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The Royal College of Psychiatrists Improving the lives of people with mental illness
Partners in Care

Depression

Working in partnership with psychiatrists and carers

Introduction

This leaflet is for:

  • anyone who gives practical help and support, without payment, to a relative, partner or friend with depression (referred to as 'carers' in this leaflet) 
  • any professional - psychiatrists, GP, or other member of the health team - involved in the care and treatment of someone with depression.

It looks at ways of encouraging clearer communication and better collaboration between patients, carers and professionals. 

 

For the carer

About depression

Most of us feel sad and miserable at times, but when these feelings last more than a few weeks, and are so bad that they interfere with the person’s everyday life, professional help is usually needed.

 

Changes in the person’s behaviour

As a carer, you may notice that the person:

  • is unhappy most of the time
  • has lost confidence in themselves
  • expresses feelings of guilt, shame and worthlessness
  • is irritable and, perhaps angry
  • is tearful
  • has lost their appetite, or eats more than usual
  • has changed their sleeping pattern
  • is extremely tired
  • has problems concentrating
  • looks and feels anxious
  • is withdrawn and has lost interest in life, including sex
  • isn't looking after themselves as well as usual
  • talks of suicide.

Making a diagnosis

The professional – a doctor, nurse or social worker – needs to understand both recent events and what has happened to someone in the past. To do this, they need to talk to both the patient and, often, a close relative or friend. After considering all other possible causes of the symptoms, including physical health problems, a diagnosis of mild, moderate or severe depression may then be made.

 

Treatment

Depression is a disorder that can be helped successfully. It can be triggered by life-events, or may appear suddenly with no apparent cause. Most people with depression are treated by their GP. Some may need more specialist help and may be referred to a psychiatrist and/or to a Community Mental Health Team (CMHT), where they could see a community psychiatric nurse (CPN), social worker, psychologist or occupational therapist. Admission to hospital is only needed for about 1 in a 100 people with depression.

 

A number of treatments are available:

  • self-help, including relaxation techniques and exercise
  • talking therapies, such as counselling, Cognitive Behavioural Therapy (CBT) or one of the psychotherapies
  • medication, such as antidepressants
  • herbal remedies, such as St John’s Wort.

As a carer, how can you help your friend or relative?

  • Encourage them to tell you how they feel.
  • Try to be a good listener – even if you hear the same thing several times.
  • Remind them that depression is treatable and is not their fault.
  • Keep reassuring them that they will get better.
  • Encourage them to get some regular exercise and to eat a balanced diet.
  • Encourage them to accept professional help.
  • Help them to stay away from alcohol.
  • Take them seriously if they talk about feeling hopeless or harming themselves.

As a carer, you may feel:

  • impatient with the person’s behaviour
  • worried about:
    • losing the person you knew
    • coping and asking for help
    • the future, including money problems
    • stigma – what other people might be thinking or saying
    • the person’s safety and the risk of suicide
  • exhausted by listening and caring
  • isolated from your other friends and contacts.

 

Caring for someone with depression can be difficult, stressful and lonely, but help and support are available.

 

Tips for carers

In partnership with your doctor and members of the health team

It's important that there is clear, regular communication between the doctor, other professionals, the person with depression and their carer. It doesn't happen automatically, and will take time and effort. For instance, if you really feel that you need more time than usual to talk about what is happening with your GP, you can book a double appointment which will give you more time.

 

Decision-making/partnership

People have different views about how much they want to be involved in making decisions about their care and treatment. Some people are happy to leave it to the doctor, some people like to make the decision for themselves, and others prefer a collaboration of some sort. Whatever the patient's 'decision preference', they and their carer should be as involved as they want to be in any discussions about treatment or care plans. A vital part of this is that you and your friend or relative get all the information you need to make the decisions you need to.

 

Making a trusting relationship with all the staff involved really helps. The staff get a clearer picture of what is happening – and how much help and support you can offer. You get a clearer idea of the choices available and what to expect – and how you can get some support yourself.  This of great benefit, particularly in the provision of on-going support and information.

 

 

  Questions to ask the doctor
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Can you explain what the diagnosis means? 

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  What can we expect in the near future and over time?

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  What treatments are available?
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Why have you chosen this particular treatment?

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  How long will it take for the medication to work?

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  How long will the person have to take the medication?

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  What are the possible side-effects - and how common (or uncommon) are they? 

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  Would talking therapies or CBT be helpful?

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  How often should the person come to see you?

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  Are there things we can do to help ourselves?

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  Is it safe for the person to drive?

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  Do you have any written material about depression and its treatment? If not, who does?

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  Are there any organisations or local community services that may be of help?

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  Who do we contact if we need help 'out of hours'?

* Remember to arrange the next appointment before you leave.

 

Regular and well prepared visits to the doctor, or with other members of the mental health team, will make sure that you both get the best care and support.

