Mental Health and the Triangle of Care

Carers Trust (formerly The Princess Royal Trust for Carers) and the National Mental Health Development Unit today published a guide which emphasizes the need for better local strategic involvement of carers and families in the care planning and treatment of people with mental ill-health.

“The Triangle of Care - Carers Included: A Best Practice Guide in Acute Mental Health Care”, recommends better partnership working between service users and their carers, and organisations.

Care Services Minister Paul Burstow endorsed the guide, saying: “it shows how professionals, service users and carers can better work together to access the support needed.

“As a society we are becoming more aware that mental health issues touch all of us. One in four of us will experience some kind of mental illness in our lifetime but the wider role of family and friends in helping to care for those affected is still too easily over looked, especially when crisis situations arise.”

Welcoming the guide as an innovative step towards allowing staff in psychiatric wards and acute care settings to work better with service users and their carers, Carole Cochrane, the Chief Executive at The Trust pointed out that:

“There are currently 1.5m carers in the UK who look after someone with mental health problems, many of whom are also being treated in acute care settings. Sadly, too often we see that carers’ own expertise being ignored by professionals, or carers being left unsupported in their caring role.

“In these uncertain economic times, staff must recognise the values of working in partnership with carers.”

The ‘Triangle of Care’ approach was developed by carers and staff to improve carer engagement in acute inpatient and home treatment services. The guide outlines key elements to achieving this as well as examples of good practice.

Read more about the 'Triangle of Care' and download the Best Practices Guide

Hear what people have to say about Triangle of Care: Watch this video from an event organized by CWP in partnership with Carers Trust (formerly The Princess Royal Trust) aimed at strengthening and building partnerships with carers and families. To watch a film about the event, please see below.


I would welcome any ideas

I would welcome any ideas about helping my son to cope with the medical side of treatment, sharing of experiences, and knowledge of how to get support from other carers of family members with a mental health condition. I am thinking of writing up my own experiences of helping my son. This will include the effects on me and my family and what it takes to continue to support him.

Hello Margaret Thank you for

Hello Margaret
Thank you for your enquiry.
I am the Policy and Development Manager at The Princess Royal Trust for Carers leading on mental health.
You don't state where you live, but firstly I would recommend checking on our page on carers' centres and contacting your local centre. They will be able to provide you with support as a carer and a number of centres have specialised mental health carer support projects. If they do not have they will be able to signpost you to services nearby. These projects can help you support your son, but also link you with other carers in similar situations.
In relation to information on best supporting your son and for a vast range of other information I would recommend the Royal College of Psychiatrists website and the Partners in Care information (which was a join project between us and the royal college):
I would also signpost you to and both of which have a wealth of information.
I hope this information proves useful for you.

Signpost to the signpost TO


I know exactly what you mean.

I know exactly what you mean. My son has schizophrenia. I live in a rural area of the south west and have tried everything to find a group that I can join. The mental health team provide no support for carers. I tried DevonCarers who could find nothing in the area. They can do plenty if you are caring for an elderly person, but nothing for someone caring for an adult with a chronic mental health problem. Likewise Rethink could find nothing either. Like you said, a signpost to another another signpost and nothing comes of it, except for frustration and despair.

I too would welcome some help

I too would welcome some help with my own issues which have arisen through caring for my son. He has mental health issues as yet undiagnosed specifically, I never know whether I am doing the right thing or saying the right thing and I know I often escalate the problem by what I say. It is seriously affecting my marriage and I feel like in order to support one I have to forego the other. I notice it is a while since you posted and that worries me because to date I have not found any help out there and wonder if you did.

Hi Liz Thank you for your

Hi Liz
Thank you for your query. I am the Policy and Development Manager for Mental Health at The Princess Royal Trust for Carers.
I would recommend much of the guidance I have offered the other enquirers on this page. However I would also suggest a couple of areas in addition to this.
You say you are not sure if you are doing or saying the right thing, one of the crucial things is to be supportive and encouraging to your son. Avoid raised voices and arguments. You may want to seek counselling for yourself which can allow you to talk through the vast range of emotions that you experience during this challenging times.
A number of mental health trusts or local mental health organisations offer "family therapy" or "family interventions" this isn't as daunting as it sounds but allows you to come together as a family and explore how to move on together addressing issues you may all be experiencing.
A support group is also very good to provide an opportunity to talk through issues.
As recommened before try your local carers centre, Rethink or Mind.
I hope this helps.

I went to the doctors to see

I went to the doctors to see if I could be referred for counselling sessions. I have been told that it will be several months before I am likely to get an appointment!

