For a scheme to be successful it is important for a mental health trust to acknowledge the specific needs of carers and the key role they play. There needs to be a framework for supporting carers that mirrors the standards encompassed within the ‘Triangle of Care’ model and where carers have a high profile and staff are ‘carer aware’ and trained in carer engagement strategies.
- When developing a Carer Passport mental health trusts should take time to ask carers their views. Their expertise and insights are crucial at all stages of the development, implementation and promotion of the scheme. Learning from the feedback of carers about current carer initiatives within the trust and forming a carers’ focus group to inform the Passport development will help ensure that the scheme is owned by and works for carers themselves.
- For Passports to be successful, a mental health trust needs to invest in them appropriately. There will need to be senior level commitment and Passports should be given a high profile in order to bring everyone on board. Policies and practices should be developed that highlight the benefits of a Carer Passport and clearly communicate them to all staff. Ensuring there is a strategic as well as an operational lead to take on the development, implementation and management of a Passport scheme will help drive its success.
- Clear guidelines should be developed early on in the development of a Carer Passport scheme so that staff and carers understand its scope. Clarity needs to be established about the criteria for a Carer Passport, what it offers, where the scheme operates, how long a Passport lasts for and who is eligible for one. There is general acknowledgement that Passports need to be as open as possible and not based on local authority assessment criteria.
- Before a scheme is implemented, systems for record keeping need to be established which ensure carer confidentiality is maintained. Consideration needs to be given about where information is stored, who manages the information and whether it’s stored electronically. Measures for monitoring the success of the scheme should be developed in order to capture the breadth of the scheme and its outcomes for carers and for the Trust.
- Health professionals should consider the whole family when identifying carers. They should recognise that children and young people may also undertake caring responsibilities and that young carers will have specific needs. Visiting times should be available that don’t conflict with their education and comfortable facilities for them to visit family or friends made available.
- Professionals should be aware of young carers as a potentially ‘hidden’ group and recognise the importance of communicating with them appropriately, providing them with age related information and considering and involving them in decision making. Approaches which are right for adult carers are not always appropriate for young carers.
- The information would take the form of a leaflet or information pack and might link to further information on a webpage and might include might include details about car parking, the complaints procedure, confidentiality, advocacy and the visiting times and staff shift times. Key contacts would be provided for the Carer Support Worker, Carers Lead or Carers Champion where there is one and an emergency number for carers to call if required. Key information to assist a carer
- Information should also be included about carers’ assessments and contacts for social services and other organisations that can provide further advice, information and support. A scheme might also provide carers with more regular information through a physical newsletter, e-newsletter or text service.
Challenges to overcome
- Dovetailing with existing schemes
One potential challenge for the development of a Carer Passport scheme within mental health trusts is ensuring that there is clarity around how a Passport sits in relation to an existing initiative. There are a range of carer initiatives across the country and some mental health trusts are still developing their own understanding of carer awareness.
- Carer identification and uptake of a Carer Passport
Once a Carer Passport scheme has been established in a mental health trust, one of the challenges is likely to be the identification of those caring for people with mental health needs and the uptake of the Passport.
There remains stigma around accessing mental health services and this can be a barrier to the identification of carers for people with mental health needs. Services and professionals may not ‘see’ this group of carers or deal with them or involve them in the same way as they might deal with carer of someone with a physical disability. This group of carers may also not feel that they can approach or join carer groups themselves.
Since health services will possibly be the only agencies interacting with the carer around their caring role, they are vital to their identification. It is crucial therefore that there are strong procedures for identifying and engaging carers at an early point. This must also include young carers who may be particularly overlooked in regards to being identified as a carer within mental health trusts.
- How a Carer Passport is perceived by staff
Staff working under pressure and with competing demands and initiatives may not necessarily see the support of a carer as a priority for them. They may not recognise the benefits to their patients of supporting the carer. Staff therefore will need to receive regular carer awareness training to ensure that they understand the importance of supporting carers of people with mental health needs.
There may be a perception that implementing a Carer Passport would be expensive and involve significant extra work. A scheme must therefore be easy for staff to use and its benefits and impact should clearly be communicated.
- Confidentiality and information sharing
There is recognition that patient confidentiality restricts information sharing with carers however, a Carer Passport ought not to increase challenges related to confidentiality, but rather may help to mitigate such challenges by improving communication. Likewise, the absence of a Carer Passport should not necessarily be a restriction for carers to receive information about a patient.
In relation to carer confidentiality, carers should be asked about who can have access to the information collected about them thorough the scheme.
Promoting mental health Carer Passport schemes
A coordinated launch of a Carer Passport scheme across the mental health trust and its active promotion by staff will help drive its success. The ongoing perception that staff have of the scheme will then play a key role in maintaining that success.
For a Carer Passport scheme to be effective and to become embedded within a mental health trust, it needs to be championed and given status from a high level. Staff, including bank staff, need to recognise the value of a Carer Passport and support for carers in general. The value of the scheme therefore must be presented cogently and as a scheme develops, feedback from carers and the impact of the scheme should be communicated effectively.
To support the promotion of a Carer Passport, regular carer awareness training needs to be embedded across a trust. Several trusts are now involving carers in the design of new training for staff. At The Greater Manchester Mental Health NHS Foundation Trust the Carer Lead coordinates training for the Carer Champions who disseminate this to their teams. Each hospital ward and Community Mental Health Team (CMHT) has at least one designated Carer Champion. The Carer Lead coordinates the training for Carer Champions who then disseminate this into their own teams.
There is acknowledgement that in some trusts carers may not always be aware of schemes or may not receive the appropriate information fast enough. Staff should proactively promote the Carer Passport and its benefits to carers as soon as possible, so that carers are informed about what a Passport offers, who can access it and how to access it. Trusts are using a variety of promotional methods such as carers’ noticeboards, leaflets, webpages and dedicated carer areas where literature is placed.