Free Hit Counter Carer and user, and the professional

Mental illness is different from physical illness. Schizophrenia is different from all other mental health conditions
The illnesses are different. Mental illness services are conducted separately from physical illness.

People with physical disabilities can monitor their own progress, can remember their history,
can describe their deficiency, and from that can point to the help that would be good in their particular circumstance.
They can engage with other people about their disability.
All that helps the professionals and the carer to consider and adjust day to day living with the physically ill and compensate for deficiency.
Physical illnesses have a trajectory which can be predicted and allowed for in severity and extent
with the advice of professionals who have studied the condition and gained experience through following other cases of the same conditions.
Carer can discover balancing and coping responses .
They can prepare themselves for the future of caring, rally all their family resources.
All can understand.
It will go according to the nature of fault in the organ the organ or system .
The fault can be understood in terms of its basic change or loss of function.
The organ or system normally does this or that and, now failing, the person cannot do this or that.
The deficiency is seen. It can then be balanced by substitutive aids, or changes of behaviour which lessen the fault.
Its future can therefore be discounted, ameliorated, compensated for, by setting up the appropriate environment .

The normal mental mechanism that is the awareness of changes to the self, and how that it is those changes in self affects others, that allows the individual sufferer to explain physical troubles and give an account of those difficulties to another person , who then can see the consequences – as they would feel it them selves in the same predicament. The professional and carer can therefore identify what would be needed to make up for the failure of the part or the system in the sufferer that has failed.

For many people for the 'serious mental illnesses ' there can be some identification with the sufferer and therefore general sympathy. They've gone too far

: obsessional = behaviour an exaggeration of fussiness
: For manic-depression = an over active sense of mood heghtened or lowered
: for anxiety states , phobic disorders = we all have some of that
: for eating disorders = over done the dieting or the chocolate wolfing
: even for personality disorders - we all have sometime had thoughts like that, or watched or read narratives of the kind, but we hold back

Schizophrenia always excludes that sort of ordinary assessment of shared reality, that identification which brings empathy.

Differences of opinion about their illness arise: between as seen by others and as seen by the sufferer. Sufferer cannot, and does not, usually observe their own illness with recall

How can carers know that the professional does not able to get from 'user' the information that carer has from observation - they think this is something that the professional expertise can do - assess seriousness from a relatively brief interview without seeing the carer - who does have community observation of behaviour outside the interviews.
Carer takes a while before realising that the professional interviewer is 'in the dark'. Carers withdraw from offering observation - we don't want the current balance of care threatened, unsatisfactory as it is - change has been a promise but left without fulfilment - too difficult to judge what is going on within the illness - it's best left to the professionals - who often pass around the parcel we don't know what's going on either - let sleeping dogs lie - but don't tell the public.

The sufferers within the illness cannot control its effect, and cannot use their mental mechanism to bring others to an identification with what is going wrong.

The descriptive mental mechanism is the ill thing itself.
The sufferers have little or no will over it.
The illness carries it's 'will' over them. It carries them into behaviour they cannot explain or account for to others.
Often not remembering and often denying the behaviour subsequently.
They will not and cannot therefore later describe it to others.
They cannot recall its florid display and portray its content for others - for the professionals who are trying to assess the impact of the illness.
Within the illness they cannot point to what is wrong or what help is to be given. Their capacity for that is not enough available.

So how does a professional - registered MHA consultant psychiatrist or Approved Mental Health Person [ AMHP - = old Approved Social Worker for MHA Act application - have the information to estimate the degree of illness, so as to apply 'sectioning'

Carers living with mental illness are therefore living in permanent apprehension of the living arrangements they have made getting out of control in such a way, that the cannot compensate or accomodate. They are continually anxious that things may go too far for retrieval of reliable companionship to be possible. They are 'in negotiation' all the time. They are always apprehensive about what the professional tells the 'user' because carer knows that 'user' will not . cannot , always remenber or relate what has gone on 'in between'. 'User' wants to get in and out of the interview, and says what seems to be needed to succeed in that. They are helped in that by the formal structure of the professional interview.
User is dependent, in flurries of fluctuating illness, totally upon carer, therefore carer has to be in charge.
User , although not appreciating the detail and the extent that their illness worries others, does have a general awareness that something is wrong, and that they should generally accept the cultural respect for medical advice. It is helpful for carer to be able to say to their family sufferer – this is what the doctor/cpn said.
Where 'user' is living with and or dependent upon carer any professional intervention should reinforce the recognition that the carer is there to be in charge when the user cannot take care of themselves, and the 'user' does not know they have lost their ability to be in charge of themselves.
The professional must tell user that this is the case.

Carers feel that in serious mental illness professionals do not give sufficient respect for the authority, indeed the coercion, that the carer has to display in between professional contacts. Carer would like more backup for … 'this is what is the medical advice from those with the best long experience of the iollness and the best qualification at dealing with it, is which we must follow, and we are told and obliged to report, if you are not following it'.
Especially in respect of medication.
Because of the variation in the influence of the illness and its unpredictable presentation, users do not, cannot , give a true picture to professionals of what has gone on in-between appointments.
Professionals often exclude the carer from information sharing – on the basis of
building a therapeutic alliance trust and confidence which will allow user to reveal what they otherwise would not reveal. And therefore – they think - being able to intervene and manage on a better informed understanding.

Carer will say this cannot be achieved – user cannot and does not give a full account - and this is often the basis for misleading professional guidance.

Carers therefore have the added apprehension that the professional judgement is falsely based upon what the professional can see in the brief and structured setting of their contact. They cannot trust the judgement of the professional.
It is NOT based upon shared experience of the care situation.

Confidentiality – the privacy of the session – means that the professional, cannot be seen to be seeing the carer separately and discussing things separately – because the above trust would disappear, and professional would never get anything out of user.

This emphasis separates the carer from user, and can endanger the balance in the care situation in which the user is the dependent on the carer being able to carry that dependence. It is carer who will receive the recrimination.
Carers of mental illness are therefore continuously afraid that the professional intervention with user will spring from a wrong appreciation of the capabilities of user, and will place too great social pressure upon the current care balance.
They are apprehensive of the effect of misguided professional authority, and also reproach professionals for not lending that authority to the position of the carer.
The cultural use of medical authority should, in the case of serious mental illness , be on the side of the domestic carer in the care situation.
Without making arrangements for the professional to obtain the observations from carer , done in way which protects carers from recrimination, professional judgement based upon what the user says, is falsely based.
Carers knows this and distrust the competence and authority of professionals who show by their behaviour that they do not take steps to correct this.

This is one reason that carers need independent carer support – to put in their experienced assessment into any professional assessment which may be leading to a change of care direction. Carer support workers can help with this. But they will do it successfully largely when the social workers are a working part of the locality mental health team and are seen as the connecting route for carers to put in their opinions, which they have learnt from experience over a long time.
At present carer is not consulted properly.

Carer Assessment is a form filling exercise without any coherent examination of the whole carer situation. Carer is not offered any 'menu' of what is available to improve their caring role.

Temporary 'breaks' are welcome but do not lead anywhere. Carers mostly want to improve the lot of their family members.

'Breaks' for carers, are those which come from taking the 'user' into meaningful occupational activity on some regular days in a structured week: 'breaks' are activities for the cared for which safely revive an individual skill and interest in a setting of un-pressured companionship is what most carers would ask for – if local Mental Health Trusts had any sort of coherent aftercare system and direction.

Every service should have occupational therapists, should have a social work Housing service, should have the management of the local day centres

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Carer and confidentiality