What support can community mental health nurses deliver to carers of people diagnosed with schizophrenia? Findings from a review of the literature

Abstract

Objectives: The purpose of this review was to determine the nature of support that mental health nurses could deliver to carers of people diagnosed with schizophrenia. The aim was to identify approaches that could be delivered within community practice to reduce burden and increase knowledge, mental health and coping. QUESTIONS ADDRESSED: What effect did support have on carer burden and other needs? What were the key elements of effective support? What effective supports could mental health nurses deliver within practice?

Design: This review covers the international scientific literature published between 1980 and 2008.

Data sources: Searches were made of electronic databases relevant to nursing. All papers, published in English, were assessed. Hand searches of review papers and references were also carried out. Sixty-eight studies were included.

Study appraisal and synthesis: Only comparative studies providing a quantitative assessment of carer outcomes were included. Findings were synthesised in narrative format and grouped by intervention type.

Results: Of the 68 emerging studies, 12 (18%) directly included nurses in delivering the intervention and 16 (24%) included nurses as part of a multidisciplinary team. There is fairly robust evidence that education improves carer knowledge of schizophrenia. There is, however, little evidence that it addresses more substantive areas such as burden, coping or mental health. Supportive family education moves beyond information giving by developing coping. As might be expected these approaches can reduce burden. More intensive programmes such as behavioural family therapy aim to address stressful relationships which commonly occur in families of people diagnosed with schizophrenia. These programmes are particularly effective in reducing burden and can also improve mental health. Community support such as intensive outreach is also effective in reducing burden. Finally, there is some evidence that mutual support groups reduce burden and improve coping.

Conclusions: Research on effective support for carers of people diagnosed with schizophrenia is emerging. Although findings were mixed, there was some evidence supporting a range of approaches that mental health nurses could offer to carers. There is, however, still a need for pragmatic studies to determine the extent that these approaches can be delivered within nursing practice.