Mental health policy and practice across Europe: an overview

Carers and families 383
Interventions and support for caregivers
Caring is not a free resource. If family carers cannot manage they may have to be
replaced or supplemented by paid professional caregivers. Moreover, a high
level of burden on caregivers not only impacts on their own health and economic
productivity but also adversely affects the outcomes for the person
with mental health problems (Falloon 1985; Perlick et al. 2004). From a policy
perspective therefore, a key issue must be to ensure that there is an appropriate
assessment of carers’ needs, followed by access to appropriate support to help
families enjoy the rewards of caregiving while minimizing the challenges that
they face. These experiences are very much influenced by access to information,
as well as professional support. Psychoeducational interventions targeted at
family members may also be helpful in reducing family burden.
Improved access to advice and information
Despite the vital contribution made by family carers, their relationship with
local mental health services has often been described as problematic and tense
(Grella and Grusky 1989; Schene and van Wijngaarden 1995; Jungbauer and
Angermeyer 2002). Relatives may feel hostility, resentment and dissatisfaction
towards professionals who fail to understand their needs. Moreover, families
report that they lack information about mental illness, are ignored by mental
health professionals and are not consulted about treatment. One survey in five
European countries of the help given during the first episode of psychosis (de
Haan et al. 2002) reported that families expressed most dissatisfaction with the
advice received on how to handle specific problems. Another study in Rome
reported that satisfaction with services expressed by outpatients and their
families was fairly good, except with respect to information on the condition
and the level of family-member involvement in therapeutic programmes. In
particular, dissatisfaction was associated with a lack of information during
periods of inpatient care (Gigantesco et al. 2002).
Families are often in need of practical advice, information and education
on psychiatric symptoms, use of medications, and management of disturbing
behaviour and disabilities (Kuipers 1993; Reid et al. 1993; Angermeyer et al.
2000). Although information by itself has only a limited impact on families and
does not change long-term outcomes, it improves relatives’ hopes and confidence
in professionals, and can have great value in facilitating coping with
the emotional impact of mental disorders. Emotional support is particularly
important in the first episodes of illness (Tennakoon et al. 2000; Lenior et al.
2002; Wolthaus et al. 2002). At this time, relatives must simultaneously cope
with their own emotional reactions while providing support to their loved one.
Psychoeducational interventions
Effective family support interventions have been developed in the last 25 years
(Falloon 1985; Leff et al. 1990). These psychoeducational interventions share a