Michael Yousif looks at how carers’ experiences can be incorporated into psychiatric training
As the relationship between patients, carers and healthcare professionals continues to evolve, so too does the role of patients and carers in medical education.
Carers are increasingly recognised as experts in care delivery and partnership between professionals and carers is of crucial importance in the delivery of future care services. This partnership is reflected in the drive to promote carers to having a more active role in training psychiatrists.
The benefits of carers’ active involvement in doctors’ training have been championed for some time. The national service framework for mental health emphasises that “service users and carers should be involved in planning, providing and evaluating education and training”.
The national continuous quality improvement tool for mental health education, published in 2005, aimed to help postgraduate mental health training programmes fulfill this commitment.
In 2004 the Royal College of Psychiatrists, together with the Princess Royal Trust for Carers, launched the Partners in Care campaign to promote partnership between carers, patients and professionals. A key policy initiative arising from this campaign was to actively involve carers in training.
Last year, the Department of Health reasserted in Refocusing the Care Programme Approach that “[a]n essential element of all training, whether developed nationally or locally, should be the involvement of service users and carers in its development and delivery”.
As a psychiatry trainee, I was offered the opportunity to supplement my core training by attending a course for carers of people with mental illness in order to learn more about carers’ perspectives of living with mental illness and dealing with mental health services.
Supportive family training educates and supports carers who attend the once-a-week classes for 11 weeks. The course is run by a local charity, Caring4Carers (formerly called Mencare until 2008), which has close links with the Barnet, Enfield and Haringey Mental Health Trust and its medical education committee.
As part of the trust’s commitment to involve patients and carers in postgraduate training, local psychiatry trainees are now encouraged to attend the SFT course and it was through this route I was presented with this opportunity.
Caring4Carers primarily provides a local service for carers. The potential for SFT as a training resource for psychiatrists, however, arises from the link forged between this charity and the local mental health trust. Different trusts will have different support services that may also be able to accommodate trainees.
In many psychiatry training posts the pressures of clinical work can make it difficult to spend enough time with patients and their families to grasp the full impact of living with mental illness.
SFT provided an alternative dynamic between the doctor and carer, and an opportunity to gain a deeper understanding of this impact as well as both the positive and negative aspects of care-giving.
Understanding the impact of mental illness on patients and their families is integral to psychiatric practice and the provision of holistic care. Novel training opportunities that offer the time and space to learn directly from carers can enable better understanding of their own and patients’ psychosocial needs, making psychiatrists better placed to deliver more personalised treatment plans.
Workshops providing alternative interface between doctors and patients have already been set up to focus on and develop certain clinical and communication skills. This is in keeping with the principles of Modernising Medical Careers, which aims to structure postgraduate medical training so that clinical skills and expertise can be developed more effectively and efficiently.
Studies have already demonstrated the benefits of patient and carer involvement in training in the development of key communication skills.
Such training experiences can also highlight different aspects people’s experiences of services that may not come about in the clinical setting. A recurrent theme throughout SFT was carers’ sense of alienation by adult mental health services. Much of this stemmed from what carers perceive to be professionals’ excessively rigid adherence to patient confidentiality.
In a Royal College of Psychiatrists document specifically for carers on confidentiality, the College warns that excluding carers from important discussions and decisions can “have serious practical, financial and personal consequences for both carer and patient”. This underlies the importance of being more actively inclusive towards carers in clinical practice.
Carers’ presence at appointments and meetings can ensure open dialogue between the patients, carers and professionals and help forge partnership in care delivery. Direct contact between doctors and carers, such as that offered in SFT, will make each more aware of the other’s position and more likely that professionals will seek to involve carers more in care delivery while helping carers understand the obligations of the professional.
Carer involvement in training has been a mandatory policy for psychiatry training programs since 2005. It is therefore incumbent on training programme directors to make these invaluable training opportunities available to trainees. In the ethos of self-directed learning it is up to trainees to be willing to engage in novel training opportunities that go beyond the curriculum to broaden clinical horizons and contribute to one’s own professional development.
The author would like to thank Jeffrey Breslaw, founder of Caring4Carers and co-leader in supportive family training, Suzanne Clinton-Davis, co-leader in SFT, all the carers who attended SFT for their contributions in making this training opportunity available, and Professor George Ikkos, chair of the Barnet, Enfield and Haringey Mental Health Trust medical education committee, for his advice and support in producing this article.
Dr Michael Yousif is a psychiatrist at Barnet, Enfield and Haringey Mental Health Trust.