When supporting someone with a mental health condition, there may be times where you are involved in conversations about their mental health and the care they receive. In this article we explore when carers can make decisions on behalf of someone else as well as how carers can be involved in hospital admission, treatment and discharge.
In most cases, family members and friends cannot make decisions about someone else's care. You can be provided with information and consulted in discharge planning but you will require consent from the person you are supporting to make decisions about their care and treatment plans.
However, there are some situations where you may be able to make decisions without the individual's permission.
It may be in that situation they are deemed to 'lack capacity'. These include:
- If the individual is under 18.
- If the carer has Lasting Power of Attorney.
- If the individual has been sectioned and you are their 'nearest relative’. Please note that ‘nearest relative’ is not the same as ‘next of kin’.
As their carer, it may be difficult to see them so unwell, especially if symptoms have worsened over time, but individuals have 'the right to refuse treatment' and it is important to respect their freedom to be in that position.
How can I encourage the person I care for to get help?
Although in most cases you are not able to force someone to get help, you can encourage them to seek support. The following tips may help.
- Emotional encouragement. Encourage them with empathy, patience and honesty about your concerns.
- Be sensitive when raising the topic. Having a sit-down conversation can be difficult for some people. They may feel embarrassed or even defensive. Therefore, you will need to decide on the best approach depending on the individual. You could plan a sit-down discussion or take a more subtle approach and weave it into a short chat. Whatever you decide, it is important they don’t feel you’re blaming or judging them, but you want to support them.
- Language to use. Avoid using words like ‘should’ and ‘must’. Instead say that you are concerned and ask if they have considered talking to a doctor.
- Keep trying. If you are unsuccessful, try again another time. People can change their mind depending on their mood and environment.
- Do your research. Read up and ensure you have a really good understanding of their condition. By showing you have an understanding and are on their side they may feel encouraged to access help and support.
What other carers have told us to keep in mind when encouraging someone to access support
Some carers who are receiving support from Carers First suggested the following tips to keep in mind when supporting someone with a mental health condition.
Remember that the person you care for has an illness, and their behaviour is a result of this.
Take some time to put yourself into their shoes. Think about how the person’s mental health issue affects them and what it may be like to live with that condition. For example, if they are living with OCD, it may seem odd to you that they have to turn a handle repetitively 3 times before leaving a room, but for them it might feel suffocating and life limiting to live with the fear of not doing that action. Although it is difficult for you, it can be far more difficult for them.
Learn what may trigger certain behaviours and if needs be adapt. To reduce the risk of a stressful situation, perhaps consider the difference between supporting and indulging their behaviours, making an effort to understand. For example, if they need to touch the handle before walking into a room then let them do that with no rushing or sighing. This is because the need will still be there but with the added pressure and stress.
Every person with a mental health condition is individual, and this is reflected in how they experience their condition and want to manage it. If you have tried everything in your power to help them to seek support, and they are refusing, it is ok to stop trying and accept the situation.
Who can section someone?
In most cases, the person will need to be assessed by three medical professionals in order to be sectioned. However, someone can also be sectioned in emergency situations by a police officer or a court.
It is worth noting that police officers can admit someone to a hospital or detain them at a police station if they have been sectioned under the Mental Health Act 1983.
Someone can be sectioned if they meet the following criteria
- They need to be assessed and treated for a mental health problem urgently
- Their health would be at serious risk of getting worse if they did not get treatment quickly
- The individual's safety or someone else’s safety would be at serious risk if they did not get treatment quickly
- A doctor thinks the person needs to be assessed and treated in hospital - for example when they are given new and powerful medication which may need to be monitored.
The person I am supporting has been sectioned – what does this mean?
When someone has been sectioned it means they are required to receive treatment under the Mental Health Act 1983.
Under the Mental Health Act 1983, for someone to be sectioned in the UK, they must be an immediate danger to themselves or others due to their mental health condition, or their condition is so severe that they require immediate medical treatment.
Someone can be sectioned in a hospital setting which means they must stay in hospital, but individuals can also be sectioned through a Community Treatment Order to receive treatment at home (although this is less common).
For more information about sectioning
How will I be involved if the person I care for is admitted for acute treatment?
If the person you are supporting has been admitted for treatment, you will understandably want to know what is going on. You may want to be involved with their treatment plan and you may need to provide the professionals with a background.
Professionals understand the importance of consulting with families and carers as it enables important information to be obtained that ultimately could save lives.
Where possible, professionals will encourage the person in treatment to give consent to share information with family and carers. However, if consent is not given and the individual is deemed to have capacity under the Mental Health Act 1983, then the professionals will be limited on the information they can share with you.
Reassuringly, due to some recent changes in mental health care (as a result of the 2021 SHARE report), there is some basic information you are entitled to request, without compromising the confidentiality restrictions requested by the service user. This information includes:
- What behaviour is likely to occur and how to manage it, particularly in a crisis situation.
- Information on medication – benefits and possible side effects.
- Local inpatient and community services, with contact details of the care coordinator
- Guidance on patient safety.
- An outline of the care and treatment pathway.
- Local and national support groups and resources.
In some circumstances it is possible to share more detailed information, for example if there is a possible risk of harm, and by sharing information, the risk will be alleviated.
- The present situation.
- The treatment plan and its aims.
- Any confidentiality restrictions requested by the individual.
- Any written care plan, crisis plan or recovery programme.
- How to access help, including out of hours.
- The role of each professional involved in the patients care.
- The opportunity to see a professional on your own and have a discussion in confidence.
- The right to your own confidentiality when speaking with a professional.
- Encouraged to feel part of the support team, able to voice views and concerns.
- Access to emotional and practical support.
- An assessment of their own needs with their own written care plan (ie if the individual has a serious mental illness).
What happens when the person I am supporting is discharged from mental health inpatient services?
The process for discharging someone from a mental health inpatient service will depend on whether the individual is in hospital as a voluntary in-patient or they are there as a result of being sectioned.
In either case, when someone is ready to be discharged from a hospital or mental health facility, they will be part of a meeting to discuss what support or care services will be needed when they return home. They will have a needs assessment to determine what community care services they require from the Community Mental Health Team.
If their needs are more complex, they may be placed under the Care Programme Approach. With all these discharge options, there is an opportunity for you as their carer to be involved, for more information about hospital discharge see our article on caring for someone coming out of hospital.