Partners in care. Who cares for the carers?

Mike Shooter, President of the Royal College of Psychiatrists has highlighted an important aspect of psychiatric care in his recent editorial ‘ Partners in care. Who cares for the carers?’ (Psychiatric Bulletin, September 2004, 28, 313-314).

This is very relevant to the developing countries as many clinicians depend heavily on relatives or carers with regard to various aspects of a patient's management, as social services and other supportive systems are poorly developed. For instance in many in-patient units in Sri Lanka, relatives or carers are encouraged to stay with the patients. Sometimes relatives take turns to stay with the patients to minimise the burden and disturbance. This helps ‘overworked staff members’ to alleviate the burden at least to some extent. When the patient is discharged from the in-patient unit, administration of medication and rehabilitation programmes are done with the help of the carers. Carers are further distressed prior to the admission of a patient for assessment or treatment. For instance as the existing mental health act does not address the admission policy comprehensively in Sri Lanka, relatives or carers have to play a major role in accommodating the disturbed patient until taken to a hospital for assessment/treatment/admission.

The other important area is the rapidly increasing elderly population in developing countries. At the moment many elderly people are looked after by their family members. For example, in Sri Lanka about 80% of the elderly population are living with their children and the main caregivers are female (National Council for Mental Health, Sahanaya, 2002). We are bound to see more and more people with dementia and other disorders encountered in old age. Services for the elderly are not well developed compared with the West and the families, particularly females, are expected to look after their elderly relatives.

The other important area that needs to be highlighted is the introduction of community care without many resources. Management of mentally ill people in the community without resources will add to the burden on the carers. It is noteworthy that the crisis assessment teams are either poorly developed or non-existent in many developing countries.

We totally agree that the concept of ‘caring for the carers’ should be further emphasised and the undergraduate and postgraduate medical and nursing curricula must be strengthened with regard to this aspect of care.