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Up to one and a half million people in Britain are involved in caring for a relative or friend with mental illness or dementia. Recent government policy has emphasised the needs of this particular group of carers, but effective support can be implemented only if managers and practitioners know what works.

Researchers from the Social Policy Research Unit (SPRU) at the University of York, working with consultancy Acton Shapiro, recently looked at services for these carers. There were two strands: a review of the literature and a consultation exercise.

The literature review revealed that there was little evidence to show that the support services recommended by government as crucial to carers, such as short breaks, were effective.

A range of approaches to evaluating effectiveness of interventions also emerged. Nearly three-quarters of the studies reviewed used standard outcome measures, such as carer burden, stress, physical health, emotional well-being, depression and knowledge levels to determine effectiveness. Changes in the scores before and after an intervention were taken as indicators.

However, there were instances when scores from these outcome measures did not tally with carers' views - for instance when a satisfaction survey showed that carers rated the service in question highly while standard outcome measures suggested it was ineffective.

In contrast to researchers' often narrow approach towards effectiveness, the professionals and carers participating in the consultation took a more holistic view, considering benefits for carers, benefits for the person supported, benefits for the family as a whole, impacts on service usage and long-term outcomes for society.

Some contributors believed that the number of referrals or self-referrals would indicate how effective the service was. But a telephone helpline, for example, might be effective in reassuring and supporting carers even if the number using it was low.

Carers felt that the effectiveness of services could be judged through satisfaction surveys, client evaluation forms, testimonials, letters or meetings. They emphasised that carers should be involved in designing the questions to be asked and also that providers had to respond to carers' views and modify services accordingly.

Contributors acknowledged that evaluating the effectiveness of mental health carer support services could be difficult and time-consuming. They noted that evaluation was not always a priority for service providers, who were busy delivering the service, and that the more integrated a service the more difficult it was to identify those components which work.

Despite these potential problems, many local authorities are enthusiastic. One had commissioned an evaluation that included postal surveys, client interviews and the shadowing of support workers. Another was compiling a mailing list of carers willing to be involved in evaluation, or to be trained to interview other carers.

A key message from the study was the importance of using diverse research methods to increase the depth and breadth of data collected; and to seek the perspectives of a range of groups, including carers or families, the cared-for person and professionals. Other approaches to evaluating services need to be used with the standard outcome measures, and there is a case for drawing on the expertise of carers themselves.

Adopting more innovative and inclusive approaches towards evaluation stands to give policy makers and practitioners a broader picture of what services and interventions work for carers of people with mental health problems - and why.

HilraryHilary Arksey is a research fellow, Social Policy Research Unit, University of York.

Background Reading

H Arksey, L O'Malley, S Baldwin, J Harris, E Newbronner, P Hare and A Mason, Services to Support Carers of People with Mental Health Problems: Overview Report/Literature Review Report,  York, 2002, from Social Policy Research Unit, University of York

E Newbronner and P Hare, Services to Support Carers of People with Mental Health Problems: Consultation Report, York, 2002, Social Policy Research Unit, University of York

Website

The above documents can be downloaded at www.sdo.lshtm.ac.uk/mentalhealthcarers.htm