Items marked in Items marked in Red are new or are important
If at any time you are at a loss as to what to do and have been blocked off everywhere else. If, for example you missed out on the first Care Programme Approach [ Care Plan and Needs Assessment ] - not knowing much about it at the time, then
You must - should ask for a Carer Assessment .The Local Authority are obliged to do one with you.
Quite often, now, a member of the Mental Health Trust Team will do one, designated to do one as part of an initial 'Core Assessment' [part of the CPA needs assessment] - where you and patient have your future needs recorded.
If coming late into the system, you can put on record what you are experiencing as shortcomings in the caring situation and what other support you feel is lacking, is your frustration, and complain about how your family member is treatedFirst, get the reassurance that what you say is confidential information, between you and the community team members only - not the patient.,
More positively, you should be asked - and if not - this is the guide for you
- Would you find it helpful to have ' breaks from caring in the week' .... would it be helpful to you if we helped your family member to have some time to themselves outside the home
- to give them a routine of their own in the week outside the care base, a future purpose and an interest; and the famly some time to itself ?When they have been, think about writing a follow up letter to the team who are seeing your family member, putting in their record, what should happen and what might be done.
Other channels available to you if there is dissatisfaction, - you might try with success are
1. to discuss the issue with the PALS advisor - it is for patients, but they can be peruaded to be pro-active if a patient is the issue being raised.
Or 2. write to the CHief Executive of the local Mental Health Trust that is giving you the grief. Thats the official route for carers to complain. And keep at that till you get a full and a satisfactory accounting - if you don't, then
3. go to your GP and to your MP.
Now back to the beginning of your Carer Journey - for Carer Assessment
Get yourself right in the system at the very beginning - be registered by the Mental Health Trust Team as the Carer.
1st. Ask the local Mental Health Team for a Carer assessment in the first Core Assessment by the team, , right at the beginning of the admission stage to the Secondary Service - the mental health Trust service - at the Needs Assessment Stage - the first part of the service in the Care Programme Approach [CPA ] so as to o make sure you understand what the future holds for your caring situation, and what relief during the week you can expect.You must ask thsat th Care Plan contains an undertaking for 'breaks in the week' from caring, as above
Recent revision of this link to current NHS CPA carer guidanceis helpful to carers guidance so that they know what involvement and consultation they should get in the NHS management of the family patient.
2nd ...... whenever there is a change in the condtion of your family patient and you are not satisfied.
3rd ..... If there is a decision to remove your patient frm the Care Programme Approach and take them out of the Mental Health Trust service.
If you do not ask you will not be given consideration - that is from general experience.
"Are you a carer of a person with a mental health problem?
You may think of yourself as a mother or father or spouse or daughter or son - but you will be called the carer if the sufferer is going to be with you.
The term carer is used here to describe someone who provides or intends to provide practical and emotional support to someone with a mental health problem. You may or may not live with the person you care for. You may be a relative, partner, friend or neighbour. You may be a young person but you now find yourself in the position of needing to support a person who is unwell.
The term mental health problem is used to describe a common mental illness such as a situation or stress related anxiety or depression, a persistent obssessional state [ OCD ], serious eating problems [anorexia or bulimia ], a severe and enduring mental illness such as schizophrenia or bi-polar affective disorder (manic depression).
WHAT CARERS SHOULD EXPECT FROM MENTAL HEALTH SERVICES
Carers Assessment
Under the Carers (Equal Opportunities) Act 2004 a legal duty has been placed on the Local Authority to inform carers of their right to an assessment.Under the Carers and Disabled Children Act, 2000, the local authority has a statutory duty to undertake an assessment of the needs of any carer who requests one regardless of whether the person they care for has had an assessment or wants one themselves.
For mental health the carers assessment should, ideally and properly for the carer , be asked for and made, when the first Care Programm Approach needs assessment is made for the person you care for.
That really means the Trust service that is dealing with your family member should identify you as a CARER on first contact, and tell you about the entitlement to have your future as a carer - assessed to see what your 'wants' for that future will be.
But do not leave it to them - tell the specialist mental health 'first contact' [ admission or Home Treatment ] team representative that you are a carer and that you want a carer assessment right away, before you will accept that your family member continues in your care, or to somewhere where you will be expected to give support, and may have to intervene on their behalf.
[ The family patient will be examined from the point of view of the Care Programme Approach - initially a needs assessment .... the first contact examination which should lead to a needs assessment for them, and out of that a care plan of what the patient requires as an aftercare service to stay well ... ]
You should also have the care plan drawn up based on your needs and ability to care.
Now that Home Treatment is the government preferred option - you are going to be faced maybe with looking after your family sufferer all their lives.
So, the first needs assessment for the patient must include what you see as to what must be put in place before you can accept Home Treatment.
This is a crucial step.
