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The medicines management needs of carers during an episode of mental health crisis.

People in an acute mental health crisis are increasingly being successfully managed in the community by crisis resolution and home treatment teams (CRHTs), who offer an alternative to hospital admission. The Department of Health recognized the importance of CRHTs in the 1999 National Service Framework for Mental Health (Department of Health 1999) and has since implemented CRHT teams across most areas of England. A total of 1.5 million people care for someone with a mental illness in the UK (Department of Health 2010), and they play a crucial role in maintaining the health and well-being of people with mental health problems. During an episode of crisis, there is a risk of increased pressure on carers when service users are treated at home. Managing medicines is an important aspect of an episode of crisis, and the involvement of carers has not been explored in the literature. Six key elements have been identified to achieve a therapeutic alliance for carers, patients and staff (Department of Health 2010). They are: 1. Carers and the essential role they play are identified at first contact or as soon as possible thereafter. 2. Staff are ‘carer-aware’ and trained in carer engagement strategies. 3. Policy and practice protocols regarding confidentiality and sharing information are in place. 4. Defined post(s) responsible for carers are in place. 5. A carer introduction to the service and staff is available, with a relevant range of information across the acute care pathway. 6. A range of carer support services is available. One of the key underlying principles is that carers should be actively involved in all aspects of the treatment of an acute episode. Currently, there is growing impetus to address the enormous responsibility and unpaid support that carers provide to people with mental health problems. Practice examples of ways of supporting carers include: establishing the mental health needs of carers, offering practical support to enable regular breaks from their responsibilities and more sensible approaches to confidentiality and information sharing between carers and statutory services (General Medical Council 2009). The expertise, knowledge and opinions of carers with respect to medicines have not always featured highly for CRHTs dealing with an acute episode. Teams have a duty to ensure carers are able to withstand the duress of the situation, and ‘scaffold’ support wherever possible. A CRHT by definition will be examining the viability of home-based treatment rather than inpatient admission; therefore, the needs of the carer and the ability to manage medicines safely are paramount if this option is to be considered safe. A recent publication highlighted the importance of carer involvement in managing medicines during a mental health crisis (National Mental Health Development Unit 2010). Carers are often involved in storage, collection and administration of medicines, and each of these processes has been highlighted as an area of concern. There can also be frustration at perceived lack of success with medicines as well as concern about prescribing by several clinicians from different services. One recommendation from this report was that training packages should be developed to help carers understand issues such as side effect profiles of particular medicines, and basic information on frequency, dosage and safe storage (especially if there are children in the home). The support should enhance their understanding of mental health conditions and treatment options. Journal of Psychiatric and Mental Health Nursing, 2012, 19, 190–192