I would welcome any help on

I would welcome any help on what help that i can give my daughter who may have bipolar. my family want to help and we need to understant what the symptoms are and how to deal with any situation, what help and support we can give her. What governing bodies do we approach for support?

Hello I am the Policy and


I am the Policy and Development Manager leading on mental health for The Princess Royal Trust for Carers.
Thank you for your enquiry.
I would recommend contacting your local carers' centre - the details can be found on our web page. The centre will be able to provide you with information on your rights as carers, services in your local area and also support that is available to your daughter.
I would also recommend the following which are filled with information on mental health conditions and related issues.
I hope these prove useful.

Hello Firstly, thank you for

Firstly, thank you for your enquiry. I am the Policy and Development Manager responsible for Mental Health at The Trust.
It is common for many carers to want to help the person they care for and not be sure where to turn to.
Firstly, I would recommend contacting your local carers centre, you don't say where you live so if you look on our map you will be able to find your nearest:

Carers' Centre will be able to offer you information, advice and support and a number offer specialised mental health services.
If you look at the information on our pages about mental health which links to the Royal College of Psychiatry Partners in Care project which has a huge amount of information about mental health conditions, the mental health system and how to support yourself and the person you care for.
Also, if you read our Triangle of Care guide, this is what should be reasonable for you to expect from your mental health trust.
I would also recommend visting our Carers' Chat pages where you can speak to other carers about your experiences. This is a great way to get peer support.
I hope this helps.
Best regards

I would like to know if there

I would like to know if there are any support groups for families in West Yorkshire dealing with a father who has schizophrenia.

I am currently living in Australia and I have 3 brothers in the UK who are trying to deal with my father. He was having severe paranoid episodes about 5 years ago and we managed to get him to a psychiatrist who put him on medication which totally zonked him. He stopped having the paranoid episodes, but slept alot and put weight on and hardly left the house and was drinking heavily. He decided to stop taking the medication about 8 months ago and is now showing other signs of schizophrenia, being extremely erratic, hardly sleeping, spending money on useless items and hoarding things. We also think he is having paranoid thoughts but won't tell us about them anymore. He has always refused to admit that he has schizophrenia and still insists that the paranoid thoughts were all real. He just tells the doctor what he thinks the doctor wants to hear, and won't admit to anything. Theres alot more to it, that I won't go into now. I would very much appreciate it if you could point us in the right direction so we can get some support as the doctors are not worried because he is not a danger to himself or anyone else.

many thanks in advance

Hello Claire Thank you for

Hello Claire

Thank you for your enquiry. As you don't specify in West Yorkshire where your father and brothers live I can't provide specific guidance on support groups. However, I recommend checking which carers centre is closest to your brothers. Your local carers centre can provide practical advice and support as well as advocacy for your brothers. They will have local support groups in addition to this and be able to link your brothers to other specific mental health services that are in their area.
If you go to the above page and enter your brothers' location it will let you know the nearest centre.
I think one of the crucial issues here is that the health professionals are not hearing the whole story of your father's ill health. I would advise that your brother's request a meeting with your father's care manager, psychiatrist or GP to explain the situation more fully. They ahve the right to do this as confidentiality doesn not prevent health professionals listening to what carers have to say.
I would also recommend the Partners in Care information on the Royal College of Psychiatry's webpage (as mentioned in another post) as well as the Rethink Mental Illness page.
I hope this helps.

my partner was admitted to

my partner was admitted to hospital 4 years ago,he had been reg visiting a psychiatrist for 1 year and diagnosed with bi polar,no for the past 18months ,he will hardly leave house ,just wants to sleep day and night,wont comuniate with family or anbody ,except me ,i treid his doc to get bk it touch with his support worker ,doc told me he dont deal with mental health ,so i phones his support woker but was told he no longer reg there as he was doing ok ,so told meto go bk doc and ask for referal,seen someone last week who doesnt deal with mental health he just a co-ordinator ,dont no where to turn now

I would like to comment that

I would like to comment that all the advice out there for carers of young people with eating disorders are great in theory, but in practice I find myself alone, drained, misunderstood and financially devastated. I try very hard to maintain my own interests, and am trying desperately to find work that can actually make us enough money to live on, but having been denied carer's allowance, my own determination and resolve are draining away. I simply cannot find the support, understanding, group support, (only once a month is not enough), and intelligent dialogue I need to help me get through. I feel the doctors are tired of seeing me and their message seems to be that somehow I am preventing my daughter from recovering through my being overprotective, whilst at the same time she is in great need of comfort and support. The psychiatrist and therapist do not see what I see...I do not even know where to begin to express my despair and frustration at this point...