You must insist - register the request - that there must be in place a programme of continuing aftercare - in the CARE PLAN part of the Care Programme Approach - [CPA } which gives your family patient a life of meaning outside your home, and you as a carer a assured 'break' time during the week on a regular, committed and supported basis.
For your family patient it should be something like three sessions, morning or afternoon, on different days per week, as suits your care situation
It may be education or retraining, it may be sheltered work, or a placement in a protected work programme, it may be regular interest activities - or a combination of all three.
The point is the NHS team must give a commitment to ensure this programme or they must register it as an 'unmet need' - a failed plan to be mended - and the Trust must indicate this with the local NHS commissioners - the Primary CareTrust, so that the latter body can build in a corrective funding allocation into their planning.It may be that a decision has been made that often the best person to do the CARER ASSESSMENT is the worker from the TEAM that is to deliver a care plan. The team will need the best knowledge of the social support network surrounding the person they will normally visit to monitor aftercare This will usually be the Care Co-ordinator for that person, who may be a CPN, (Community Psychiatric Nurse), Social Worker, Occupational Therapist, (O.T.) or other member of the Community Mental Health Team (C.M.H.T).
If you do not wish an assessment from the same person who visits the person you care for, ( and this can be a natural requirement where the Care Co-ordinator is acting in a closed off ' confidential ' contact with the patient and is not obliged to pass on anything you say ) - then you should ask the Community Mental Health Team to find another mental health worker from within the team. [ I advise you to ask for the social worker ] In either case they must be a worker with experience, knowledge and skills in the local mental health service .
If you would like an assessment from a worker who is independent from the Community Mental Health Team [ CMHT} you can approach your local Social Services department. The worker they allocate to you will be a skilled assessor, but may not have the same level of experience, knowledge and skills in mental health.
If your first approach is to Social Services and they decide, with your agreement, that you would be better getting an assessment from the C.M.H.T, they must ensure that a worker from that team has been identified and has agreed to do the assessment. The bottom line is that the Local Authority has a statutory duty to ensure that the assessment takes place.
and I would add - at a meaningful time - this is where there will be excuse after excuse but insist and give no agreement to anything else until you have a carer assessment before aftercare is embedded preferably at the very beginning of any illness, and not precluding a 'second thought' assessment at some time later on in your caring. In my experience be prepared for whoever does the assessment not to comprehend what caring for someone will involve
Together the health and social care community must ensure that your experience and your input into the care of the person with a mental health condition is recognised and understood.
They must ensure that you receive support, information and involvement in the assessment and care planning processes.
A review will be offered at least annually and a carer can request a re-assessment of their needs at any time and as circumstances change.pp
So what is a Carers' Assessment?
As the relative, partner or friend of the person you care for, you will have a great deal of knowledge and understanding of that person. It is vital that this is listened to and that you are recognised as a partner in providing care.[ This was mentioned at a carer group meeting - for the answer from one there - equal partner ! .... they see my family member perhaps once a week - he is with me every hour every day every month - for ever - they should remember that. ]
It is also necessary that your own needs should be recognised and any help or support provided.
It is also essential so that the Care Co-ordinator has an understanding of your input to build as complete a picture as possible of what life is actually like, both for yourself and the person you care for. Without this it would be very difficult for the Care Co-ordinator to do a full assessment and to provide an informed care plan for their patient and/or yourself.
Sometimes the Carers' Assessment will identify a need for further support, or practical help including, breaks for you.
This may result in the Care Co-ordinator assisting you to apply for a Carer's Grant.
It might mean a referral for the type of short-term breaks provided by the "Time-Out" service, operated by Re-think (more details below).For longer term support and for a full, independent service providing information, advice and a "listening ear", the Care Co-ordinator may refer you to the local Carer Support Worker Project.
You can also approach them direct to refer yourself. You can do this even if the person you are caring for is not currently receiving a service from the C.M.H.T.
It may be that the Carer's Assessment will not result in any follow-up work.It should still be valuable for you to have a chance for your experiences to be recognised and understood and for you to be able to contribute to the care planning and assessment process of the person you care for.
You should be given some choice as to where and when the Carers' Assessment takes place and who should be present when the assessment takes place.For example it may be important to have an opportunity to express your views without the person you care for being present (see below under "confidentiality". for an explanation how the resulting information should be handled and kept confidential ) with a venue offered away from your home.
In other instances it might be better for the person you care for to be present, especially if you want them to be fully aware of your contribution to and understanding of your role as their carer.
There can be no absolute rules on this, save the statement that the different options should be discussed openly and agreement sought between all concerned.
What about meeting other Carers?
There are or should be local support groups for carers of people with a mental health problem which many carers find helpful.
