Professionals' understanding of their responsibilities in the collaboration with family caregivers of older persons with mental health problems in Norway

Abstract

Research has highlighted the importance of health and social care professionals' collaboration with family caregivers. In the field of mental healthcare, involvement of family members is perceived as beneficial to the recovery process of the care recipient. Furthermore, family care‐giving is an essential part of elderly care. It is well documented that family members need support to prevent negative consequences of care‐giving. Nevertheless, involvement of and support for family caregivers have not developed into a common practice, and research has identified professional barriers to collaboration with family caregivers in several areas. The aim of this study was to explore professionals' experiences of collaboration with family caregivers of older persons with mental health problems, and how they understood their responsibility towards families. We conducted three focus group interviews with 18 health and social care professionals working in community‐based services, in three rural municipalities in Western Norway. The thematic analysis by Braun and Clarke guided the analysis. The findings in relation to the professionals' role and responsibility towards family caregivers are presented in three themes: family caregivers – a resource that needs support; a responsibility with unclear boundaries; and balancing different needs. Professionals recognised family caregivers' need for support and acknowledged the importance of family relationships. However, they experienced dilemmas in performing their dual responsibility of caring for the older care recipient as well as the family member, which they described as having unclear guidelines. They also experienced that they had insufficient knowledge to take on this responsibility. We argue that the exercising of discretion is essential for the professionals' responsibility, and that clarification of their responsibility is needed. We recommend a stronger focus in education on developing competence in the family perspective. Furthermore, the apportionment of professionals' responsibility needs to be formalised, especially when several services are involved in providing care.

A Balancing Act: A Systematic Review and Metasynthesis of Family-Focused Practice in Adult Mental Health Services

“…Practitioners, in principle, acknowledged the importance of considering wider family, including children, in their service-users' care (Grant et al, 2019;Grant & Reupert, 2016;Hjärthag et al, 2017;Leenman & Arblaster, 2020;Maddocks et al, 2010;O'Brien et al, 2011;Pfeiffenberger et al, 2016;Sjöblom et al, 2005;Skundberg-Kletthagen et al, 2020;Slack & Webber, 2008;Strand & Rudolfsson, 2018;Radley et al, 2021;Tchnernegovski et al, 2018a;Ward et al, 2017). It was described by some as a "basic attitude" (Sunde et al, 2021, p. 5) that had the ability to "break the cycle of intergenerational mental illness" (Tchernegovski et al, 2018a, p. 5) and support recovery efforts (Foster & Isobel, 2018;Sunde et al, 2021;Ward et al, 2017).…”

“…(Strand & Rudolfsson, 2018, p. 66) We all know that if you don't engage the family meaningfully, people's recoveries are limited. (Ward et al, 2017, p. 3) Despite reflections of FFP as important, most practitioners believed FFP was an additional duty and extension to their routine practice requiring more time and resources (Grant & Reupert, 2016;Krumm et al, 2019;Lauritzen and Reedtz, 2013;Leenman & Arblaster, 2020;Pfeiffenberger et al, 2016;Skundberg-Kletthagen et al, 2020;Strand & Rudolfsson, 2018;Sunde et al, 2021;Radley et al, 2021;Ward et al, 2017). FFP is not suitably resourced despite increased practice demands, which led to a need to prioritise elsewhere (Grant & Reupert, 2016;Lauritzen & Reedtz, 2013;Strand & Rudolfsson, 2018;Sunde et al, 2021).…”

“…Many practitioners supported the notion that FFP was their role and responsibility (Foster & Isobel, 2018;Grant et al, 2019;Grant & Reupert, 2016;Hjärthag et al, 2017;Leenman & Arblaster, 2020;Maddocks et al, 2010;O'Brien et al, 2011;Pfeiffenberger et al, 2016;Sjöblom et al, 2005;Skundberg-Kletthagen et al, 2020;Strand & Rudolfsson, 2018;Tchernegovski et al, 2018a;Radley et al, 2021;Ward et al, 2017). At the same time, practitioners felt opportunities to deliver FFP were "scarce" (Sunde et al, 2021, p. 3), largely due to insufficient resources (Grant et al, 2019;Krumm et al, 2019;Lauritzen and Reedtz, 2013;Skundberg-Kletthagen et al, 2020;Strand & Rudolfsson, 2018;Sunde et al, 2021). Conversely, some participants did not believe FFP to be within their role and that working with children was outside the remit of an adult mental health practitioner (Foster & Isobel, 2018;Hjärthag et al, 2017;Maddocks et al, 2010;Radley et al, 2021;Slack & Webber, 2008).…”

“…(Pfeiffenberger et al, 2016, p. 604) They're with us with a view to help them address their symptoms and be able to recover so their primary need is to get well and obviously we expect that if we achieve that, they will be able to parent their children successfully. (Radley et al, 2021, p. 7) Some practitioners indicated uncertainty with regard to the boundaries of their role (Foster & Isobel, 2018;Radley et al, 2021;Strand & Rudolfsson, 2018;Sunde et al, 2021) describing it as "blurry and unclear" (Strand & Rudolfsson, 2018, p. 64) and a "grey area" (Radley et al, 2021, p.7). Even studies conducted in countries where FFP was mandated, practitioners described ambiguity in relation to their roles related to FFP (Lauritzen & Reedtz, 2013;O'Brien et al, 2011;Pfeiffenberger et al, 2016;Tchernegovski et al, 2018a).…”

A qualitative study of the interaction experiences between family caregivers and community nurses for disabled elderly people at home

“…The collaboration between family caregivers and community professionals' can effectively improve the mental health level of the disabled elderly [22]. Other studies have shown that the establishment of professional community medical and nursing service institutions can take over the care of the disabled elderly when their families can not take care of them, so as to avoid their worries [23,24].…”