Assessing Care Support Needs and Impact

The assignment explores the impact of a Carer Support Needs Assessment Tool (CSNAT) intervention in palliative home care, and assesses the determinants of care costs for patients with dementia or cognitive impairment. It also examines the health status of informal caregivers compared to non-caregivers and caregivers of other conditions.

Mental Health Issues
Discussion: Mental health problems can have a
dramatic effect on both the individual and their
family.
Writer
Institute
Date

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Executive Summary
There is growing evidence of the global impact of mental illness among elder. Mental health
disorders have been established as the most important contributors, among others, to the burden
of disease and disability worldwide. These disorders can affect teh caregivers how they think,
feel and behave. Mental health disorders affect around one in four people in Britain, and range
from common mental health problems, such as depression and anxiety, to more rare issues such
as schizophrenia, dementia and bipolar disorder.
This assignment is all about a comprehensive discussion of a mental health disorder,
schizophrenia, suffered by John’s parents, and thus John has to care for them. As an informal
carer John’s life is impacted dramatically. This paper has explored the needs of John as an
informal carer and his parents living with schizophrenia. The types of support John might
provide to his parents living with schizophrenia and the impact on the carer’s life were also
explored and analysed. The range of support available in United Kingdom and the most pertinent
policy and legislation have been addressed.
Informal carers are integral to make sure quality of life of their loved ones in the family or
community living with schizophrenia. There are well-documented high burden levels and
psychological morbidity, as are determinants predicting which carers are at great risk of these.
Nevertheless, there are suitable policies, legislations and even interventions with the strong
potential to ameliorate these effects and hence enhance the quality of the life of both
schizophrenic people and their carers.

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Table of Contents
Executive Summary.....................................................................................................................................2
1. Introduction.........................................................................................................................................4
2. Mental Health Disorders......................................................................................................................4
2.1. Mental health problems or disorders have many types including the following:.........................4
3. The Needs of John and His Parents with Schizophrenia......................................................................4
4. The Types of Support for Schizophrenic People and Their Impact on Young Informal Carers...........6
5. The Support Available for the Informal Carers and the Schizophrenic People....................................6
6. The Impacts of Policy and Legislation................................................................................................7
7. Conclusion...........................................................................................................................................8
References...................................................................................................................................................9
Appendix...................................................................................................................................................11
Case Study.............................................................................................................................................11

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1. Introduction
This assignment aims to discuss mental health disorder with parents of John, an informal carer,
(case study appendix 1) who are living with schizophrenia. This paper will explore the needs of
John as an informal carer and his parents. The types of support John might provide to his parents
living with schizophrenia and the impact on the carer’s life will then be explored. The range of
support available for both and the relevant policy and legislation will be addressed.
2. Mental Health Disorders
2.1. Mental health problems or disorders have many types including the following:
Depression: This condition refers to a low mood feeling lasting extensively and affecting
everyday life of both the patient and carer. It can make an individual feel desperate, culpable,
valueless, unmotivated and shattered, affecting the aspects of self-esteem, sexual relationships,
appetite, physical health and sleep.
Anxiety: This mental health condition is what individuals feel they are worried, nervous or afraid,
specifically regarding things that are on the way.
Phobia: This condition is a severe form of fear or anxiety sparked by a specific situation or
object, even when it is very unlikely to be hazardous. When the fear is out of proportion to the
danger it is converted into a phobia, lasting for at least six months. Phobias have a major impact
on the ways individuals live their routine lives.
Schizophrenia: It refers to any of various mental health disorders defined by distortions of truth
and turbulence of thought and language and extraction from social contact. Symptoms of this
disorder include hallucinations or delusions (psychosis), lack of order and illogical thinking,
feeling isolated and even disconnected from own, difficulty concentrating and not wanting to
take care of self.
3. The Needs of John and His Parents with Schizophrenia
The research has established that informal carers, such as John in this case, provide a person
living with schizophrenia in their family with practical, emotional and social support (Nolan,
Davies and Grant, 2001). John has to provide care and support to his parents with schizophrenia

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while fulfilling other demands or commitments of his own life, which is related to his education,
professional career, family relationships and child rearing (Nolan, Davies and Grant, 2001).
Different challenging issues for and needs of informal carers are addressed by the research,
which may be related to moody and behavioural changes in John’s parents with schizophrenia,
loss of care giving support from John, conflict in relationships with the parents, adverse impact
on career and education, and so forth (Gupta et al., 2015). Besides, parents with schizophrenia
(loss of memory, mental power, consistency, social skills and typical affecting responses) is
another major problem experienced by John (Brodaty, 2010).
Moreover, John, while caring and supporting his schizophrenic parents, may also face numerous
exclusion sources and there is unrelenting and strong stigma (Velilla, 2018), unsociability and
segregation (Robison et al., 2009). Schizophrenia is such a mental health condition that generates
fear, insecurity and alarm among individual going through this problem and that leads to role
changes in the family members (Dungen et al., 2011). A caregiver’s tasks transform throughout
the caring process, progressively imposing and escalating the physical and psychological
pressure and leading to various health problems (Chiao, Wu and Hsiao, 2015). Without proper
care and support, both the individual with schizophrenia and his/her informal carer have to face
the dramatically negative consequences impacting their physical and emotional health, social life
or financial situation (Wolfs et al., 2012). Who experience more burden of care are children, if
they are residing with schizophrenic person or parents and have to take of themselves, such as
their education, and their family responsibilities at the same time. It is common for feelings of
guilt to accumulate, for anxiety disorders, depression, difficulty in the expression of feelings to
appear and for the feeling of loneliness and isolation to increase. In the UK, the Care Act 2014
highlights the need for local authorities to support wellbeing of young informal carers by
motivating them to participate in training, education and recreation activities (Tetley et al.,
2018).
A loved one with schizophrenia will need support at home as the disease gets worse. Majority of
the schizophrenic patients reside at home and are supported by their loved one. Nevertheless,
when their cognitive functions starts to deteriorate, they need more attention by an informal
carer, and it is then necessary to move them to a professional schizophrenia care centre, where
formal carers provide professional attention and support with consistency (Handels et al., 2013).

