat over a cup of tea with other carers.

Bradbury House, Beaumont Street West, Darlington, DL1 5SXTelephone: 01325 362832


DAD Carers’ Support ServiceCarers Support Workers can offer a listening ear and someone to talk to about your role as a carer, in confidence. This can be over the telephone, at home, at the office or in a place of your choice. The service has a specialist mental health carer’s support worker

Enterprise House South Entrance, Valley Street, Darlington DL1 1GYTelephone: 01325 357533Email: [email protected]

North East Council on Addictions (NECA)NECA provides a confidential counselling service if your life is particularly affected by drugs or alcohol use.John Dobbin Road, 158-166 Northgate, Darlington DL1 1QU

Telephone: 01325 267230.

RethinkThis is a national charity which provides support services and information to improve the lives of everyone affected by mental health issues. Rethink offers information, advice and one to one confidential support either over the telephone or face to face. Telephone 0300 5000 927Rethink Advocacy contact Telephone 01388 766310

SamaritansSamaritans provide a confidential listening service, 24 hours per day.


mailto:[email protected]

Telephone: 01325 465465

13 Support groups

Darlington Young Carers ServiceSupport Young Carers aged 25 and under who help to care for someone at home. They aim to reduce the impact on caring by offering one to one support activities and support groups, information, advice and guidance-whole family support and advocacy.Darlington Young Carers ServiceUnit 2B Enterprise House, Valley Street North, Darlington DL1 1GY Telephone 01325 483038.

Support groups provided by Alzheimer’s Society

Dementia Support Group The Dementia Carers' Support Group runs twice a month on the 1st and 3rd Thursday from 1.30pm to 3.00pm.

The Dementia Café runs on the second Wednesday of the month from 1.45pm to 3.45pm. The Dementia Café is an opportunity for people with dementia and their families/carers to meet in an informal atmosphere for peer support, information, speakers and socialising.

Both groups meet at Age UK Darlington, Bradbury House, Beaumont Street West, Darlington DL1 5SX.


St.Herberts D Caf Community

Meet the 3rd Tuesday of the month at St Herberts’s Church Hall, 343 Yarm Road, Darlington DL1 1BD

The Lawns Café

Meet the 1st Wednesday of the month 10-12 noon at The Lawns Care Home, Ridsdale Road, Darlington DL1 4EG

For further information contact Jenny Leeming on 07725 214 684 or Shamaza Ali on 07850 928 924.

Darlington Bipolar GroupThis provides specific support and an opportunity to talk to other people who experience similar issues and to gain a better understanding of the illness.Meets the last Monday of the month at 7pm. For venue and more information contact Dennis Haithwaite Telephone: 01325 469594

Mental Health Carers’ Support GroupDAD Carers’ Support Service organises this group, which meets on the last Tuesday of every month from 1.30pm to 3.00pm at Evolution (near the Boot & Shoe) Church Row, Darlington. The group offers an opportunity to meet other carers, share information and experiences, and gain information from a range of speakers. You can telephone the Carers’ Support Service if you would like to talk to a worker before you come along to the groupTelephone: 01325 357533.


14 How to get support and information for yourself and the person you care for

DAD Advocacy ProjectProvide advocacy support for people in Darlington who have a learning disability, mental health needs, physical or sensory needs or are older people and carers of people in these groups. Our clients will also be receiving support from Adult Social Services in Darlington or Mental Health Services. Contact Advocates on 01325 360524.

Alzheimer’s SocietyThe Alzheimer's Society has a Dementia Support Worker in Darlington who can provide one-to-one support for people with dementia and their family and carers. The support worker can provide assistance with issues such as obtaining a diagnosis, effective care planning, information, and advice.

Unit 1, Suite 40, Evans Business Centre, 10, Stephenson Court, Skippers Lane Industrial Estate, Middlesbrough TS6 6UT Telephone: 01642 442030 or contact Jenny Leeming on 07725 214 684.Website: www.alzheimers.org.uk


Carers UKCarers UK provides a national voice for carers in the UK. Carers can become a member and receive regular mailings, keeping them up to date with carers’ issues.

