Josef is 16 and lives with his mother, Dorota, who was diagnosed with Bipolar disorder seven years ago. Josef was born in England. His parents are Polish and his father sees him infrequently.
This case study looks at the impact of caring for someone with a mental health problem and of being a young carer, in particular the impact on education and future employment.
When you have looked at the materials for the case study and considered these topics, you can use the critical reflection tool and the action planning tool to consider your own practice.
Name: Josef Mazur
Gender: Male
Age: 16
Ethnicity: White European
First language: English/ Polish
Religion: Roman Catholic
Josef lives in a small town with his mother Dorota who is 39. Dorota was diagnosed with Bi-polar disorder seven years ago after she was admitted to hospital. She is currently unable to work. Josef’s father, Stefan, lives in the same town and he sees him every few weeks. Josef was born in England. His parents are Polish and he speaks Polish at home.
Josef is doing a foundation art course at college. Dorota is quite isolated because she often finds it difficult to leave the house. Dorota takes medication and had regular visits from the Community Psychiatric Nurse when she was diagnosed and support from the Community Mental Health team to sort out her finances. Josef does the shopping and collects prescriptions. He also helps with letters and forms because Dorota doesn’t understand all the English. Dorota gets worried when Josef is out. When Dorota is feeling depressed, Josef stays at home with her. When Dorota is heading for a high, she tries to take Josef to do ‘exciting stuff’ as she calls it. She also spends a lot of money and is very restless.
Josef worries about his mother’s moods. He is worried about her not being happy and concerned at the money she spends when she is in a high mood state. Josef struggles to manage his day around his mother’s demands and to sleep when she is high. Josef has not told anyone about the support he gives to his mother. He is embarrassed by some of the things she does and is teased by his friends, and he does not think of himself as a carer. Josef has recently had trouble keeping up with course work and attendance. He has been invited to a meeting with his tutor to formally review attendance and is worried he will get kicked out. Josef has some friends but he doesn’t have anyone he can confide in. His father doesn’t speak to his mother.
Josef sees some information on line about having a parent with a mental health problem. He sends a contact form to ask for information. Someone rings him and he agrees to come into the young carers’ team and talk to the social worker. You have completed the assessment form with Josef in his words and then done a support plan with him.
Josef Mazur
What others like and admire about me
I can draw
Good at football
Finished Arkham Asylum on expert level
What is important to me
Mum being well and happy
Seeing my dad
Being an artist
Seeing my friends
How best to support me
Tell me how to help mum better
Don’t talk down to me
Talk to me 1 to 1
Let me know who to contact if I am worried about something
Work out how I can have some time on my own so I can do my college work and see my friends
Don’t tell mum and my friends
Name: Josef Mazur
Gender: Male
Age: 16
Ethnicity: White European
First language: English/ Polish
Religion: Roman Catholic
Date chronology completed: 7 March 2016
Date chronology shared with person: 7 March 2016
Date | Life Event | Outcome and/or response |
1997 | Josef’s mother and father moved to England from Poznan. | Both worked at the warehouse – Father still works there. |
11.11.1999 | Josef born. | Mother worked for some of the time that Josef was young. |
2006 | Josef reports that his mother and father started arguing about this time because of money and Josef’s mother not looking after household tasks. | Josef started doing household tasks e.g. cleaning, washing and ironing. |
2008 | Josef reports that his mother didn’t get out of bed for a few months. | Josef managed the household during this period. |
October 2008 | Josef reports that his mother spent lots of money in catalogues and didn’t sleep. She was admitted to hospital. | Mother was in hospital for 6 weeks and was diagnosed with bipolar disorder.
Josef began looking after his mother’s medication and says that he started to ‘keep an eye on her.’ |
May 2010 | Josef’s father moved out to live with his friend Kat.
Josef stayed with his mother. |
Josef reports that his mother was ‘really sad for a while and then she went round and shouted at them.’
Mother started on different medication and had regular visits from the Community Psychiatric Nurse. Josef said that the CPN told him about his mum’s illness and to let him know if he needed any help but he was managing ok. Josef saw his father every week for a few years and then it was more like every month. Father does not visit Josef or speak to his mother. |
2013/14 | Josef reports that his mother got into a lot of debt and they had eviction letters. | Josef’s father paid some of the bills and his mother was referred by the Community Mental Health Team for advice from CAB and started getting benefits.