Confidentiality & information sharing
You should include in your carer assessment what your views are about the future care of your family patient, and what your experience - what you have observed - of the behaviour of your family patient - the family patient is not going to be able to do this - they do not have relaible access to their memory of previous ill behaviour - so the specialist team will not know the extent of the difficulties the family has had with the family patient.
You and the person you care for have the right to expect that information about yourself or the person you care for will not be shared with other people without your consent. This includes information provided by you as a carer not being shared with the person you care for and vice versa.This can only be over-ridden if justified through risk or a requirement in law.
Confidentiality should not be accepted as an excuse for not listening to you. You should be given sufficient information by mental health services, in a way that you can readily understand, to help you provide care effectively.
The information you provide will be held in the file of the person you care for and under the Client Access to Records Entitlement (Social Services Department), Access to Health Records (Cornwall Partnership Trust) and the Data Protection Act). The information you have given will be removed from the file before the person you care for has access to their file.This is to ensure that your right to provide information confidentially as a carer is respected, maintained and protected. Similarly you would not normally be able to access records of the person you care for.
However this should not be used as an excuse to exclude you from the process of assessment and care planning. It may well be that the service user will be happy to share their care plan with you.
Certainly a care plan that is arrived at without listening to the carers' views and without their full involvement is unlikely to be effective in terms of either the service users recovery, or the reduction of stress for you.
Back to Home Page
back to Care programme approachFurther Information:-
an example, local to Cornwall only
These leaflets provide additional information:
"Mental Health Services in Cornwall and the Isles of Scilly" (green leaflet in Community Care in Cornwall Series). This gives a full explanation of the Care Co-ordination process, explaining how screening, assessment and care planning should take place.
"A Commitment to Carers" compiled by Re-think and the Department of Health provides a good account of what carers should expect from mental health services.
"Commitment to Mental Health Carers in Cornwall" provided by Cornwall Partnership Trust.
HELP IN YOUR CARING ROLE
1) Carers' Break, Carer Support Worker Project. Countywide service offering advice information and support to carers' looking after people with severe and/or enduring mental health problems and carers groups for carers of a person with a mental health condition.
Telephone (01209) 613456.
2) Re-Think "Time Out" Service. Provides breaks for carers' of adults experiencing mental health problems. This service is provided by Community Care Assistants (C.C.A's) who give time to the person with the mental health problems.
Telephone: (01208) 815676.
3)Community Mental Health Teams.
below for telephone numbers.
Help Out of Hours
Social Services and Health both have an out-of-hours service. Details of both are provided below.
Cornwall Partnership NHS Trust Out of Hours Service – Monday to Friday 8pm-9am and 5pm-9am Saturday, Sunday and Bank Holidays:
(0800) 587 3377. Currently this is staffed by Community Psychiatric Nurses (CPN's).
Social Services - Out of Hours Helpline(01208) 251300.
Provides Community Care, Children's services and Approved (Mental Health) Social Workers out of hours.
FURTHER INFORMATION FOR YOU AND THE PERSON YOU CARE FOR:
Community Mental Health Teams
Community Mental Health Teams (CMHT's) are made up of people from various professions and include Community Psychiatric Nurses (CPN's), Social Workers, Psychiatrists, Psychologists and Occupational Therapists (OT's).
YOU CAN CONTACT YOUR LOCAL Community Mental Health Team DIRECTLY:
Alternatively don't forget that Cornwall Partnership Trust Switchboard can put you through to any team,
individual or department within the Mental Health Services. (01208) 251300.
Penwith (01736) 575524 Kerrier (01209) 881883 Carrick (01872) 356004
North Cornwall (01208) 251408
Restormel (01726) 291212 Caradon (01579) 335226
Additionally a new "Assertive Outreach" service has been set up to work intensively with those who have severe and enduring mental health problems who for a variety of reasons have chosen not to engage with existing mental health services.
You can contact the relevant Team on:
North & East Cornwall (01566) 779538 Mid Cornwall (01872) 354334 West Cornwall (01736) 758970
for more detailed information of mental health services in cornwall, please ask for a copy of the mental Health Directory available from your local Community Mental Health Team.
USEFUL CONTACTS
Age Concern Cornwall: (01872) 266388.
Alzheimers Society: (01872) 560148.
Benefits Agency:(01872) 355000.
Child & Family Service: (01872) 354350.
Cornwall Alcohol & Drugs Agency: (01872) 263001.
Cornwall Community Drugs Team: (01209) 881907.
Cornwall Counselling Centre: (01872) 553733 or
(01736) 795032.
Freshfield Drugs Counselling:(0500) 241952.
Mental Health Co-ordinator:For information on the six district Mental Health Forums - (01872) 261037.
NHS Direct:(0845) 4647.
Nightlink:User-run, User-led supportive telephone listening service for service users and carers. Monday to Sunday, 8pm-1am. Telephone (01872) 263003 or Free phone (0808) 8000 306.hours might changing.
