The triangle of care carers included a guide to good practice in mental health care
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The Triangle of Care Carers Included: A Guide to Good Practice in Mental Health Care. Ruth Hannan, Policy & Development Manager. Carers Trust – Who are we?.

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The triangle of care carers included a guide to good practice in mental health care
The Triangle of Care Carers Included: A Guide to Good Practice inMental Health Care

Ruth Hannan, Policy & Development Manager

Carers trust who are we
Carers Trust – Who are we?

  • Carers Trust is a major new charity for, with and about carers, combining the knowledge, skills, expertise and experience of its founder charities –The Princess Royal Trust for Carers and Crossroads Care – and all of its Network Partners.

  • • Carers Trust has been operational since 1 April 2012.

  • • The Princess Royal Trust for Carers was founded in 1991.

  • • The first Crossroads Care pilot project was set up in 1974.

  • • Carers Trust is the largest provider of comprehensive support services, reaching more than 398,000 carers, including more than 24,500 young carers, through a unique network of 124 independently managed carers’ centres, 73 schemes, 107 young carers services and interactive websites.

  • • Carers Trust manages seven different websites for different target audiences plus a policy blog.

  • • In many locations, Network Partners support young carers. Young carers are children and young people who often take on practical and/or emotional caring

  • responsibilities that would normally be expected of an adult.

  • “The Carer’s needs are as great as the patient’s needs.” (Hospice Movement)

  • “They didn’t know who I was, they told me nothing and I wasn’t expecting him when he was sent home.” (Carer)

  • “Why involve the carer? They are already involved – and are likely to continue to be involved after the professional has moved on.” (Consultant Psychiatrist)

A disconnected model of involvement
A Disconnected Model of Involvement

  • Can Lead to…

  • Carers being excluded at certain points of the care pathway

  • Failure to share information on risk assessment and care planning

  • Requests by carers for information, support and advice not heard

  • Carers unique and expert views on the service user can be missed

The triangle of care project in england
The Triangle of Care Project in England

  • Guide developed by a carer (Alan Worthington) over a number of years.

  • Guide launched in final format in July 2010 at the House of Commons. Partnership project between The Princess Royal Trust for Carers (PRTC) & the National Mental Health Development Unit (NMHDU)

  • NMHDU closes March 2011

  • PRTC take lead on initiative setting up a national Triangle of Care Steering Group

  • Write to all mental health trusts in England (58 in total) – one quarter reply.

National project
National Project

  • Carers Trust awarded funding as part of Department of Health’s Innovation Programme

  • Establish National Steering Group made up of Carers Trust Network Partners, Mental Health Trusts, National Charities, Representatives of RCN and RCPsych and Carers.

  • Hold a series of Regional Events

  • Establish Regional Groups – 48 Mental Health Trusts involved and over 30 local carers organisations.

Project outcomes
Project Outcomes

  • Produce quarterly Triangle of Care good practice newsletter

  • Develop three leaflets promoting the benefits of the Triangle of Care

  • Hold regional events and develop regional groups

  • Research good practice mental health respite models

  • Gather good practice examples to be collated on the Virtual Ward

  • Develop a Triangle of Care “Kitemark” – more later

  • Evaluate the Triangle of Care Model

The principles of the triangle of care
The Principles of the Triangle of Care

  • Carers and the essential role they play are identified at first contact or as soon as possible thereafter

  • Staff are “carer aware” and trained in carer engagement strategies

  • Policy and protocols re; confidentiality and sharing information are in place

  • Defined post(s) responsible for carers are in place

  • A carer introduction to the service and staff is available, with a relevant range of information across the acute care pathway

  • A range of carer support services is available

  • And regular assessing and auditing to ensure these six key elements of carer engagement exist and remain in place.

Why do we need it
Why Do We Need It?

  • Aim of Service User? To Get Well

  • Aim of Carer? To Support Loved One to Get Well

  • Aim of Professional? To Support Patient/Client to Get Well

The benefits for carers of the triangle of care
The Benefits for Carers of the Triangle of Care

  • Recognition for the carer.

  • • An appreciation of the carer’s unique knowledge about the person they

  • care for.

  • • Information being provided about the person they care for including their illness, medication and prognosis.

  • • Emotional and practical support – enabling carers to have a life of

  • their own alongside their caring role.

  • • Assistance with care planning and knowing who to contact in a

  • crisis or emergency.

  • • Helping carers to feel part of a team and less isolated.

  • • Helping carers feel stronger, more resilient and better able to cope

  • with caring.

Benefits for service users of the triangle of care
Benefits for Service Users of the Triangle of Care

  • Comprehensive care and support from home to ward.

  • A more personal service, where a service user’s views and feelings are respected and implemented.

  • Reducing the need to repeat information again and again.

  • A more stable and calmer home environment where a service user and their family feel less stressed.

  • Less need for a service user to act as a ‘go between’ between mental health staff and carers.

Benefits for staff of the triangle of care
Benefits for Staff of the Triangle of Care

  • Creating a more helpful, supportive relationship with carers.

  • Giving carers and service users realistic expectations.

  • Ensuring staff have information about service users’ moods, behaviours and the best way to interact with them.

  • Getting more support from carers on the ward.

  • Partnership working – if the service user exhibits challenging behaviour, the carer may be able to influence their behaviour.

  • Reduced admissions – a carer can often recognise the signs that a service user is becoming unwell. By listening to carers, steps can be taken to help reduce the need for a service user to be admitted.

Local implementation feedback
Local Implementation – Feedback

  • South West London & St George’s Mental Health Trust

  • Covers 5 boroughs & 5 carer organisations – all working on TOC but in different ways. All have reported successes:

  • Carers involved in promoting TOC

  • Increased identification of carers and referrals to carers services

  • Trust-wide protocol of all carers to be invited to a meeting within two weeks of patient admission

  • Carers survey introduced via real-time feedback

  • Carers accessing Recovery College courses

  • Reduction in complaints and increase in compliments

  • Positive outcomes for carer wellbeing

Next steps for evaluation and research
Next Steps for Evaluation and Research

  • Stanbridge, R. (2012), “Including families and carers: an evaluation of the family liaison service on inpatient psychiatric wards in Somerset, UK”, Mental Health Review Journal, Vol. 17 No. 2, pp. 70-80.

  • Schizophrenia Commission, (Rethink Mental Illness, 2013) – recommendation

  • Needs:

  • Impact of Triangle of Care on carers, service users and professionals

  • Outcomes for professionals, carers and service users

  • Evaluation of the project