Telephone: 0808 8087777 Website: www.carersuk.org

Citizens Advice Bureau (CAB)CAB provides advice on many issues, including housing, finance, benefits, welfare rights and community care services. As well as appointments at their main office CAB also has arrangements with some GP surgeries in Darlington.

Telephone:01325 256999.

D.A.D Carers’ Support Service provides a listening ear, information and advice and acts as a signpost to services. The service also provide a quarterly newsletter. The Carers’ Support Service can answer queries about a whole range of issues. Common enquiries include how to get the right services, how to organise taking a break, what happens when someone goes into hospital and what benefits carers may be entitled to. Staff are able to visit carers in their own home, or arrange office appointments. Complementary therapies are also offered.

Telephone 01325 357533E-mail [email protected] Website: www.darlingtondisability.orgRevised November 2013


Darlington MindThe organisation provides a variety of services for people experiencing mental ill health and/or emotional distress. Confidential counselling, ICT, art and creative crafts, drop-in service, supported housing, education and employment support and advice are just some of the services on offer.

Telephone: 01325 283169 Website: www.darlingtonmind.com

First StopThe charity is able to provide support associated with drugs and alcohol misuse. The organisation offers advice, information and support to carers.Telephone: 01325 254463 Website: www.darlingtonfirststop.org.uk

ICASThe Independent Complaints Advocacy Service (ICAS) provides a free confidential service to help guide you through the NHS complaints process. Telephone: 0300 456 8348

Mental Health Matters HelplineThis provides an out-of-hours telephone and support and information service, providing emotional support to anyone who calls. Information can be provided on many local and national services specific to mental health. The telephone line is open from 5.00pm to 9.00am weekdays and 24 hours at weekends and Bank Holidays.Telephone: 0800 0857027 (free phone)


Non Emergency Medical Advise ServiceTelephone 111

Talking ChangesFor people who feel anxious, stressed or depressed. A variety of therapies available. GP or self referral. Telephone 0191 374 0044

North East Council on Addictions (NECA)NECA provides drugs and alcohol awareness workshops and information and advice in person or over the telephone about drugs, alcohol, gambling or other addictions.Telephone: 01325 267230.

RethinkRethink offers free, independent and confidential advice covering medical, legal, financial and personal matters.Telephone: 0845 4560455 or 01388 766456 E-mail [email protected]

SanelineThis is a volunteer telephone service providing information on local and national resources which may be of assistance. Saneline is open every day of the year from 6.00pm to 11.00pm and can offer support and during a particularly difficult time, the call-back service will be offered, at an appropriate and agreed time. Telephone: 0845 7678000



Specialist Mental Health ServicesStaff teams are attached to West Park Hospital in Darlington. If the person who you are caring for has a severe mental ill health and you have a Care Co-ordinator you may contact whichever is the relevant team.

Carers who are worried about the health of the person they are caring for are more than welcome to telephone and speak to the duty worker at either team. Telephone: 01325 552000

Tees, Esk and Wear Valley NHS Trust Patient Experience TeamThe service offers advice and support. Staff will guide the patient, their family and friends through the different services available at the Trust, helping to sort out any concerns about the care being received. They provide information and can refer you to independent or specialist advisory services if requested. They also offer the opportunity to raise, in confidence, any problems, concerns and comments about the care and services being received and provide an early resolution. Telephone: 0800 052 0219 Email: [email protected]



15 Carers’ register

As a carer you can register with DAD’s Carers’ Support Service. The Carers’ Register:

enables you to receive regular information about services and support

gives a more accurate picture of carers in Darlington provides a way for Health, Social Services and other

organisations to ask what you think about services.

You can also register with your GP as a carer. GP practices have a responsibility to identify and record carers who use their services and to provide carers with appropriate support.

The Carers Support Service has a very strict code of confidentiality and we are not allowed to pass on your details to any other agency without your permission. Sometimes we agree to send out information on behalf of Health or Social Services, but only if it seems relevant and appropriate. In such instances the agencies pass on the information to ourselves and we mail it out to you. They do not see any of your details or know whom we have sent it to.

We are obliged by law, through the Data Protection Act, to update our information regularly. Once a year we write to all carers on our register asking for permission to continue to hold their details.


