European study - Caregivers generally satisfied with care of relatives involuntary admitted to hospital

An eight country European study has found that caregivers are generally happy with the treatment given to their loved ones who have been admitted to hospital against their will.

The findings contrast with smaller studies, which have found high levels of dissatisfaction, with carers and patients unhappy with the information and guidance they were given, and particularly critical of their lack of involvement in treatment decisions and discharge planning.

The study was carried out as part of the European Evaluation of Coercion in Psychiatry and Harmonisation of Best Clinical Practice (EUNOMIA) in Bulgaria, Czech Republic, Germany, Greece, Italy, Poland, Slovakia and Sweden.

It consisted of 336 patients and 336 caregivers; just over 56% of the patients were male and the average age was just under 39; two thirds of the patients involved had been admitted to psychiatric hospital before.

Of the caregivers, 62% were women with an average age of 51; 46.4% were parents; 30.4% were spouses; 10.7% siblings and 7.1% sons or daughters. The remainder were another relation, such as a grandparent, aunt or uncle, or a friend.

Patients were recruited from between one and five hospitals per country and the interviews were carried out at the time of the admission and four weeks after by a team independent of those giving treatment.

Participants rated their views of the treatment using a seven item Clinical Assessment of Treatment scale, with the caregiver questionnaire modified slightly to capture their views more effectively.

The average approval score for caregivers was 8.5 (out of 10), with an average score of  7.7 for patients.

Out of seven questions, the highest ranking score for caregivers was for the question: ‘Do you believe your relative is receiving the right medication?’ and the lowest score was for the question ‘Do you believe his/her relations with other staff members are pleasant or unpleasant for him/her?’

For patients, the highest score was in response to the question: ‘Are relations with staff members pleasant/unpleasant for you?’; the lowest score was for ‘Do you believe you are receiving the right medication?’

The research found that when patients showed a favourable symptom change after four weeks, caregivers tended to have a more positive view of their treatment.

The researchers conclude that higher caregivers’ satisfaction is related to the success of the treatment. Improving information and support for caregivers should help clinicians to better engage with caregivers.

They say: “The findings suggest that caregivers actually have a ‘point’ when appraising the patients’ hospital treatment. Taking into consideration the views of caregivers about the quality of treatment that involuntary patients receive in hospital – and taking those views seriously – might therefore be not only an ethical requirement and a move to involve caregivers as requested by mental health policies, but also reveal relevant information.”

References

Caregivers’ appraisals of patients’ involuntary hospital treatment: European multicentre study. Giacco D, Fiorillo A, Del Vecchio V, Kallert K, Onchev G, Raboch J, Mastrogianni A, Nawka A, Hadrys T, Kjellin L, Luciano M, De Rosa C, Maj M and Priebe S. The British Journal of Psychiatry, 2012, epub ahead of print, 25 October 2012.

For further information please contact Gary Ward, Temporary Media & Communications Manager, Royal College of Psychiatrists.

Tel: 020 7235 2351 ext 6298; email: gward@rcpsych.ac.uk