Josef started doing the correspondence. |
2015 | Josef left school and went to college. | Josef got an A (art), 4 Cs and 3 Ds GCSE. He says that he ‘would have done better but I didn’t do much work.’ |
26 Feb 2016 | Josef got a letter from his tutor at college saying he had to go to a formal review about attendance. | Josef saw information on-line about having a parent with a mental health problem and asked for some information. |
2 March 2016 | Phone call from young carer’s team to Josef. | Josef agreed to come in for an assessment. |
4 March 2016 | Social worker meets with Josef. | Carer’s assessment and support plan completed. |
7 March 2016 | Paperwork completed. | Sent to Josef. |
Young Carers Assessment
Do you look after or care for someone at home?
The questions in this paper are designed to help you think about your caring role and what support you might need to make your life a little easier or help you make time for more fun stuff.
Please feel free to make notes, draw pictures or use the form however is best for you.
What will happen to this booklet?
This is your booklet and it is your way to tell an adult who you trust about your caring at home. This will help you and the adult find ways to make your life and your caring role easier.
The adult who works with you on your booklet might be able to help you with everything you need. If they can’t, they might know other people who can.
Our Agreement
Worker:
- I will share this booklet with people if I think they can help you or your family
- I will let you know who I share this with, unless I am worried about your safety, about crime or cannot contact you
- Only I or someone from my team will share this booklet
- I will make sure this booklet is stored securely
- Some details from this booklet might be used for monitoring purposes, which is how we check that we are working with everyone we should be
Signed: ___________________________________
Young person:
- I know that this booklet might get shared with other people who can help me and my family so that I don’t have to explain it all over again
- I understand what my worker will do with this booklet and the information in it (written above).
Signed: ____________________________________
About me
Name: Josef Mazur
Address: 1 Green Avenue, Churchville, ZZ1 Z11
Telephone: 012345 123456
Email: jmazz@apple.com
Gender: Male
Date of birth: 11.11.1999 Age: 16
School: Green College, Churchville
Ethnicity: White European
First language: English/ Polish
Religion: Baptised Roman Catholic
GP: Dr Amp, Hill Surgery
The best way to get in touch with me is:
Do you need any support with communication?
No*
*Josef is bilingual – English and Polish. He speaks English at school and with his friends, and Polish at home. Josef was happy to have this assessment in English, however, another time he may want to have a Polish interpreter. It will be important to ensure that Josef is able to use the words he feels best express himself.
About the person/ people I care for
I look after my mum who has bipolar disorder. Mum doesn’t work and doesn’t really leave the house unless she is heading for a high. When Mum is sad she just stays at home. When she is getting hyper then she wants to do exciting stuff and she spends lots of money and she doesn’t sleep.
Do you wish you knew more about their illness?
No
Do you live with the person you care for?
Yes
What I do as a carer
It depends on if my mum has a bad day or not. When she is depressed she likes me to stay home with her and when she is getting hyper then she wants me to go out with her.
If she has new meds then I like to be around.
Mum doesn’t understand English very well (she is from Poland) so I do all the letters. I help out at home and help her with getting her medication.
Tell us what an average week is like for you, what kind of things do you usually do?
Monday to Friday
Get up, get breakfast, make sure mum has her pills, tell her to get up and remind her if she’s got something to do.
If mum hasn’t been to bed then encourage her to sleep a bit and set an alarm
College – keep phone on in case mum needs to call – she usually does to ask me to get something or check when I’m coming home
Go home – go to shops on the way
Remind mum about tablets, make tea and pudding for both of us as well as cleaning the house and fitting tea in-between, ironing, hoovering, hanging out and bringing in washing
Do college work when mum goes to bed if not too tired
Weekend
More chores
Do proper shop
Get prescription
See my friends, do college work
Sunday – do paper round
Physical things I do….
