Mental health policy and practice across Europe: an overview

382 Mental health policy and practice
available and patients were more frequently involved in rehabilitative programmes.
However, social networks were stronger in the south where traditional
community-orientated values remain strong.
The experience of these caregivers was also compared with a sample of 646
family carers of people with a long-term physical illness (brain disorder, heart
disease, diabetes, kidney or lung diseases). While the impact of caring was
substantial for all, subjective burden was greatest for those supporting someone
with schizophrenia or a brain disorder. Moreover, access to social support and
emergency help was much lower for the carers of people with schizophrenia;
those with less access to social networks and support had higher levels of both
subjective and objective burden (Magliano et al. 2005a). These groups of carers
were also compared with 714 members of the general population. Sixty-one
per cent of the general population had been contacted by family or friends
during a two-month period compared to just 38 per cent of carers of people with
schizophrenia (Magliano et al. 2006b).
At a European level, the availability of cross-cultural research in this area is
poor; most studies have been carried out in just a single country. Findings are
not necessarily applicable in other contexts, as burden is likely to be influenced
by factors such as public attitudes toward mental illness and the level of service
provision, which significantly vary both within and across countries. One
European study, conducted between 1994 and 1997, that specifically explored
family burden and coping strategies in schizophrenia, looked at 236 relatives of
people with schizophrenia recruited in Italy, the United Kingdom, Greece,
Germany and Portugal (Magliano et al. 1998, 1999). In all locations, relatives
reported that caring for someone with schizophrenia resulted in restrictions in
their own social activities, had negative effects on family life and engendered
a sense of loss. A higher level of burden and a more frequent adoption of
ineffective coping strategies such as resignation, reduction of social interests
and avoidance of the person with schizophrenia were found among relatives
who had poorer social network support. In contrast, relatives were better placed
to use problem-solving strategies, such as involving their relative in their social
activities, positive communication, seeking information and talking with friends
to help them adapt to caring when they had access to a large and supportive
social network.
While there were common findings across the five centres, there were also
differences, some apparently reflecting a divide between the Mediterranean
centres and the north-European centres. For example, relatives in the Mediterranean
centres were more resigned and frequently used spiritual help as a coping
strategy, unlike those in northern centres. Similarly, the former group report
a greater level of reduction in social interests, and lower levels of support
from their social network. One-year follow-up data (Magliano et al. 1999)
showed that burden was stable over time in the absence of significant changes
in the pattern of care. However, when burden decreased, a related improvement
over time was found in: a) relatives’ tolerance of an individual’s behaviours;
b) practical support provided to families by their social network; c) course of
illness; and d) the person with schizophrenia’s social functioning.