Jaelea Skehan writes:
Mention the phrase ‘carer’ and you get an instant warm, fuzzy feeling along with a picture of someone strong and healthy, helping someone frail. But these images can be very misleading.
It is estimated that 2.6 million Australians are carers, many of whom are providing practical day-to-day and emotional support for people experiencing mental illness. A picture that represents this type of caring role is harder to imagine for most. It is a situation where the illness is not visible and recognising the ‘carer’ is not always immediately obvious.
People who love, live with or support someone experiencing depression do not traditionally identify themselves as ‘carers’. This means that the significant role they play in the lives of one million Australians who experience depression every year, can go unnoticed.
The practical, physical, economic and emotional demands of supporting a loved one with a mental illness can be enormous. But to date, most of our national discussions about mental health carers have focussed on their right to be involved in service delivery only.
This is indeed an important step in the right direction and was highlighted by the Australian Government’s announcement yesterday about the national Care Aware campaign. It reinforced the need to recognise carers as partners in patient care more broadly. This announcement however, and many similar in health and mental health, just don’t go far enough.
What about a national agenda that also recognises the rights of those that care for someone with a mental illness not to have their own mental health and wellbeing compromised because of the vital caring role they play?
A case for prevention approaches
We know from research that investing in the promotion of mental health and wellbeing, and the prevention of mental ill-health, leads not only to a more efficient use of mental health resources but it has a flow-on effect to a range of other health and community outcomes.
A recent report estimated the direct health expenditure on mental illness to be $13.8 billion. A logical argument would attest that without investment in evidence-based prevention programs, that number will continue to grow.
So why is meaningful investment in prevention approaches often so hard to achieve?
The problem is that promotion of mental health and wellbeing and the prevention of mental ill-health are often seen as separate tasks to the delivery of mental health services, and have been seen as competing with service delivery for scarce resources. Many would argue that the results are often not seen for years and so estimating the return on investment can be difficult.
But I would argue that programs addressing an immediate risk, such as those that target the information and support needs of carers, can show immediate as well as long-term benefits.
Snapshot: Supporting those who care
The Hunter Institute of Mental Health has today launched Supporting Those Who Care: Partners in Depression National Program Outcomes, showing the potentially severe mental health, family and social consequences of the caring experience.
Also released today was a summary of a six-paper research series, How Can We Best Support Those Who Care?, co-funded by beyondblue: the national depression initiative. The research series builds on what we know about the specific needs of those who care for someone with depression and the skills and capacity of the mental health workforce to address these needs.
At the very least, the National Evaluation of Partners in Depression shows that the need for the program is great. Upon entering the program, carers reported poor physical and mental health, challenges with their relationships and reduced participation in social activities.
Even more worrying, people entered the program with significant levels of psychological distress. Levels that were much higher than the Australian population and that suggested an immediate risk of mental ill-health.
In evaluating the effectiveness of the program we were able to show significant reductions in these levels of psychological distress by the time the program ended and six months following the program.
Participants also reported improvements in relationships, a better understanding of depression and 93% had already implemented what they learnt from the program at six-month follow-up.
Video and written testimonials from those who care are available.
Snapshot: The Partners in Depression program
The Hunter Institute of Mental Health developed the Partners in Depression program to fill a national service gap. It is six week education, support and skill building program that has been designed to address the specific needs of those who care for someone with depression, regardless of whether they see their role as a traditional caring one.
The program was first piloted in 2007–2008 with matched funding support from beyondblue, and then a three-year investment from the nib foundation meant that the program could be disseminated nationally from 2009.
The program is rolled out in partnership with locally based family and mental health workers. At the time of the evaluation there were over 160 accredited trainers in every state and territory delivering Partners in Depression and over 1,600 people have been through the program to date. Many more have been through the program now.
Partners in Depression provides a practical solution to national policies and reports which highlight the needs of carers and also the need for prevention approaches. By using existing mental health professionals, located within communities across Australia, we are able to develop this workforce to deliver our program at a minimal cost.
Partners in Depression is costs effective and could be rolled out in every community across Australia. The ongoing costs to deliver this program stand at just $24 per person per session.
A call to action
In releasing the evaluation and research associated with Partners in Depression, the Hunter Institute of Mental Health now calls on a national agenda that also includes prevention. Recognising the rights of those in caring roles to be involved in service delivery is only part of the solution. We also need to recognise their right to have their own mental health and wellbeing supported.
People who love, live with and care for someone with a mental illness, including those with depression, need timely and equitable access to interventions enhance their wellbeing and prevent the onset of mental ill-health.
For full access to reports released today are available online.
Jaelea Skehan is the A/Director of the Hunter Institute of Mental Health.
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