(for example cooking, cleaning, medication, shopping, dressing, lifting, carrying, caring in the night, making doctors appointments, bathing, paying bills, caring for brothers & sisters)
I do all the housework and shopping and cooking and get medication
Things I find difficult
Emotional support I provide…. (please tell us about the things you do to support the person you care for with their feelings; this might include, reassuring them, stopping them from getting angry, looking after them if they have been drinking alcohol or taking drugs, keeping an eye on them, helping them to relax)
If mum is stressed I stay with her
If mum is depressed I have to keep things calm and try to lighten the mood
She likes me to be around
Things I find difficult
When mum is heading for a high wants to go to theme parks or book holidays and we can’t afford it
I worry that mum might end up in hospital again
Mum gets cross if I go out
Other support
Please tell us about any other support the person you care for already has in place like a doctor or nurse, or other family or friends.
The GP sees mum sometimes. She has a nurse who she can call if things get bad.
Mum’s medication comes from Morrison’s pharmacy.
Dad lives nearby but he doesn’t talk to mum.
Mum doesn’t really have any friends.
Do you ever have to stop the person you care for from trying to harm themselves or others?
No
Some things I need help with
Sorting out bills and having more time for myself
I would like mum to have more support and to have some friends and things to do
My week
On a normal week, what are the best bits? What do you enjoy the most?
(eg, seeing friends, playing sports, your favourite lessons at school)
College
Seeing friends
When mum is up and smiling
Playing football
Xbox
On a normal week, what are the worst bits? What do you enjoy the least?
(eg cleaning up, particular lessons at school, things you find boring or upsetting)
Nagging mum to get up
Reading letters
Missing class
Mum shouting
Friends laugh because I have to go home but they don’t have to do anything
Fun stuff!
What things do you like to do in your spare time?
Drawing
Playing football
Xbox
Do you feel you have enough time to spend with your friends or family doing things you enjoy, most weeks?
No
Do you have enough time for yourself to do the things you enjoy, most weeks?
(for example, spending time with friends, hobbies, sports)
No
Are there things that you would like to do, but can’t because of your role as a carer?
Yes
Can you say what some of these things are?
See friends after college
Go out at the weekend
Time to myself at home
It can feel a bit lonely
I’d like my mum to be like a normal mum
School/ College
Do you think being your caring role makes school/college more difficult for you in any way?
Yes
If you ticked YES, please tell us what things are made difficult and what things might help you.
Things I find difficult at school/ college
Sometimes I get stressed about college and end up doing college work really late at night – I get a bit angry when I’m stressed
I don’t get all my college work done and I miss days
I am tired a lot of the time
Things I need help with…
I am really worried they will kick me out because I am behind and I miss class. I have to meet my tutor about it.
Do your teachers know about your caring role?
No
Are you happy for your teachers and other staff at school/college to know about your caring role?
Not sure
Work
Do you think that being a carer will make it more difficult for you to find or keep a job?
Yes
Why do you think being a carer is/ will make finding a job more difficult?
I haven’t thought about it. I don’t know if I’ll be able to finish my course and do art and then I won’t be able to be an artist.
Who will look after mum?
What would make it easier for you to find a job after school/college?
Finishing my course
Mum being ok
How I feel about life…
Do you feel confident both in school and outside of school?
Somewhere in the middle
In your life in general, how happy do you feel?
Quite unhappy
In your life in general, how safe do you feel?
Very safe
How healthy do you feel at the moment?
Quite healthy
Being heard
Do you think people listen to what you are saying and how you are feeling?
No
If you said no, can you tell us who you feel isn’t listening or understanding you sometimes (eg, you parents, your teachers, your friends, professionals)
I haven’t told anyone
I can’t talk to mum
My friends laugh at me because I don’t go out
Do you think you are included in important decisions about you and your life? (eg, where you live, where you go to school etc)
Yes
Do you think that you’re free to make your own choices about what you do and who you spend your time with?
Not often enough
Is there anybody who knows about the caring you’re doing at the moment?
Yes
If so, who?
I told dad but he can’t do anything
Would you like someone to talk to?
Yes
Supporting me
Some things that would make my life easier, help me with my caring or make me feel better
I don’t know
Fix mum’s brain
Tell me how to help mum better
People to help me if I’m worried and they can do something about it
Not getting kicked out of college
Free time – time on my own to calm down and do work or have time to myself
Time to go out with my friends
Get some friends for mum
I don’t want my mum to get into trouble
Who can I turn to for advice or support?
I would like to be able to talk to someone without mum or friends knowing
Would you like a break from your caring role?
How easy is it to see a Doctor if you need to?
