Supporting young carers effectively
Treatment challenges, and impacts on young carers
Despite examples of good practice, there remain practical and organisational difficulties in treating people with substance misuse problems and/or dual diagnosis.
Conflicts between staff, services and carers often result from the difficulty of assessing which set of needs may be at the root of the problem; is substance misuse causing the mental health problems or vice versa?
Likewise, it can be very difficult to provide effective treatment for either condition while the other is present. In this way, there are anecdotal reports of mental health services refusing to work with clients until they have dealt with their drug problems. Similarly, some drug and alcohol services are reluctant to work with people with mental health problems, on the grounds that this is not their area of expertise. Services being 'siloed' in this way means that families and young carers of these service users are less likely to be identified or have their needs addressed.
Despite the potential problems involved, this does not excuse services from supporting young carers for someone with substance misuse problems or a dual diagnosis. Certainly, when young carers are looking after parents, there will be realistic child protection concerns that the parents will have drugs or alcohol, rather than their children, as their first priority. So what can help?
In addition to standard good practice in working with young carers, such as offering support, information, social, learning and fun activities, there are a number of other options available.
When you are working with young carers for people with substance misuse problems or dual diagnosis, there is NICE and Department of Health guidance which can be used as:
(a) a template for local services, and
(b) a means to hold statutory services to account by patients, carers and voluntary agencies.
Firstly, NICE’s guidance on psychosocial interventions and opioid detoxification states that healthcare professionals should "discuss with families and carers the impact of drug misuse on themselves and other family members, including children, and:
- offer an assessment of their personal, social and mental health needs
- give advice and written information on the impact of drug misuse
Where the needs of families and carers have been identified:
- offer guided self-help (usually a single session with written material provided)
- inform them about support groups - for example, self-help groups specifically for families and carers – and facilitate contact
If families and carers continue to have significant problems, consider offering individual family meetings (normally at least five weekly sessions). These should:
- provide information and education about drug misuse
- help to identify sources of stress related to drug misuse
- promote effective coping behaviours."1
Secondly, the 2007 Clinical Guidelines on Drug Misuse and Dependence (or 'Orange Book') provide guidance on treatment for drug misusers for all clinicians in the UK, particularly those in Drug Action Teams (DATs). A key principle of the Orange Book states that while the clinician's focus must be on the patient, the impact of the patient’s drug misuse on other individuals (i.e. carers and dependent children) should be taken into consideration.
The Orange Book states that carers should be given help and information; it includes a list of specific information, advice and support that should be given to the carer by clinicians. It also states that "children [of drug misusers] have a right to express their views and to have them taken into account when decisions are made about what should happen to them" (point 2.5.3, p.22):
Finally, the National Treatment Agency for Drugs and Alcohol (NTA) also has guidance to DATs on involving and supporting carers, specifically for England. This is currently focused more upon adult carers, but is due to be updated. It is useful as a guide as to what families should expect from DATs:
So, as staff working with young carers:
- use the resources and guidance above to support young carers effectively
- remind colleagues in drug and alcohol, mental health or other health/social care teams of these responsibilities, if you consider that they are failing to meet them, and neglecting young carers’ needs
- if young carers are not being involved in decisions that affect them, direct clinicians and other colleagues’ attention to the Orange Book
Sustained support for young carers across multi-disciplinary teams and agencies is also in line with the Children’s Plan, Think Family and Hidden Harm reports.
There is a new directory of carers services across the Trust's network which outlines where there are specialist services offered to substance misuse carers, including young carers:
Further useful resources:
1 Extract from Drug Misuse: Psychosocial Interventions and Opioid Detoxification - NICE Quick Reference Guide, p.7, produced by the National Institute for Clinical Excellence, July 2007