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1 © Carers Trust The Triangle of Care Carers Included: A Guide to Good Practice in Mental Health Care Ruth Hannan, Policy & Development Manager

2 © Carers Trust Carers Trust – Who are we? Carers Trust is a major new charity for, with and about carers, combining the knowledge, skills, expertise and experience of its founder charities –The Princess Royal Trust for Carers and Crossroads Care – and all of its Network Partners. Carers Trust has been operational since 1 April 2012. The Princess Royal Trust for Carers was founded in 1991. The first Crossroads Care pilot project was set up in 1974. Carers Trust is the largest provider of comprehensive support services, reaching more than 398,000 carers, including more than 24,500 young carers, through a unique network of 124 independently managed carers’ centres, 73 schemes, 107 young carers services and interactive websites. Carers Trust manages seven different websites for different target audiences plus a policy blog. In many locations, Network Partners support young carers. Young carers are children and young people who often take on practical and/or emotional caring responsibilities that would normally be expected of an adult.

3 © Carers Trust “The Carer’s needs are as great as the patient’s needs.” (Hospice Movement) “They didn’t know who I was, they told me nothing and I wasn’t expecting him when he was sent home.” (Carer) “Why involve the carer? They are already involved – and are likely to continue to be involved after the professional has moved on.” (Consultant Psychiatrist)

4 © Carers Trust A Disconnected Model of Involvement Can Lead to… Carers being excluded at certain points of the care pathway Failure to share information on risk assessment and care planning Requests by carers for information, support and advice not heard Carers unique and expert views on the service user can be missed

5 © Carers Trust It’s a simple solution…..

6 © Carers Trust The Triangle of Care Project in England Guide developed by a carer (Alan Worthington) over a number of years. Guide launched in final format in July 2010 at the House of Commons. Partnership project between The Princess Royal Trust for Carers (PRTC) & the National Mental Health Development Unit (NMHDU) NMHDU closes March 2011 PRTC take lead on initiative setting up a national Triangle of Care Steering Group Write to all mental health trusts in England (58 in total) – one quarter reply.

7 © Carers Trust National Project Carers Trust awarded funding as part of Department of Health’s Innovation Programme Establish National Steering Group made up of Carers Trust Network Partners, Mental Health Trusts, National Charities, Representatives of RCN and RCPsych and Carers. Hold a series of Regional Events Establish Regional Groups – 48 Mental Health Trusts involved and over 30 local carers organisations.

8 © Carers Trust Project Outcomes Produce quarterly Triangle of Care good practice newsletter Develop three leaflets promoting the benefits of the Triangle of Care Hold regional events and develop regional groups Research good practice mental health respite models Gather good practice examples to be collated on the Virtual Ward Develop a Triangle of Care “Kitemark” – more later Evaluate the Triangle of Care Model

9 © Carers Trust The Principles of the Triangle of Care 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 protocols re; 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 And regular assessing and auditing to ensure these six key elements of carer engagement exist and remain in place.

10 © Carers Trust Why Do We Need It? Aim of Service User? To Get Well Aim of Carer? To Support Loved One to Get Well Aim of Professional? To Support Patient/Client to Get Well

11 © Carers Trust The Benefits for Carers of the Triangle of Care Recognition for the carer. An appreciation of the carer’s unique knowledge about the person they care for. Information being provided about the person they care for including their illness, medication and prognosis. Emotional and practical support – enabling carers to have a life of their own alongside their caring role. Assistance with care planning and knowing who to contact in a crisis or emergency. Helping carers to feel part of a team and less isolated. Helping carers feel stronger, more resilient and better able to cope with caring.

12 © Carers Trust Benefits for Service Users of the Triangle of Care Comprehensive care and support from home to ward. A more personal service, where a service user’s views and feelings are respected and implemented. Reducing the need to repeat information again and again. A more stable and calmer home environment where a service user and their family feel less stressed. Less need for a service user to act as a ‘go between’ between mental health staff and carers.

13 © Carers Trust Benefits for Staff of the Triangle of Care Creating a more helpful, supportive relationship with carers. Giving carers and service users realistic expectations. Ensuring staff have information about service users’ moods, behaviours and the best way to interact with them. Getting more support from carers on the ward. Partnership working – if the service user exhibits challenging behaviour, the carer may be able to influence their behaviour. Reduced admissions – a carer can often recognise the signs that a service user is becoming unwell. By listening to carers, steps can be taken to help reduce the need for a service user to be admitted.

14 © Carers Trust Local Implementation – Feedback South West London & St George’s Mental Health Trust Covers 5 boroughs & 5 carer organisations – all working on TOC but in different ways. All have reported successes: Carers involved in promoting TOC Increased identification of carers and referrals to carers services Trust-wide protocol of all carers to be invited to a meeting within two weeks of patient admission Carers survey introduced via real-time feedback Carers accessing Recovery College courses Reduction in complaints and increase in compliments Positive outcomes for carer wellbeing

15 © Carers Trust Next Steps for Evaluation and Research Stanbridge, R. (2012), “Including families and carers: an evaluation of the family liaison service on inpatient psychiatric wards in Somerset, UK”, Mental Health Review Journal, Vol. 17 No. 2, pp. 70-80. Schizophrenia Commission, (Rethink Mental Illness, 2013) – recommendation Needs: Impact of Triangle of Care on carers, service users and professionals Outcomes for professionals, carers and service users Evaluation of the project

16 Carers Trust is a registered charity in England and Wales (1145181) and in Scotland (SC042870). Registered as a company limited by guarantee in England and Wales No. 7697170. Registered office: 32–36 Loman Street, London SE1 0EH. © Carers Trust Thank you Follow us on twitter @CarersTweets Like us on Facebook Ruth Hannan

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