 

Planning for a follow-up visit:

  • Discuss any new worries or changes in mood, thoughts and behaviour.
  • Keep a note of these changes as they happen, with the dates.
  • Keep a note of any reactions to medication, again with the dates if possible.
  • Just before the next visit, look at your notes and decide, with your friend or relative, the most important points.
  • Write down your top three concerns to make sure that you discuss these, and take the other notes with you. These could include:
  • changes in symptoms and behaviour
  • side-effects of medication
  • general physical health, e.g. putting on or losing weight
  • your own health as a carer
  • any extra help you need
  • when the person will be fit to return to normal activities, including work and driving.

During the visit:

  • If either of you do not understand something, ask questions until you do.
  • Encourage your friend or relative to tell the professional about how they feel.
  • Take notes of what you are told. At the end, tell the doctor what you and the person have understood, so that any misunderstandings or omissions can be cleared up.

Confidentiality

All professionals working in mental health services have a duty of confidentiality. This means that, unless there are exceptional circumstances, they cannot release information about a patient without the patient's consent.

This means that professionals can sometimes be uneasy about sharing such information with a carer – or even refuse to do so at all. 

However, more and more health professionals want to involve carers and will encourage the patient to allow them to do so. (See our leaflet ‘Carers and confidentiality in mental health).

Even if the patient has not consented to sharing their personal information, professionals can give carers general information on conditions, rights and services, as long as the information provided does not breach confidentiality.

If the doctor is unwilling to involve you as a carer, there are a number of things you can do:

  • ask the person you are caring for if you can stay with them at some of their appointments, or for part of their appointment
  • talk to other members of the health team
  • contact the helplines listed at the end of this leaflet
  • involve local mental health advocacy workers.

Don’t forget to take care of yourself:

  • Share your worries with trusted friends and family members – but do respect the patient's right to privacy.
  • Don’t struggle on alone, do ask for help when you feel you need it.
  • Make time for yourself and leisure activities.
  • Make sure you eat well and get enough exercise.
  • Go and see your own doctor if you find it hard to sleep or are anxious or depressed.
  • Ask if a family support worker is available.

Tips for professionals

The assessment

You can see the patient and the carer separately, as well as together.

Is there enough time to?

  • Listen, ask, listen?
  • Obtain a life history?
  • Ask about any bereavements, possible abuse, or other traumatic events?
  • Explain how you arrived at the diagnosis?
  • Talk about short- and long-term prognoses?
  • Leave time for questions and discussion?

In the management of depression do you?

  • Discuss all possible treatments including medical, psychological and self-help?
  • Talk about the possible side-effects of medication?
  • Discuss how to meet the care needs of both the patient and the carer?
  • Talk about positive outcomes?
  • Spend time asking about the carer’s physical and emotional health?

Points to remember

  • The carer may be in need of respite.
  • Make it clear that you will be happy to talk to other members of the family.
  • Make sure there is a professional available whom the family can contact during working hours.
  • Give an ‘out of hours’ telephone number.
  • Make sure that the patient and carer have the information they need about:
  • their care and treatment
  • the whole range of local services available – exercise, nutrition or self-help groups, for example
  • depression and its treatment
  • relevant mental health or carer organisations.
  • Do send copies of letters to the patient and the carer.

Further help

Depression Alliance

Depression Alliance does not currently run a helpline but you can call for an information pack on 0845 123 23 20; email: information@depressionalliance.org

 

Carers Trust

Carers Trust is a new charity which was formed by the merger of The Princess Royal Trust for Carers and Crossroads Care in April 2012. Carers Trust works to improve support, services and recognition for anyone living with the challenges of caring, unpaid, for a family member or friend who is ill, frail, disabled or has mental health or addiction problems. With their Network Partners, they aim to ensure that information, advice and practical support are available to all carers across the UK.

 

This leaflet was produced as part of the Partners in Care campaign, a joint initiative between the Royal College of Psychiatrists and The Princess Royal Trust for Carers.

One of the aims of the Partners in Care campaign was to show that if all those involved in the care of people with mental health problems or learning disabilities can work together, a trusting partnership can be developed between carers, patients and professionals which will be of benefit to all.

Original author: Jill Siddle

User and carer input: members of Depression Alliance
Editor: Dr Philip Timms, chair, Royal College of Psychiatrists' Public Education Editorial BoardDepression alliance


© May 2010. Review date: May 2012.
 
Royal College of Psychiatrists. This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit is gained from its use. Permission to reproduce it in any other way must be obtained from the Head of Publications. The College does not allow reposting of its leaflets on other sites, but allows them to be linked to directly.
 

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For a catalogue of public education materials or copies of our leaflets contact: Leaflets Department, The Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB. Telephone: 020 7235 2351 x 2552. 
 

Charity registration number (England and Wales) 228636 and in Scotland SC038369.

 

 

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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