Dear Janet I am the Policy

Dear Janet
I am the Policy and Development Manager responsible for mental health. I am sorry to hear about your situation and that you feel alone.
I don't know where in the country you live but I would recommend that you contact your local centre or scheme to see what support they can offer you. You can find which services are in your local area here:
You may also find this website useful which is run by an carer who cares for her daughters with eating disorders.
I hope some of these options can offer you some support and help.
Best regards

Hi,I have read previous post

Hi,I have read previous post re the lack of support for carers. I work in a Mental Health Centre and support adults with MH issues. We are hoping to develop a respite service whereby carers can use the availability of 24 mental health nurses, accommodation and support for their loved ones in a beautiful homely environment. For assessment of mental health, day care, periods of respite or longer term care. Do you think this would benefit carers? And how do you advise we get ourselves noticed and generate referrals?
I would be grateful of comments and advice from professionals and carers.
Many thanks in advance,

My husband has vascular

My husband has vascular dementia, and I am 74 and find it very hard to care for him, My son who is out of work wants to be our carer, can he do that and still claim his dole money. please help me to get some answers. My son is 52.

Firstly, I notice that there

Firstly, I notice that there are no replies from the Carers organisation, to the most recent enquiries and requests for help. Is there some reason for this?

Secondly, I feel having read through them all that "the illness" isn't always the issue - the experiences and needs of carers are remarkably similar, whatever, the ill persons problem is. What would be helpful in this thread of communication would be feedback on what or whether people have been able to find solutions to the very real practical and emotional problems they/I are encountering as carers.

Hello I am 86yrs old and I am

Hello I am 86yrs old and I am looking after my wife who is 84yrs and is suffering from a very special form of epilepsy (N C S E none convulsive status epilepticus) this takes the form of her being perfectly normal for four to four and a half days and then being in an epileptic state for about 30 hours, she is at present under the care of the neurological hospital at Queens square London.
When in this state she is very depressed and weeps and talks repeating none nonsensical things constantly, she doesn't understand anything I say,I do have great difficulty in getting her to bed when in this state, (no co operation)
Can you give me any pointers to what I should do to get any form of help, in this special case as I am finding it very difficult and stressful now.
The hospital has tried six different form of medication with no effect, they have taken her off all meds to see if this helps.Thank you Albert Newman

This is a very helpful blog

This is a very helpful blog posts! Ive read everything said by all people. Some interesting views on caring and general nursing practice, I agree with most but not everyone, but I guess everyone is entitled to their own opinion at the end of the day.

I would just like to say that

I would just like to say that the supported groups at rethink are really good. When my son was first diagnosed with paranoid schizophrenia I began going to the carers support group. The people who go understand what your going through and give tips to one another how they have coped in a similar position. Some of the stories of their relatives make you feel lucky you don't have the same problems with your own relative. I have found with my son that it helps to be honest with him about his illness, not to agree with his delusions but to just tell him I don't see things the same as him. To him they are very real and sometimes he's petrified by them. I keep very calm around him and also try to set boundaries. Even though he's ill I try to keep him doing small chores around the house and not to complain if its not a good as I want it but thank him. With this approach my son is well on his way to recovery. I tell him all the time that the doctors are there to help even if sometimes he does not agree. To find out about carers allowance visit direct/gov carers allowance.

Hope you all find solutions to your problems and get the support needed

Hi Susie I have 20 years old

Hi Susie

I have 20 years old son who was diagnosed with Paranois Scchizophrenia, in October 2013. He was hospitalised, twice last year as a result of not taking his med. It was a very stressful and traumatic time for us.

I would like to go useful support groups> He has been under Early intervention for Pscychosis, but they are very underfunded , have not got the right staff, or the ones they have like Care co ordinator , is all im can say USELESS. I learned everything myself, have had any advice or help, noe he is in a very bad depression, does not get out of bed, still delusional, does nopt accept the ilness he has. Every thing he belives is very real to him, and when i make comments he get angry with me. I must say we have been arguing recently, as i suffer from depression myself, you can immagine the double stress on me. I am scared, worried and fell helpless and hopeless. Although he is not in a acute state , as he was up to July 2013, and when he was discahrged from hospital in mis Sep 2013, he was graduly showing signs of coming out of acute episode.. But as i am very disappointe with EIS. NOT HELPFUL AT ALL, underfunded, so as a result we are not getting good support. I would like to try MIND, the eir support group. How do yoyu Manage, is there any hopefor me? I would appreciate if you get intouch with me. Many thanks.

Hi Susie This is Danna,

Hi Susie This is Danna, Just want to correct my comment on the top, I noticed some spelling mistakes, as I am so anxious, can not concentrate properly.

I like to correct the date of my son's diagnosis, it was October 2012, not 2013, I made a mistake, as a lot happened for us re. my son's illness in 2013!

