Caregivers’ perspectives of their relative’s admission

Abstract

Caregivers often act as invisible pillars of support to both the service user and their adjoined mental health service. Caregiving can have a profound positive and negative effect on the caregiver’s health and relationship with their relative. In Ireland, approximately two-thirds of involuntary admission orders were submitted by a caregiver. However, to date, little is known about how caregivers experience their relative’s admission. This study set out to examine the caregiver’s perspective of the service user’s admission to psychiatric hospital. This thesis primarily focused on caregivers’ perceptions of coercion, pressures and procedural justice at admission and whether such perceptions were influenced by the service user’s legal status. It also addressed whether the constructs most frequently associated with caregiving: burden, psychological distress, expressed emotion and coping style, were linked to how caregivers perceived the admission. As caregivers' perceptions of caregiving and burden may affect both their care and their relative’s adherence to treatment and possibility of subsequent readmission, it is reasonable to question whether their perceptions surrounding the admission may also have an impact. In this study, caregivers perceived the service user’s psychiatric admission as less coercive and more procedurally just than reported by service users. Perhaps surprisingly, caregivers of voluntarily admitted service users perceived the admission as more coerced and less procedurally just than caregivers of involuntarily admitted service users. Overall burden and psychological distress did not differ between caregivers. However, caregivers of those who were involuntarily admitted reported that they provided a higher level of supervision to their relative. When these key factors were entered into a regression model, we found that neither perceived coercion nor perceived pressures predicted burden or psychological distress in caregivers. Nonetheless, those who viewed the service user’s admission as more procedurally just were less burdened and distressed. Furthermore, a number of other hypotheses are suggested within the thesis. Our findings may, therefore, indicate a need for caregivers and their relatives to share their experiences regarding the admission and instill their preferences for possible future admissions by means of advance directives. Furthermore, caregiver psychoeducation that focuses on reducing expressed emotion and the use of maladaptive coping skills may help improve caregivers’ ability to care and reduce the incidence of readmission.