The Triangle of Care - Video

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The Triangle of Care (Video file)

The Triangle of Care

The Triangle of Care is a guide for staff working in mental health services to promote the inclusion of carers in care-planning, decision making and the treatment of people with a mental illness. 

This film which accompanies the guide includes interviews with Anna Chan, Alan Cork and other Oxleas carers.

Nobody but a carer knows what they are going through and they need help because they are not trained to deal with someone who is dealing with psychiatric illness

Sky News Update: 
The point about helping carers is that I think we need to help them go on doing what they are doing.  Talk to any carer and they will say the one thing they need is a break, and I do not think enough now, actually put the budget in their hands and say you deicide how best to get that respite break, to get the extra help in your home.  I remember trying to do this myself with the care for my son and it’s incredibly complicated this whole agenda should be abut putting power and control in peoples hands letting them do more, because if Britain’s armies of carers gave up that would cost our country £50 billion and actually lead to heartbreak for so many people they really are hero’s and heroines.

Anna Chan: 
I think my job is really interesting because as well as working with clinicians I work with carers as well and that gives me a very good perspective of both sides because I am a carer myself and I attend support groups. I understand why they are not happy of certain aspects of the services they receive or their family members receive.  I am able to communicate with them and explain the difficulty our staff have in sharing information and offering support to them.

Alan Cork:   
My caring role stands for 30 odd years because it started with my wife, and then after her death it then started with my daughter.  It has been long journey and it is still going.

Woman 1:
I am a carer for my daughter now she has got the same illness as my mum, she has Schizophrenia and plus I am a carer to my husband, so I care for two. Somebody had actually told me you are a carer before then I was just doing what I could for my son like protecting him.

Alan Cork:
In the early days of my wife’s illness I was not told anything and I used to go to the  GP and ask what was happening and they would say ‘Sorry we cannot discuss this with you due to patient confidentiality’ but what they did not seem to understand was that I had taken over the persons life completely as their life was out of control so I was having to manage their life.

Anna Chan:
I think first of all when someone is admitted to an acute ward, we try to get their consent to share information with family carers.  If they give consent that will make  our work a lot easier but even if they do not give consent we can still share general information about the ward's and treatment in general.  We do not want to stop communicating with carers just because the service user will not give us permission.

(MAN – Picture with trees)
My wife tried to kill herself one day and it was shortly after the birth of our son.  I did not realise at the time but she was suffering from post natal depression.  She was admitted to first of all Greenwich hospital where she had been in a coma which I suppose that’s when I became a carer but after that it became quite severe so she was taken back into hospital because she continuously threatened to kill herself. 

Its very hard because my daughter couldn’t be left by herself I had to be with her all the time, I didn’t have a life.

Alan Cork:   
And I had friends and relatives who turned their back on us because they got fed up with the hostile reception they got when they came to our house.  I became more and more isolated, and equally I was looking after two young children who were growing up.  It became increasingly frustrating, i.e. I would often sit alone in the dark and cry because I didn’t know where to turn to or who to talk to.

Woman 2:   
Initially absolutely no listening as far as patients when my son was the patient and I was his mother there would be officials and the officials were talking down to me.

Anna Chan:   
At Oxleas we have a number of training programmes to help staff to work with families and carers.  The main training programme is called family inclusive practice training, which is based on a training course developed by Somerset NHS trust.  It’s a two day, team based training course, and which involves a carer talking about the caring experience which I think is actually the most important part of the course.

Woman 2:
You can’t have the correct amount of sleep because you are worrying about what the future is going to be, and the problems of the day ahead.  You then worry about the attitude of the staff and doctor.  It all just crowds in on you.

At some point I don’t know when, my relationship eroded, but I was coming back from the hospital one day and I was seeing this pain in my head and then the next thing I know I am out in front of a bus and thankfully I had my arm out stretched and the bus hit the arm and knocked me back on to the foot path.  The strain of seeing your wife, you know the person you love, not being the person you love, it all takes a great strain.

Anna Chan:
A number of our carers have been involved with the training course that I mentioned, the Family Inclusive Practice training course. We find it really valuable because we are helping clinicians to understand the burden of caring and also their contribution in helping the patient to recover.  In fact a number of carers have said to me it is really good therapy to talk to clinicians because it helps them to unburden their worries and also to have someone to listen to them.

I recognise by not involving carers we are missing out a lot of information about the person that may be unwell.  Clinicians only see the patient when they are unwell, they do not know what type of person they are when they are well so I really believe that we should involve family and carers.

So it is interesting I think that the new generation of people coming up in the psychiatric profession have got a different attitude to the carers and are listening and understand the problems of being a carer.

Baeti Mothobi:
In the last 18 months the staff from Oxleas have been the opposite of what they was before, and things are so much better.

Alan Cork:
I notice that when I got to the GP surgery, and also to hospitals that there are lots of leaflets about where to get help to give up smoking, to lose weight, or if you have drink or drug problems, but there is nothing up there for carers and I think that this is an important issue that carers need to have help and support as soon as they start but they never know where to go and these things are not properly publicised or promoted and I think every doctors surgery should have information about carers support groups on their notice boards, and leaflets regularly available for those who need help. 

Anna Chan: 
At the trust we have a range of handbooks and leaflets for carers the main one is the information handbook which tells carers about services within Oxleas trust and also local services if they need help from carer centre or organisations such as Re-think and Mind.

At Oxleas we recognise it is quite difficult to engage with working carers so we have to start a really exciting two year project to look into using technology to communicate with carers and service users by using things like webcam, telephone and video conferences.  I believe we can engage carers by inviting them to meetings in acute ward or the community mental health centre.  We also hope to set up an online carers support group as well.  We do recognise the difficulties for working carers so in two of our acute wards we have evening carers support groups. 

I spoke to a number of staff who attended the family inclusive practice training course and they all found it really useful especially listening to the carer talking about his experience of caring.  I think sometimes when you work with the patient you have no idea what happens with the family when they leave the hospital, who takes care of them the type of things that families have to do for the patient, things like cooking, shopping and even things like banking.  Really simple things like driving them around to friends, also just reminding them to take medication.  I think after listening to the carers experience I think staffs are a lot more sympathetic and a lot more respect for the work cares do at home for the patient.