Many people with mental health problems and their carers are helped by services in the community instead of – or in addition to – doctors and hospitals. Such services include Community Mental Health Teams, housing officers, the police, social services and others.
Community Mental Health Teams
In addition to psychiatrists, Community Mental Health Teams consist of Community Psychiatric Nurses (CPNs), social workers, psychologists, occupational therapists, and others. Usually each patient has a ‘key worker’ or ‘care coordinator’ in the team who is responsible for getting to know him or her and their needs, and to keep in touch with other services to make sure everyone is working together properly. The team should make a care plan for each person and should involve their families and carers.
Many carers felt ‘tremendously supported’ by their Mental Health Team, and people especially commented on the help given by CPNs. CPNs and key workers often visit people at home and many carers said CPNs really helped them with information, with managing difficult situations and sometimes by acting on their behalf. Some carers had been introduced to community centres by the CPN.
The CPN helped when Gou’s son had trouble with the police.
Others felt that teams initially had not supported them much as carers. One man said that while the CPN came to give injections, she provided little information.
Initially, Nick got little information from the CPN.
One carer said that all her CPN gave her was a tape of John Cleese talking about living with schizophrenia. A couple of carers found it frustrating that CPNs could do only what the psychiatrist told them to do. Another woman said relationships broke down when a social worker in her father’s team wanted to section him when he was physically very ill and she did not think he should be moved.
Some said people with mental health problems and their carers don’t always know what the Mental Health Teams are meant to do. Some also felt that while the staff can be highly educated ‘they need practice, not only theory’ to be able to work well with people with mental health problems and their carers.
Amar says people with mental health problems are not told of their rights to have assessments and…
Agnes did not think her daughter’s key worker was fair when filling in a housing application.
Professional home carers
Social services are responsible for organising respite care and professional home carers for those who need it. They do this by buying services from care agencies who employ home carers.
Some people with mental health problems need home carers to help with personal hygiene or practical tasks such as laundry and cleaning. Some of the people we talked to had home carers coming in three times a day. People were grateful for this service and some said it was reassuring to know the carers would come and ‘keep an eye on things’ when they were not there themselves.
People said that some home carers are great and go ‘beyond the call of duty’. Even so, having ‘strangers’ coming in to your home several times a day can ‘be a disruption to life’. The constant change of staff made it difficult for carers (and those being cared for) to get to know the home carers.
Not all home carers are equally good. Some people said they needed to keep an eye on how they carried out the work and ‘keep a mental note of things’ that are not done properly. One carer felt that the quality of the service had deteriorated after it was privatised.
The home carers are helpful, but he monitors their work and has complained when things are not…
She finds some of the home carers very rude to her aunt.
People said some home carers ‘lacked respect’ and ‘bedside manners’, that they would come late, cut corners, not pay enough attention to the needs of the person who was unwell, and some even talked about neglect and abuse.
When the home carers left their aunt in her own waste, Indira and her cousin believed it was a…
Several people had complained when things were ‘not good enough’ and had insisted on getting home carers they knew and trusted. Others said ‘you are fighting against a large system so you can’t win’ and had decided to learn to live with a poor service.
People did have some sympathy with the lot of home carers, saying they have a boring, ‘dirty sort of a job’, that they are not always trained properly and are paid ‘peanuts’.
Anton says that home carers’ jobs can be unpleasant and they have poor pay and working conditions.
She says home carers need more training.
Many of the carers had dealings with the police when the person they cared for went through a crisis, was sectioned or went missing. Some said the police are ‘nice and supportive’. Others found the police less helpful and said ‘they don’t want to know, they just want to get them away’.
People said it is emotionally hard to have to call the police about a loved one. Some had to call the police because of ‘gaps in the system’. For example, if a person with mental health problems has been drinking during a crisis, the mental health team can’t go to their home, and calling the police may be the only option. One woman had been told by the hospital to call the police because nobody was available to give her son his medicine. However, the police said they could do nothing unless he became violent.
Leah was told to ring the police because no one was there to give her son his injection…
Some carers said it is wrong that people with mental health problems get into the mental health care system via the police and criminal justice system. They said that services should be trained to recognise mental health problems instead of ‘shoving them into prison’.
Other services in the community
Carers were concerned that other services in the community lack knowledge about mental health problems and that staff don’t receive mental health training. People made such comments about supervised or sheltered accommodation, housing officers, job broker services, and crisis phone lines.
When living in a supervised home, Nicks son managed to avoid taking his medicine and relapsed.
Tina says the ability housing officers are not giving her clients the support they are paid for…
One woman was angry that people in services ‘don’t do all they can to help’. Despite her anger, she does understand that it is hard to work on the ‘front line’ of services.
Knowing their limitations and regulations doesn’t stop Ramila sometimes feeling angry with services.
Several carers said that services ‘suddenly’ became available only after people with mental health problems made suicide attempts.