Beyond the call of duty: A Qualitative study into the experiences of family members acting as a Nearest Relative in Mental Health Act assessments

Abstract

Research shows that tensions between family carers and professionals become acute where the issue of compulsory admission to hospital is at stake. In England and Wales, a specific family member is appointed to safeguard the interests of a person assessed under the Mental Health Act 1983. This currently occurs through the Nearest Relative (NR) role. The Government is proposing to replace this with a Nominated Person role, chosen by the service user. Drawing on the concept of carer burden, this study reports on the views of nineteen NRs in England to discover their experiences of being involved in a Mental Health Act assessment. Participants identified that they undertook the role due to a sense of duty. Their experiences were mixed with participants highlighting both feelings of distress during the assessment and feelings of relief once their relative had been detained. Participants reported feeling conflicted when their relative was detained and feelings of frustration towards mental health services. The findings have implications for proposals to reform the Mental Health Act 1983. They show that education and support programmes should be created for NRs/Nominated Persons and that research is needed to assess whether such support is effective at reducing carer burden.

Experiences of support received by carers of people who are involuntarily admitted to hospital under the Mental Health Act: qualitative study of carers’ perspectives

“…25 The need for emotional support highlighted by carers in the current study aligned with previous qualitative findings from the nearest relatives of people who have been involuntarily admitted to hospital under the MHA (a family member who holds specific responsibilities and power for someone detained under the MHA). 9 Both studies suggest that this support be offered more widely to carers. The current study's findings also suggest the need for the support offered to be formalised and provided by trained individuals, potentially those with previous experience of supporting someone treated under the MHA.…”

“…The level of understanding that a peer can offer through their experience of supporting someone who has been involuntary admitted to hospital was highly valuable to participants, and was seen as additional to professional support (Table 6, quotes [9][10][11].…”

A qualitative meta-synthesis of service users’ and carers’ experiences of assessment and involuntary hospital admissions under mental health legislations: a five-year update

“…Negative emotions. Carers reported fear about service users' symptoms and behaviour prior to detention (56,57), high stress and hypervigilance in the build-up to a service user's crisis (58); and frustration when health professionals ignored or 'failed to grasp the gravity of the service user's illness' (56). Carers felt bad about initiating coercive measures (45) and found assessment distressing (56), and admission traumatizing (57).…”

“…2 Availability of support for carers Carers own health. For their own health, carers need support to be offered proactively, before, during and after detention, to help them make sense of the illness, deal with stress, and accept their situation (45,56).…”

“…3 Carer involvement in decision making and care Recognising carer expertise. Carers' familiarity with the relative they care for, having been with them when they were well and during previous episodes of illness, and knowing the circumstances of the latest admission, gives carers expertise (45,56,57). 'He's been with me all his life.'…”