Of course there are as many different stories of a Carer’s and cared-for people’s ‘journeys’ as there are people who become mentally unwell. There tend to be a number of stages that have to be passed through and it is generally unlikely that there is a short cut!
Carers are often so focussed on the wellbeing of the cared-for person that they can ignore their own issues and emotions until the situation calms down, if then. So there is a higher incidence of stress related ill health in Carers than others. The message is always ‘look after you.’ There is no benefit in having two people becoming unwell.
The main obstacle to getting advice quickly often seems to be that the person concerned does not feel that they need help. They may be embarrassed or unwilling to admit that they are not coping well. It may be that they feel fine and believe that the problem lies with others. If they cannot be persuaded to see a GP and, just as importantly, tell them honestly what is happening, then this stage prior to getting help can last a very long time. You are convinced that there is something significantly wrong and they are convinced that you are exaggerating, misled, troublemaking or unhelpful. This is a frustrating situation.
It may be a question of accepting that you are waiting either for this to go away or to get worse, in which case treatment will be less easy to avoid. If you feel the person is at serious risk, please see ‘Crises and high risk situations’.
MH services are accessed through a ‘gatekeeper’, the GP, who has to do an initial assessment. The patient may find it helpful to run through their thoughts and rehearse or even write a list out before they see them. If they are happy for you to be there then that could be useful too, but it is necessary that the doctor has an opportunity to find out what his/her patient thinks about it all. It’s a fine line between you saying too much or too little!
If you make statements that the cared-for person disagrees with it can be the cause of friction, so it is good to get these issues sorted out first wherever possible. If you really feel that the crucial issues won’t get heard, then ask to speak to the doctor separately or write a note for them. What is vital is to communicate any risks in the situation, the finer details can be shared over time.
During this time Carers can face very difficult decisions about offering short term benefits rather than long term help. For example, if someone is highly anxious about going out they may stay home more and more. If you get all their shopping does this help?
There may come a point where there is room for negotiation. Perhaps this would be a ‘I will carry on helping you with X, but in return I would like you to see the GP even though I know you don’t want to.’ In real life of course it can be far more
complex, but there is a need to recognise if your help is possibly lessening the chances they will see a GP.
You can see the GP alone if the person just won’t go, but unless there is a serious risk they may be able to do little but offer general advice.
What treatments can a GP offer?
Crucially, there needs to be a clear statement from the person or yourself about the behaviour or feelings that are causing concern.
Medication. GPs vary in their response to MH problems, often they will prescribe medication as a first line of treatment. Reading the leaflet in the packet or looking on the internet can prepare you to spot side effects if they occur. These lists can be very frightening! It is worth remembering that these side effects do not affect everyone and often they are worse in the first few days/weeks and then fade as the medication becomes more effective, which is why it is often necessary to give it a fair trial. Some medications take several weeks to really kick in.
If you have questions a pharmacist is accessible and very knowledgeable.
Talking treatments. Currently there is an option for GPs to refer mild to moderate anxiety or depression symptoms to an organisation which offers talking therapies – both one to one and in groups. You can self-refer to them, but a GP referral is preferable.
These organisations (there is a different one in each area of the county) offer cognitive behavioural therapy (CBT), a process which looks at how someone can help themselves to change repetitive, unhelpful patterns of thinking. There is a lot of information about CBT available and it can be a useful tool, with or without medication.
Another option may be to see a counsellor through this organisation or other sources, this is also a talking treatment but different from CBT. Counsellors allow the person time to talk over important events within a neutral, safe space and work things out for themselves. This can be extremely helpful, but is not for everyone. Those with more severe conditions who find it hard to concentrate or work rationally through problems may not benefit.
Talking treatments have side effects and may produce emotional reactions which can be tough on Carers trying to help, as well as on the person themselves.
The vast majority of MH problems fall into the mild to moderate category. When you live with someone it may not feel mild but treatment can often be obtained fairly quickly through local organisations and GPs. Sometimes there is a need to persist, to find a sympathetic GP or to change a medication that isn’t right but many recover fully given time and support.