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For schizophrenic people, access to professional health care and support along with social
services is crucial. According to the World Health Organisation (WHO, 2015), there should be a
strong bond between community and family as this approach assists the schizophrenic people
feel psychologically safe even in their domestic care setting.
4. The Types of Support for Schizophrenic People and Their Impact on Young Informal Carers
Young adults as informal caregivers care and support schizophrenic people at home using a
variety of activities of their routine living. Supporting behavioural symptoms of schizophrenic
people is also necessary.
At homes or communities, schizophrenic people rely solely on the informal support and care
given by their family relatives. John as an informal carer has to support his schizophrenic parents
with self-care, memory and communication, and mobility (Lett et al., 2014). He has also to
support them with health care, preparation of food, tasks associated with emotional or cognitive
aspects, and all routine tasks at homes and out of the home (Nolan, Davies and Grant, 2001). It is
evident that schizophrenic people are provided practical, emotional and social support by
informal carers, through which their lives become normal (Lett et al., 2014).
Nevertheless, supporting and caring for a loved one living with schizophrenia can have profound
physical, psychological and economic impacts on informal carers. These impacts are greater
compared to supporting and caring those with other aging associated conditions (van der Roest et
al., 2010). These are adverse impacts mostly related to a variety of symptoms including memory
loss, challenging behavioural patterns, and steady loss of capability of performing routine tasks
at home. For these, strong and focussed support is inevitable to be provided by formal carers
(van der Roest et al., 2010).
5. The Support Available for the Informal Carers and the Schizophrenic People
In the UK, formal social care services, mainly day care and respite care, are very effective at
tackling carer stress. Besides, incentive in terms of payment for informal caregiving may
enhance carer supply because the carers are provided with compensation for some of their caring
costs. The incentive system already provides informal carers with payments through provision of
Carer Allowance and other incentives (GOV.UK, 2019). If people as informal carer want to

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support a person with schizophrenia regardless of the opportunity costs they experience, then
incentive approach by paying them will enhance the carers’ outcomes. Further, the preferred
professional support source may be the young carers’ organisations in the UK. Thus, John as an
informal young adult caregiver may take advantage of information and support to assist in
addressing the certain needs and challenges of his parents living with schizophrenia.
For John’s parents with schizophrenia, there is a range of support available in the UK. Memory
cafes support informal settings by offering information and support, which can be attended with
a carer. There are also creative workshops, including music workshops, letting people with
schizophrenia to continue doing their hobbies or learn new ones while meeting new people.
There are day centres as well where people with schizophrenia can be provided with a quality
company and things to do. Most importantly, Cognitive Stimulation Therapy (CST)
(Ageuk.org.uk, 2019) is very effective programme for people living with schizophrenia. In this
programme, group members can partake in highly consequential and thought-provoking
activities, established to assist in keeping memory and mental functioning as well (Ageuk.org.uk,
2019).
Moreover, depending on the age people with schizophrenia can benefit from Personal
Independence Payment or Attendance Allowance (Moneyadviceservice.org.uk, 2019). Income
and savings would not be taken into account by them as these are not means-tested. Further, if a
person with schizophrenia is having difficulty dealing with routine works or facets of personal
care, local social services department is available for them providing a care needs assessment
(Ageuk.org.uk, 2019).
6. The Impacts of Policy and Legislation
The government plays a crucial role by providing support through the well-established benefits
system, services of health and social care, educational institutions, employers, non-profit
foundations created to promote the public good, and by paying for privately. It has been
discovered that majority (70%) of the young adult caring their loved ones informally experienced
much satisfaction with the support services they received (NHS, 2017). For informal carers, like
John, different social care policies have been formulated across the UK, assigning duty to local

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authorities to find informal carers to ask for their support needs’ assessment (Grande et al.,
2015).
In England, The Care Act 2014 guides both informal and formal carers how to provide
schizophrenic people with supportive care by supporting their needs. This Act also guides and
stresses on the right of carers to an assessment (Grande et al., 2015). However, last year, the UK
government has published an action plan consisting of a work programme for carers based on 2
years through which unpaid caregivers will be supported (DoHSC, 2018). Other initiatives taken
by the government for informal caregivers include enhancement of employment support, creation
of the Carer Innovations Fund to promote innovation based approaches, and financial aid for a
review of most exceptional practice in finding young adult carers (DoHSC, 2018).
7. Conclusion
John as an informal carer is integral to make sure quality of life of his parents living with
schizophrenia. There are well-documented high burden levels and psychological morbidity, as
are determinants predicting which carers are at great risk of these. However, interventions have
the strong potential to ameliorate these effects and hence enhance the quality of the life
schizophrenic people. The management of the John’s parents with schizophrenia at home
requires a thorough plan including a relationship with their son (John) and other carers, such as
doctors, health and social care workers, and communities.

