I am a general psychiatrist [ NB not in Cornwall ] and I am only too aware of the difficulties and problems faced by patients and their carers. During my training I was aware of the necessity to talk to carers but the emphasis was to acquire more information for the history of the illness. I was also aware that seeing carers on the ward rounds and in the outpatient clinic with the patient, although helpful, was very inappropriate. Indeed, if I had been the carer, I would have found the contact with the professionals very unsatisfactory.There were other groups run by the Community Psychiatric Nurses, Social Workers and other voluntary organisations to help support carers. The groups were in the evenings, encouraged by a well-motivated sincere mental health staff , but attendance rate remained very poor and the groups did not succeed.
Management of schizophrenia remains a challenge. Its cause, treatment and prognosis still produces a lot of debate, controversies and myths. From the very start I was aware that if I had to manage people with mental illness, more specifically with schizophrenia, I would have to be more open and forthcoming with the patient and his/her carers. I tried the ward rounds, the evening groups, seeing the relatives in the outpatient clinic at the patient's appointment, but I was not satisfied with my part in imparting information or support, and I was very aware that the carer left most of the time rather unsatisfied and rushed.It was about a year ago that I thought to include a 'clinic' specifically for the carers in my Weekly Job Plan. I dedicate one morning in a week to the carers and see them by appointment. If patients have been referred to me or have been treated in hospital, I offer the carers the opportunity to attend the Carers Clinic. Posters advertising the clinic are in all settings of the psychiatric services and GP surgeries, so if a carer wants to talk to me on the telephone, or make an appointment, there should be no difficulty.
I have yet to come across a patient who has refused me to see their carers. In fact, my poster advertises that I do not need to know the name of the patient or their respective clinical care. If a carer just wants to come and talk about the condition of schizophrenia or any other mental health problem then I am more than willing to offer them time.Having held the clinic for approximately a year, I am more than satisfied with this initiative. I am impressed by the way the carers have used my time to their benefit. Not only do they enquire about information on the illness and how to cope with the effects it has on their loved one, it also gives the carer and myself the opportunity to clarify any issues which may be causing undue stress to other family members.
The attendance rate has been 95% and, in fact, I sometimes struggle to see everyone and would see carers more often if I could.
The initiative has contributed to improving my understanding of the patient as a whole and, hopefully, contributes to a more supportive, informed treatment. I am aware that consultants round the country are busy people, so am I but, given all my responsibilities, I would put the carers' clinic as one of the priorities of day to day clinical work.
- taken from a 2002 issue of the National Schizophrenia Journal 'Your Voice'