Electronic Letters to:
|
|
eLetters: Electronic letters published:
-
![[Read eLetter]](/icons/misc/sectionDOWN.gif)
Assessing burden for carers
- Peter Lepping (29 May 2007)
-
burden on carers
- david h yates (31 May 2007)
|
|
|||
|
Peter Lepping, Consultant Psychiatrist & Honorary Senior Lecturer and Research Fellow North East Wales NHS Trust, Cardiff and Bangor Universities
Send letter to journal:
peter.lepping{at}new-tr.wales.nhs.uk Peter Lepping
|
Roick’s et al paper investigating the burden on carers of people with schizophrenia comparing Germany and Britain may have significant consequences for the treatment of schizophrenia in the U.K. if the results of the paper were replicated and generalisable. They appear to suggest that carer burden in Britain is higher than in Germany and that the main factor responsible for this is the lower availability of psychiatric hospital beds in the UK. If this were true it may mean that care in the community and the subsequent reduction of psychiatric hospital beds may be in the interest of patients but not necessarily in the interest of carers. It would mean that we might be treating patients in the community at the cost of increasing carer burden, which in the end may become counterproductive. Before reaching such a conclusion, however, one should look at the paper in detail and I believe that there are some aspects that limit the generalisability of the findings. The main issue is the choice of areas that were compared. In Britain they chose Islington in London and Leicestershire. Islington in particular is a very deprived inner city metropolitan area whilst Leicestershire is moderately affluent. In Germany they chose Leipzig and Altenburg in East Germany. Whilst Leipzig is a relatively large city it is one of the most affluent cities in East Germany and by no means metropolitan. Altenburg is a very rural area but is the only area with relatively high unemployment in the German sample. The two areas chosen in West Germany, Iserlohn and Heilbronn, are semi- rural areas that are particularly affluent. So on the whole the sample is skewed towards much more deprivation in the British sample. It is also skewed towards particularly high provision of psychiatric beds as is the case in East Germany. Because the German sample is fairly rural there is a higher element of family cohesion compared to the British sample, which may account for some of the findings. Furthermore, expectation of what the service ought to deliver may also come into the evaluation. Through a German carer organisation I know a couple of people who look after relatives with schizophrenia in rural areas in Germany. One happens to be part of the wider Leipzig catchment area but well outside the city centre. They report that the only psychiatric provision available to them is hospitalisation. They feel very much alone with their ill relative and thus feel relieved when hospitalisation is initiated in cases when they cannot cope any longer. Whilst casting some doubt on the generalisability of the findings, if they were replicable we would have to seriously consider the consequences for the U.K. With an increasing number of crisis resolution and home treatment teams in the U.K. it will be less and less likely for people to be admitted to hospital. This will mean that increasingly ill people will be looked after by their relatives at home. Whilst this may be in the patient’s interest, it is less than clear whether it is also in the carer’s interest. We have to watch very carefully that we do not overwhelm carers with crises that they find difficult to manage and therefore in the long run do not wish to take responsibility for. Yours sincerely Peter Lepping Roick et al: Burden on Care Givers of People with Schizophrenia: Comparison between Germany and Britain, British Journal of Psychiatry (2007); 190, Page 333-339 |
|||
|
|
|||
|
david h yates, carer retired psychiatrist
Send letter to journal:
mica{at}jidgey.e7even.com david h yates
|
Starting Home Treatment programmes at the same time as closing admission ‘beds’ warrants setting up immediate and continuing independent monitoring. . The precipitate changeover was as much to do with the saving ‘cuts’ in the mental health Trust budgets over the last three years [ to make up for commissioning overspend in general health and GP services ! ] Closing admission beds to release funding for Home treatment programmes means there is no way back. Nearly half of first episode schizophrenia start with admission. Long term schizophrenia is not a smooth course In old hospitals there developed a routine of off ward activities – sheltered work, occupational activities, off ward leisure engagements, breaking the burden on the domestic wards, and also giving sufferers with schizophrenia, a framework with which to sustain attention and to hold and connect up internal thought looseness onto outside application. There was something of a kind to do for the future Sheltered work, training, education, and interest groups were rarely pre-provisioned [ Taps programme ] in the community before closing the old hospitals. Carer ‘breaks’ funding is not seen – indeed it is insufficient to do so - as providing regular sessions in the week of sheltered activities of an acceptable kind outside the home, a necessity for continuing treatment, both to give structure onto which to engage wandering thinking, but also to reduce face to face strain from carer weariness. Nursing staff have shifts and time off and move on. Such a programme is rarely recorded, in the CPA needs assessment as necessary. It should go down there, when not deliverable, as ‘unmet needs’ to pressure NHS commissioners – and the public at large, and the College spokespeople, about future funding distribution. |
|||