12. CARER HEALTH AND WELL-BEING
The purpose of this chapter is to set out the issues about the emotional impact of caring and the physical demands, both of which can impact adversely on carers' health. The aim is to prevent a deterioration in health as a result of caring and to promote good health, recognising that carers - like anyone else - can experience poor health unconnected with caring. Carers' health can be protected if the range of support discussed in this strategy is delivered according to individual needs. Even a sensitive and supportive carer's assessment/carer support plan can reduce stress and anxiety. This chapter also sets out plans for health checks for eligible carers.
12.1 The emotional impact of caring for a relative or friend can be immense. Caring, for example, for a partner or relative with dementia or other neurological conditions, or with a severe disability or long-term or fluctuating condition, or for a child with special needs, can often affect a carer's emotional well-being more than their physical health.
12.2 The major health concerns are related to stress, anxiety, emotional health and well-being generally and the physical strains of caring, especially back problems through lifting and handling. Early identification and support of carers has a positive impact on their overall health. A good service response to changed circumstances in caring is also beneficial to carers' health.
12.3 Many carers are concerned that they cannot afford to be ill, and some feel unable to continue with their caring role. Carers who do say they are able to cope often raise concerns about increasing age and their own personal health problems.
12.4 Carers can become socially isolated and ground down by trying to get services in place for the person they care for. Moreover, disability, illness, and long-term conditions often change family relationships . Being a life-long or long-term carer is challenging. As a caring role intensifies, many carers report how previous marital, partner or parental relationships change into patient-nurse relationships. There can be strong feelings of guilt and/or anger and an inability to cope at times.
12.5 Carers centres provide carer and peer support groups within a safe, listening environment. This is extremely valuable to many carers. With the increase in more intensive and long-lasting caring situations, there is some additional demand for professional therapeutic and counselling services.
12.6 The services and resources in place to the general population such as Breathing Space and Steps for Stress are available to carers. In addition, the Scottish Government, with partners, will produce a bespoke resource for carers on stress and caring. We acknowledge in doing so that some people will not recognise themselves as carers and may therefore use Steps for Stress only.
12.7 The new Wellness Recovery Action Planning ( WRAP) promoted by the Scottish Recovery Network, who are funded by the Scottish Government, is a model with potential to help improve the mental health and well-being of the general population, including carers. The Government will work with partners to explore this further.
12.8 The Scottish Government is working closely with NHS Boards and others to expand and improve access to psychological therapies for people of all ages, as an alternative to drug treatments. This will benefit carers who need this type of support and who are concerned about the waiting times for such services. There is a specific commitment to enhance capacity and to train current NHS staff to deliver a range of evidence-based interventions.
12.9 In 2010-11, the Scottish Government is developing an access target for psychological therapies (relevant to carers as part of the general population) which will complement the existing access target for those assessed as needing specialist support through the Child and Adolescent Mental Health Services ( CAMHS).
12.10 There are other innovative approaches being taken forward at local level, such as the Carers' Counselling and Groupwork Service developed by the Voice of Carers Across Lothian ( VOCAL).
12.11 Information prescription is being taken forward in some areas in Scotland. Approved information (for example, books, DVDs, CDs and websites) can be 'prescribed' to patients and carers to enable them to learn more about the different aspects of a condition and its treatment, personal and emotional health, dealing with stress, diet and so on. These initiatives should ensure that materials are available through a wide range of distribution points, including libraries and carer support centres.
ACTION POINT 12.1
In 2011-12, the Scottish Government will continue to provide and raise awareness amongst both professionals and the general public (including carers) of Breathing Space. The Steps for Stress booklet will be available, on request.
ACTION POINT 12.2
The Scottish Government with partners, including Health Scotland and the national carer organisations, will produce a bespoke resource on issues relating to stress and caring, building on Carers Scotland publication, Finding the Balance: Promoting Good Health - A Carers' Resource Guide to Health and Well-Being26 and linking in to the NHSinform Carers Information Zone and to Steps for Stress. The resource will be widely disseminated.
12.12 The physical demands of caring can be immense, leading to exhaustion and having an impact on emotional well-being. This is especially so where both the carer and cared-for are elderly, or where the carer is caring for someone requiring a lot of moving and handling due to limited or no mobility.
12.13 It is important for carers who are able and willing, to have training on moving and handling and on the safe use of equipment. If this is carried out in the home then the training is much more effective.
12.14 Through NHS Board Carer Information Strategies some Boards have undertaken training on moving and handling.
12.15 The Scottish Government will promote the benefits of the seasonal flu vaccine to carers. It is important for carers to protect both themselves and the people they care for from the effects of seasonal flu.
ACTION POINT 12.3
In 2010-11, the Scottish Government will encourage NHS Boards, Community Health Partnerships and local authorities to introduce programmes of training for carers on person-centred moving and handling and on the safe use of equipment. This should be linked to an assessment at the point of hospital discharge planning.
ACTION POINT 12.4
From 2010 onwards, the Scottish Government will promote to carers the benefits of the seasonal flu vaccine to help protect themselves and the people they care for.
12.16 High-risk primary prevention targeted on health inequalities is supported through the Keep Well and Well North programmes. These were developed to tackle health inequalities through increased investment in primary care. The programme has been targeted at those aged 45-64 living in the most deprived 15% of areas according to the Scottish Index of Multiple Deprivation ( SIMD), and also at others at risk who would not be identified through this approach. The intervention involves:
- identifying and engaging with those people at particular risk of preventable serious ill-health (including those with undetected chronic disease);
- giving these people a holistic health check, which focuses on risk factors for cardiovascular disease and diabetes;
- offering appropriate interventions and services; and
- providing monitoring and follow-up.
12.17 The current target population is around 160,000, of whom around 70,000 have been checked. This will have included carers aged 45-64 living in the areas served by Keep Well.
12.18 It is not known how many carers have come forward for the health checks in the Keep Well areas. However, NHS Scotland is updating its training for practitioners in the Keep Well areas, and that will include training on carer awareness and support.
12.19 The Scottish Government is also consulting on the extension of high risk primary prevention targeted on inequalities. The intention to extend the health checks include making the check five-yearly, extending to all the 15% most deprived areas and lowering the 'qualifying' age to 40 from the current 45. Health Boards are also being asked to consider how to target, reach, assess and support those at increased risk who do not live in the 15% most deprived areas, including offenders, gypsy travellers and those from BME communities. Carers will now be added to that list.
12.20 The Scottish Government sees merit in carers in the relevant age bracket having access to, and being enabled to take advantage of, these sorts of health checks, where they are also at increased risk of developing cardiovascular disease and diabetes. However, creative and flexible solutions will be required to facilitate such checks when carers cannot easily attend appointments.
12.21 The Scottish Government will also consider the evaluation, when available, of the health check pilots in England, which are underway in six demonstration areas.
ACTION POINT 12.5
In 2010-11, the Scottish Government will work with NHS Board Chief Executives to ensure the inclusion of eligible carers (ie those aged 40-64) in the list of those to be considered in the mainstreaming of Keep Well and Well North.