What does the literature suggest about what carers need from mental health services for their own wellbeing? A Systematic Review

Proches aidants en psychiatrie : quelle (in)adéquation entre besoins et offres de soutien ?

INTRODUCTION

Informal caregivers play a vital role in supporting people with severe mental illness. However, this role can leave informal caregivers with significant unmet needs. The aim of this qualitative study is to identify the extent to which the support offered to informal caregivers in adult psychiatry in French-speaking Switzerland meets their needs.

METHOD

Individual semi-structured interviews and focus groups were conducted with informal caregivers, mental health professionals, and service providers. The data were analyzed by theme.

RESULTS

The need for assistance and the need for information are two themes identified as prevalent among informal caregivers. Despite a consensus on the need for more support and information, informal caregivers, service providers, and health professionals do not assign the same importance to specific aspects of these themes. Suggestions for improving practices at the institutional, socio-political, and civil-society levels are put forward. Given the diversity of viewpoints on the priority needs of informal caregivers, there is a risk of offering support that only partially corresponds to the difficulties encountered by informal caregivers.

CONCLUSIONS

Matching support and needs remains a major challenge. Agreeing on a consensual definition of support and information needs and proposing tailored approaches could make it possible to develop support services that meet the actual needs of informal caregivers.

A randomized controlled trial of a targeted support program for informal caregivers in adult psychiatry

Background

The importance of informal caregivers for persons with severe mental illness has been demonstrated. However, this role may cause a high care burden that considerably affects caregiver health. The Ensemble program is a five-session brief individual intervention designed to support informal caregivers. This trial aimed to assess the efficacy of the program versus SAU (support as usual) for participants with a high care burden.

Methods

A single-center randomized controlled trial including 149 participants was conducted. Caregivers in the intervention arm participated in the Ensemble program. The effects of the intervention were assessed using mixed models for repeated measures analysis of variance on improvements in informal caregivers' psychological health status, optimism levels, burden scores, and quality of life at three time points (T0 = pretest; T1 = posttest at 2 months, and T2 = follow-up at 4 months).

Results

Analysis of the Global Psychological Index showed no significant effect at the two endpoints in favor of the Ensemble group. However, the Brief Symptom Inventory-Positive Symptom Distress Index was significantly lower at the two-month follow-up. A significant reduction in burden on the Zarit Burden Interview was observed post-intervention, along with an increase in optimism levels on the Life Orientation Test-Revised at follow-up in the Ensemble group. No significant differences were observed in quality of life. Clinical improvements in both psychological health status and burden levels were also identified.

Conclusion

The Ensemble program offers an inclusive approach based on a recovery perspective that significantly reduces symptom distress and burden and increases optimism among informal caregivers.Clinical trial registration: https://clinicaltrials.gov/, NCT04020497.

Supported housing for persons with serious mental illness and personal recovery: What do families think?

BACKGROUND AND AIMS

Previous research on supported housing for people with serious mental illness focuses primarily on tenant/client experiences. The aim of this article is to present families' perspectives on the role of supported housing in recovery, utilizing the CHIME framework of personal recovery.

METHOD

Qualitative interviews were conducted with 14 families of individuals with serious mental illness living in supported housing. Participants were across five supported housing sites in four Canadian provinces.

RESULTS

Families credited supported housing with helping tenants redefine a positive sense of identity, re-establish social relationships and regain control over their lives. Families were less confident about supported housing facilitating future employment or 'full' recovery, focusing on stability rather than continual improvement.

CONCLUSION

This is one of the first studies to report family perspectives on the role of supported housing in their loved one's recovery processes - both strengths and weaknesses.