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References
Ageuk.org.uk (2019). Maintenance Cognitive Stimulation Therapy | Age UK. [online]
Ageuk.org.uk. Available at: https://www.ageuk.org.uk/our-impact/programmes/maintenance-
cognitive-stimulation-therapy-mcst/ [Accessed 2 Aug. 2019].
Brodaty, H. (2010). Working together: Combining pharmacological and psychosocial
interventions for people with dementia and caregivers. Alzheimer's & Dementia, 6(4), p.S90.
Chiao, C., Wu, H. and Hsiao, C. (2015). Caregiver burden for informal caregivers of patients
with dementia: A systematic review. International Nursing Review, 62(3), pp.340-350.
Department of Health and Social Care (DoHSC) (2018). Cross-government plan launched to
support unpaid carers. [online] GOV.UK. Available at:
https://www.gov.uk/government/news/cross-government-plan-launched-to-support-unpaid-
carers [Accessed 2 Aug. 2019].
Dungen, P., Marwijk, H., Horst, H., Moll van Charante, E., MacNeil Vroomen, J., Ven, P. and
Hout, H. (2011). The accuracy of family physicians' dementia diagnoses at different stages
of dementia: a systematic review. International Journal of Geriatric Psychiatry, p.n/a-n/a.
Grande, G., Austin, L., Ewing, G., O'Leary, N. and Roberts, C. (2015). Assessing the impact of a
Carer Support Needs Assessment Tool (CSNAT) intervention in palliative home care: a
stepped wedge cluster trial. BMJ Supportive & Palliative Care, pp.bmjspcare-2014-000829.
Gupta, S., Isherwood, G., Jones, K. and Van Impe, K. (2015). Assessing health status in informal
schizophrenia caregivers compared with health status in non-caregivers and caregivers of
other conditions. BMC Psychiatry, 15(1).
Handels, R., Wolfs, C., Aalten, P., Verhey, F. and Severens, J. (2013). Determinants of Care
Costs of Patients With Dementia or Cognitive Impairment. Alzheimer Disease & Associated
Disorders, 27(1), pp.30-36.
Lett, T., Voineskos, A., Kennedy, J., Levine, B. and Daskalakis, Z. (2014). Treating Working
Memory Deficits in Schizophrenia: A Review of the Neurobiology. Biological Psychiatry,
75(5), pp.361-370.

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Moneyadviceservice.org.uk (2019). Benefits you can claim when you have care needs. [online]
Moneyadviceservice.org.uk. Available at:
https://www.moneyadviceservice.org.uk/en/articles/benefits-you-can-claim-when-you-have-
care-needs [Accessed 2 Aug. 2019].
NHS. (2017). Personal social services survey of adult carers in England (SACE).
Nolan, M., Davies, S. and Grant, G. (2001). Working with older people and their families.
Buckingham: Open University Press.
Robison, J., Fortinsky, R., Kleppinger, A., Shugrue, N. and Porter, M. (2009). A Broader View
of Family Caregiving: Effects of Caregiving and Caregiver Conditions on Depressive
Symptoms, Health, Work, and Social Isolation. The Journals of Gerontology Series B:
Psychological Sciences and Social Sciences, 64B(6), pp.788-798.
Tetley, J., Cox, N., Jack, K. and Witham, G. (2018). Nursing older people at a glance. John
Wiley & Sons.
van der Roest, H., Meiland, F., Jonker, C. and Dröes, R. (2010). User evaluation of the
DEMentia-specific Digital Interactive Social Chart (DEM-DISC). A pilot study among
informal carers on its impact, user friendliness and, usefulness. Aging & Mental Health,
14(4), pp.461-470.
Velilla, L. (2018). Family Stigma, Socioeconomics And Caregiver Burden Among Caregivers Of
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Wolfs, C., Kessels, A., Severens, J., Brouwer, W., de Vugt, M., Verhey, F. and Dirksen, C.
(2012). Predictive Factors for the Objective Burden of Informal Care in People With
Dementia. Alzheimer Disease & Associated Disorders, 26(3), pp.197-204.
World Health Organization (WHO) (2015). World report on ageing and health. World Health
Organization.

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Appendix
Case Study
John is 16 and is working towards his GCSEs. He is one of more than 50,000 children and young
people in the UK who care for a parent or other close relative with a mental health problem,
which makes it difficult for John to keep focused at school. He feels stigmatised by his mother’s
mental health problem and doesn’t bring friends home, leaving him feeling isolated.