Open Door Association for Agoraphobics: (01872) 274748.
Out of Hours Service – Monday to Friday 8pm – 9am and 5pm – 9am Saturday, Sunday and Bank Holidays: (0800) 587 3377.************* number might be changing
Pentreath Industries Ltd: (01726) 850565 - Work, rehabilitation and training for people with or recovering from enduring mental illness.
Relate: (Cornwall Marriage Guidance):(01726) 74128 or 74007
Samaritans: Truro (01872) 277277
SANELINE: (08457) 678000 - Call between 2pm-12 midnight. SANELINE is the first national out of hours telephone helpline for people with mental illnesses and their carers. Launched by SANE (Schizophrenia: A National Emergency), it is designed to give immediate support to people trying to cope with weekend and night time causes. SANELINE volunteers can supply information about symptoms and treatment of major mental illnesses, and will guide callers to their nearest source of professional help.
Rethink (Formerly National Schizophrenia Fellowship): (01208) 815676
St Petroc's Society: (01872) 264153 - temporary housing for the single homeless.
Tranquillisers (National): Battle Against Tranquillisers:
0117 966 3629 or 0117 941 2020.
Tranquillisers (Local): Breakaway – Telephone support until 9pm: 07788 572908.
Women's Aid Helpline (Local):(01736) 759687
Women's Aid Helpline (National): (0845) 7023468
CARADON
Caradon Community Mental Health Team: (01579) 335226.
Caradon Befrienders Scheme:(01579) 384881.
Caradon Mental Health Forum: (01872) 261037.
Community Support Groups:(01579) 347651.
The Coach House Day Facility: (01579) 347651.
'Time Out' for Carers: National: (0208) 9746814.
Local: (01208) 815676. Calls will be treated in confidence.
CARRICK
Carrick Community Mental Health Team: (01872) 356004.
Anchor, Falmouth: (01326) 315822. Support for sufferers from
emotional stress and mental health problems, social drop-in, group work, confidential individual work, self help library and crèche.
Carrick Mental Health Forum:(01872) 261037.
Carrick Mind Befriending Scheme:(01872) 222469.
Carrick Mind:(01872) 222469.
Carrick Day Treatment & Therapy Centre:(01872) 354488.
Stepping Stones, Truro:(01872) 241783. Day Centre for people suffering from mental health problems, providing groups,counselling, social events etc.
KERRIER
Kerrier Community Mental Health Team: (01872) 881888.
Boundervean:(01209) 613006. Mental Health Day Centre and Social Club.
Carers Support Group: (01326) 563141. The Penrose Club,
All Saints Church, Helston. Meets Tuesday and Thursday.
Kerrier Mental Health Forum: (01872) 261037.
Kerrier & Penwith Mind Befriending Scheme:
(01209) 714550.
Lower Cardrew House:(01209) 881831/881830.
Penrose Club:(01326) 563141 'Drop-in' facility .
Trengweath,Redruth: (01209) 881888.
West End Club:(01872) 261037 A social club for people with mental health problems.
NORTH CORNWALL
North Cornwall Community Mental Health Team: (01208) 251303.
Rethink Cornwall Services, Armadale Centre: (01208) 815676.
Camel Club: 07773 275873 Open to anyone with mental health problems.
North Cornwall Mental Health Forum: (01872) 261037.
Bude Mental Health Resource Centre:(01288) 355695.
Bodmin Hospital:(01208) 251300.
'Time Out'for Carers:(01208) 815676. Calls will be treated in confidence.
Trelil CourtResource Centre, Bodmin: (01208) 76899. Drop-in Centre open 6 days a week.
PENWITH
Penwith Community Mental Health Team: (01736) 575525.
Penwith Mental Health Forum:(01872) 261037.
Penwith Mind:(01736) 369201.
Penzance Breadline:(01736) 366767.
Richmond House Resource Centre, Penzance:
(01736) 350752.
Stonham Housing Association (Penwith):(01736) 336615.
RESTORMEL
Restormel Community Mental Health Team: (01726) 266308.
Fountain House, St Austell: (01726) 76299. Mental Health Centre offering support, friendship and group activities for people experiencing mental health problems. Referrals by Health/Social Work professionals.
CARMSCarers Support Group: (Carers and Relatives Mutual Support) (01726) 76299.
Newquay Mind:(01637) 871063 24 hour answerphone.
Mind Befriending Scheme:(01637) 851155. Seeking volunteers to work with people with mental health problems.
Mind Restormel Mental Health Forum:(01872) 261037.
Roswyth, Newquay: (01637) 873122. Mental Health Centre for support counselling, group activities, Carers Support Group.
'Time Out'for Carers:(01208) 815676. Calls will be treated in confidence.