Effectiveness of Respite Care for Carers of Individuals with a Mental Illness.

Ms Claudia Jardim (). Effectiveness of Respite Care for Carers of Individuals with a Mental Illness. Professional Doctorate, School of Psychology, The University of Queensland.

       
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Author Ms Claudia Jardim
Thesis Title Effectiveness of Respite Care for Carers of Individuals with a Mental Illness.
School, Centre or Institute School of Psychology
Institution The University of Queensland
Thesis type Professional Doctorate
Supervisor Associate Professor Kenneth Pakenham
Total pages 209
Abstract/Summary Providing care for an adult with a mental illness is associated with a range of detrimental consequences for the carer, including psychological and physical difficulties. Research has demonstrated that the availability, quality and level of professional support provided to mental health carers has the ability to influence the level of caregiving burden they experience. Respite care services are one of the most frequently reported needs of mental health carers, however there is little existing research to support the use and effectiveness of respite care in the mental health field. Hence, this dissertation is comprised of three studies that examine the perceptions, needs, benefits and effectiveness of respite care services for carers of individuals with a mental illness. A total of 106 mental health carers recruited through two carer support organisations completed postal questionnaires comprising of open-ended questions and measures of demographics, caregiving context and carer adjustment variables. Just over a third of the participants had accessed respite care at some point in their caregiving role. This sample was used for both Study 1 and Study 2, and the comparison group for Study 3 was selected from the subsample of carers who had not accessed respite care. Study 1 examined informal mental health carers’ perceptions of respite care. Participants were 106 carers caring for an adult with a mental illness recruited through carer support organisations. Carers provided written responses to open-ended questions covering four areas: barriers, positive and negative aspects, and improvements associated with respite care. A total of 36% had accessed respite care and 64% had never accessed respite care. The most frequently reported respite themes for both users and non-users in each of the four areas relevant to carers and care recipients were: barriers - care-recipient’s reluctance to use respite (e.g., refusal, psychiatric symptoms hamper access, denial of mental disorder); carer positives – caregiving relief (e.g., opportunity to relax, break from caregiving role); care recipient positives – socialising and participation in activities; carer negatives - problematic characteristics of the service (e.g., irregular or inflexible services, staffing problems); care recipient negatives - lack of suitable activities; carer improvements – increased access and availability of services; care recipient improvements - greater support and understanding of mental health issues. Findings indicate that respite care services should be tailored to the demands of mental health caregiving, providing flexibility in options across factors such as frequency, duration, location, transport access, support levels, staff training, activities and routines, graduated entry, type of respite care (e.g., in-home, hospital, drop-in centre), and crisis/acute respite. The purpose of Study 2 was to investigate the rate, type and duration of respite care use amongst carers of individuals with a mental illness and the differences between carers who accessed respite care and those who did not use this service on demographic, caregiving context and carer adjustment variables. Of the 106 carer participants, the majority (76%) who had accessed care used it weekly, fortnightly or monthly. The most common types of respite services were in-home, day programs, and residential respite. The mean duration of respite care was 58.18 hours. Compared to respite care non-users, carers who accessed respite care reported more benefits associated with their caregiving, and were more likely to live with their care recipient and provide more assistance with activities of daily living, instrumental activities of daily living and psychosocial caring. Findings suggest that respite care services need to be varied, available for carers on a weekly to monthly basis with a range in duration, but catering for higher use of two day respite care periods. Carers who are highly engaged in a range of caregiving tasks and who live with their care recipient are more likely to have a greater need for respite care. Due to the lack of empirical evidence from effectiveness studies to support the use of respite care with carers of people with a mental illness, Study 3 evaluated the effectiveness of respite care in reducing caregiving burden, distress and improving life satisfaction and physical health for mental health carers. Ten informal carers recruited via two respite centres completed questionnaires measuring carer adjustment variables prior to accessing respite care, following the respite care period and at a three month follow up. These outcome measures were compared to a control group of 10 carers, matched on demographic variables, who had not accessed respite care. Compared to respite care non-users, carers who accessed respite care demonstrated a reduction in objective burden and an increase in stress following respite care use. Findings suggest that respite care use is associated with a decrease in carer burden, a noteworthy finding given the detrimental outcomes associated with increased burden. However, respite care use was also associated with increased stress. Reasons for this finding include barriers to accessing respite care and the use of respite care as a last resort. Respite care services must be flexible to enable carers to access support when they are experiencing the greatest difficulties associated with their caregiving role. This dissertation has demonstrated that respite care is effective in reducing carer burden, an important finding given that carers who access respite care are more heavily involved in their caregiving role. Stress has also been shown to increase following respite care use, however this is likely to be a result of the negative aspects of respite care identified by carers. Carers identify that respite care is not provided flexibly to cater for the episodic nature of mental illness, and much of the respite care provided is not designed for the unique needs and wants of adults with mental illnesses. Despite the shortcomings, carers continue to perceive respite care as beneficial and essential to the maintenance of their caregiving role.
Keyword respite care
mental illness
carers
benefits
effectiveness
qualitative
quantitative

 
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Created: Sat, 10 Oct 2009, 06:32:42 EST by Ms Claudia Jardim