And also I learned a lot from internet re: his illness, I have not had any advise, relating to his illness. I hope , I can find a good support group. It looks you are doing a good job.

Hello there Would like to

Hello there

Would like to know when the National conference is this year as our Trust would like to present this year. Remember it was around May/June time at the Macdonald Hotel in Manchester.

First of all I would like to

First of all I would like to appreciate the effort taken by the Carers Trust and the National Mental Health Development Unit for planning effective methods to ensure the treatment and wellness of people with mental illness. I am very much impressed with the concept of “The Triangle of Care”.

The biggest problem with

The biggest problem with mental health is hard to find. Once the patient is willing to take medical check up then only he are she can cure it. best essay writing offers good amount of knowledge about mental health issues. I am diagnosed with ADHD and with the help of our family I am able to cure my disease. Society and relatives must co-operate mental health patients.

Thank you for your valuable

Thank you for your valuable discussion on this great topic.

Hello, I understand that

Hello, I understand that there is a lot of complexity surrounding confidentiality – however I would like to share our story so far and also ask for any other experiences in this area. We are at our wits end:
My son has been in counselling since about April – we noticed changes in him over a period of around 18 months leading up to this, however he has always been a bit ‘quirky’ and I mean that affectionately. He displayed some traits as he was growing up; perhaps ASD, we never got him assessed, but we managed and just tried to build on strengths. Over the period leading up to him (and then us looking for help), he became very moody and over sensitive – more than usual, although we put this behaviour down to hormones and usual teenager stuff. After seeing our GP he was referred to CAMHS and was fortunate to get seen over the next couple of months even though there was some confusion about who would be the professional body involved because of his age. After 6 weeks of CAMHS, he was referred to health in mind and has had some CBT since September – as far as we know.
The problem lies in the law – it would seem that the guidelines for a triangle of care are not applied at all. When my son’s care was put over to CAMHS and health in mind we were completely shut out. I cannot understand why they cannot just send a courtesy introduction which tells the carer who they are, what they do and perhaps offer some reassurance to the family. May be they could send out leaflets or links…we were not even given our son’s practioners name and only got that from a conversation that we managed to have with our son. As parents, we have been given no support, no sign-posting or information which could help us to work in partnership with the body involved.
I would like to take this up with the trust involved because, based on this, I feel that my son has not received the best care or advice; for example the guidelines state that carers can be informed who is working with their loved one and perhaps what they can do to help…it states that it is important for appropriate information to be shared with carers. Sadly, as with many things this is left to interpretation and the advice given to the patient regarding seems to be inconsistent too. We have no idea how it was put to our son – if at all about confidentiality; for example if he was merely asked whether he wanted us involved he would have more than likely said no – anyone would. However, if it was explained as per the guidelines and with the consequences and flexibility involved I suspect that we would have been invited to support him more specifically. We do not need (or want) information about the personal details of what has been said - rather, we would like to highlight what is happening from our point of view to assist the practitioner and in turn learn strategies to aid our son's recovery. As it is, we are running around blindly, treading on egg shells and getting shut out completely far from being able to give our son practical and emotional support we are very quickly becoming stressed and unable to manage situation and I blame the secrecy and ‘closed-shop’ of the body involved.

Nice aritlce

Nice aritlce

I would like to confirm B

I would like to confirm B Sampson's comment re signpost to a a signpost which sadly gets you nowhere. I have tried Devon Carers, Rethink, indeed just about everything, and they have NOTHING to offer me.

I did find (by myself) after searching the internet for hours, one 2 hour session for carers which took place on one day in March, and then another 2 hour session 2 weeks later. Just two of us attended and I believe that was because it was not properly publicised. You'd think mental health teams would have leaflets or info on their desks to pass on to carers, but I've had zero support from them. My son was diagnosed with schizophrenia almost 7 years ago and TBH as far as the mental health team are concerned, if you are looking after him, and making their job easy, that's all they care about. *He* is their client and you as his carer are unimportant. That's how it feels. Likewise after visit to the doctors to be referred for counselling sessions, I was told it would be MONTHS before I heard anything.

As Danna mentioned, the underfunding within the mental health system is chronic. My son was in Brighton (near his father, we are separated) for a few years, during which time he suffered several psychotic episodes (refusal to take medication) and was hospitalised. The last time they had NINE people who required hospitalisation in the Brighton area and there were NO BEDS available for any of them, and they had to be farmed out to different private hospitals around London where they would have no contact with anyone they knew. nor their families. That is the state of the health system for those SUFFERING FROM chronic mental health problems, so what hope is there for the carers?

From what I see, there's a lot of fine words and good intentions. But that doesn't equal SUPPORT.

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