Miriam - Interview 05

Miriam (51) lives with her husband and her two youngest children. For the last five years or so Miriam has been caring for her oldest son, Dominic, who has been diagnosed with schizophrenia and who lives nearby.

Miriam came to the UK to work as a mental health nurse in the late 1980s. At that time, Dominic stayed behind with his father in East Africa, but he came to join Miriam some years later. When he was 21, his father died and Dominic got very stressed and started smoking cannabis. It took some time before Miriam noticed changes in his behaviour. When he eventually went to the GP and was prescribed medication, he was reluctant to take it. Dominic was eventually diagnosed with schizophrenia, but Miriam thinks what he has is drug induced psychosis.

Since then, Dominic has been in and out of hospital a number of times. In periods when he takes his medication he is fine, Miriam says, but then he stops taking it, or he takes it while also drinking alcohol, which makes them ineffective. He also suffers from bad side effects which makes him reluctant to take his medication. While Miriam understands that Dominic wants to hang out with his friends and do what young people do, it is sad to see him go into a bad period when she believes he could remain stable on medication.

Since Miriam is a mental health nurse she had a lot of knowledge about mental health problems, which can be helpful. On the other hand, it made it difficult to juggle the role of health professional and the role of mother. Dominic sometimes complained that she treated him like one of her patient and that she 'nagged' him about medicine. Working in the same Trust where Dominic was a patient added to these difficulties, as her colleagues sometimes had information about him that was kept confidentially from her, and other times she would feel protective and finding it hard to treat him as an independent person within the same system as she was working herself.  Miriam decided she wanted to focus on her role as Dominic's mother. She was able to get his case transferred to a different Trust, and Miriam decided she would let the mental health team deal with his medication so that this issue would not put a strain on their relationship.

Today Miriam keeps in frequent contact with Dominic, she phones him every other day and he visits every Sunday. She says she always on 'stand by' and looks out for signs that something is wrong.  In the periods when he is unwell, Dominic can't really look after himself properly, so Miriam goes back and forth several times each day to make sure he eats, is safe (he tends to wander and sometimes gets lost) and that he keeps himself and the flat clean. 

Miriam recognises the importance of patient confidentiality, but she says that since becoming a carer herself she sees a need for finding ways of involving families better and for sharing information between carers, health professionals and those with mental health problems. 

Miriam gets good support from her mother, but she says as a foreigner, there is limited social support available. She is careful not to talk too much about the situation with her friends because she is aware that hearing about the same issues year after year may wear out the friendship.

Although she is hopeful that Dominic will see the benefit of staying on medication and be stable, Miriam worries about what the future holds for him and she is concerned that her younger children are affected and that they see caring for Dominic as an inevitable part of their future. 

Miriam thinks there is a need for more openness around mental health problems, and particularly, she says in African communities. People need to realise mental illness exists and that people can get better with the right treatment and care. It is also important, she says, that health professionals treat people as whole person's and take into account their cultural background.