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