Contact the Carers Support Service if you decide to register with us or you simply want to talk through the situation you find yourself in. We are here for you, the carer.

DAD Carers Support ServiceEnterprise House, South EntranceValley StreetDarlingtonDL1 1GYTelephone: 01325 357533Text: 0762 481 8780 E-mail: [email protected]: www.darlingtondisability.org

This service is free, independent and confidential, providing information, advice and support.



16 Looking after yourself

It is important that as a carer, you protect your own health and wellbeing.

Darlington Association on Disability has an Information Service which can provide you with details on accessible holidays in the U.K. and abroad.Telephone: 01325 489999

Darlington Mind offers a free and confidential counselling service, holistic therapies and yoga sessions, courses which include anxiety management, assertiveness training, anger management and depression management.Telephone: 01325 283169

DAD Carers’ Support Service has a Carers’ Short Break Fund which it manages on behalf of Darlington Adult Social Care. The fund can provide the carer with the opportunity to take a break from caring. The break can include time away on holiday with or without the person being cared for, day trips, or fund other activities which gives you as a carer a break from your caring role. Telephone: 01325 357533


17 The transition from Mental Health Services for adults (under 65) to Older People’s

Services (over 65)

There are specialist Mental Health Services for older people just as there are specialist services for older people with other medical conditions. These services generally deal with people over the age of 65 years.

What happens to the person being cared for if they still require mental health services at the age of 65?If a person is receiving a service from a consultant or a member of the community mental health team the Consultant or Care Co-ordinator will reassess him/her as they reach the age of 65. If his/her needs can still be met by the same team then things may not change. Sometimes however the Consultant or Co-ordinator may recommend an assessment from a specialist team for older people. Following this, advice will be given as to which service best meets the assessed need. The person, and if they wish, his/her carer, should be fully involved at all stages of this process.

Why does an older person need to change services?As people get older their mental ill health may be complicated by issues relating to physical health and impairment. This may have an impact on their mental health, and their ability to manage independently. The teams that deal with younger people do not have the Revised November 2013

knowledge and expertise to deal with these issues in the same way that specialist teams for older people do.

How can a new team work effectively?Getting to know new people is difficult for both practitioners and the person receiving care. However, before any transfer of care takes place, details will be passed from the existing service to the new one. This will include which treatments have been effective. In addition, the new Consultant will have access to all the previous medical records.

What if the person has been well for years and has a relapse when they are over 65?In this case the person will usually be referred to the Older People’s team. The team will access any previous clinical records to assist in advising the person of the best treatment.

What the person with mental ill health should expect: the Consultant/Care Co-ordinator will reassess need when the age of 65 is reached if a referral to the older persons team is considered the reasons should be explained and consent obtained the person should be able to involve relatives or an advocate in this process if they wish a summary of the issues including an account of previous treatment should be sent to the new consultation/ team in advance someone from the older persons team should inform the family doctor of the new arrangements and of any new care plan.


18 Young carers and young adult carers

Darlington Young Carers ServiceSupport Young Carers and Young Adult Carers aged 25 and under who help to care for someone at home. They aim to reduce the impact on caring by offering one to one support activities and support groups, information, advice and guidance-whole family support and advocacy.Darlington Young Carers ServiceUnit 2B Enterprise House, Valley Street North, Darlington DL1 1GY Telephone 01325 483038.


19 Additional publications

Carers UKThe National Charity campaigning for carers has several useful free publications for carers, including:- benefits – What’s available and how to get them coming out of hospital direct payments for carers disability Living Allowance and Attendance Allowance how do I get help? England Carers Allowance and the Carer Premium juggling work and carer – For Employees taking a break Telephone: 020 73784920Website: www.carersuk.org

Darlington Association on Disability (DAD)DAD has an on-line Information Guide sections of which can be requested in printed form or an alternative format.

Tel: 01325 489999Website: www.darlingtondisability.org

Rethink‘Caring and Coping’ is a guide for those involved in providing care to people with severe mental ill health.Tel: 0845 456 0455Website: www.rethink.org


http://www.rethink.org/

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