Easy
Conclusion
To be used by social care assessors to consider and record measures which can be taken to assist the carer with their caring role to reduce the significant impact of any needs. This should include networks of support, community services and the persons own strengths. To be eligible the carer must have significant difficulty achieving 1 or more outcomes without support; it is the assessors’ professional judgement that unless this need is met there will be a significant impact on the carer’s wellbeing. Social care funding will only be made available to meet eligible outcomes that cannot be met in any other way, i.e. social care funding is only available to meet unmet eligible needs.
Date assessment completed: 7 March 2016
Social care assessor conclusion
Josef provides daily support to his mum, Dorota, who was diagnosed with bipolar disorder seven years ago. Josef helps Dorota with managing correspondence, medication and all household tasks including shopping. When Dorota has a low mood, Josef provides support and encouragement to get up. When Dorota has a high mood, Josef helps to calm her and prevent her spending lots of money. Josef reports that Dorota has some input from community health services but there is no other support. Josef’s dad is not involved though Josef sees him sometimes, and there are no friends who can support Dorota.
Josef is a great support to his mum and is a loving son. He wants to make sure his mum is ok. However, caring for his mum is impacting: on Josef’s health because he is tired and stressed; on his emotional wellbeing as he can get angry and anxious; on his relationship with his mother and his friends; and on his education. Josef is at risk of leaving college. Josef wants to be able to support his mum better. He also needs time for himself, to develop and to relax, and to plan his future.
Eligibility decision: Eligible for support
What’s happening next: Create support plan
Completed by
Name:
Role:
Organisation:
About me
Name: Josef Mazur
Address 1 Green Avenue, Churchville, ZZ1 Z11
Telephone 012345 123456
Email jmazz@apple.com
Gender: Male
Date of birth: 11.11.1999 Age: 16
School Green College, Churchville
Ethnicity White European
First language English/ Polish
Religion Baptised Roman Catholic
GP Dr Amp, Hill Surgery
About the person/ people I care for
My relationship to this person son
Name Dorota Mazur
Address 1 Green Avenue, Churchville, ZZ1 Z11
Telephone 012345 123456
Gender Female
Date of birth 12.6.79 Age 36
Ethnicity White European
First language Polish
Religion Roman Catholic
GP Dr Amp, Hill Surgery
Support plan completed by
Name
Role
Organisation
Support plan
Needs | Outcomes | Actions |
To know how to help mum better | Josef knows what he can and can’t do to help
Josef is more confident that he is doing the right thing Josef is less tired and stressed and feels happier |
Ask Community Psychiatric Nurse to talk to Josef about how to support his mum (Josef does not want his mother to know about this)
To do the ‘My Life Now’ tool to see how Josef is now and to do this again after a month |
Someone to talk to and advice if I am worried | Josef can call someone or contact them on line when he is worried
Josef knows people who understand his situation |
Josef to try going to young carer’s group at lunchtime once a week
Josef to have number for advice line |
To be able to do college work and go to college | Tutor understands Josef’s situation and supports Josef
Josef finishes his course |
Social worker to attend the review meeting with Tutor and agree a plan for coursework and some flexible carer’s leave, and permission to use mobile in class for emergencies and time out if needed |
Time for myself | Josef can go out with his friends at the weekend and has time to do his college work in the evenings | Young carers’ group to advise Josef on how to talk to his mum about time for himself
Talk to tutor about Josef doing college work on site two evenings a week |
To plan for Josef leaving college | Josef to do an art degree | Start planning for this in six months time |
Support for mum | Ultimately, for Josef’s mother to have wider circle of support and increase her wellbeing | Ask Community Psychiatric Nurse to talk to mum about whether she would be prepared to have a social care assessment – will need an interpreter |
Date of support plan: 7 March 2016
This plan will be reviewed on: 7 September 2016
Signing this form
Please ensure you read the statement below in bold, then sign and date the form.
I understand that completing this form will lead to a computer record being made which will be treated confidentially. The council will hold this information for the purpose of providing information, advice and support to meet my needs. To be able to do this the information may be shared with relevant NHS Agencies and providers of carers’ services. This will also help reduce the number of times I am asked for the same information.
If I have given details about someone else, I will make sure that they know about this.
I understand that the information I provide on this form will only be shared as allowed by the Data Protection Act.
Name
Signature
Josef has given consent to share this support plan with the CPN but does not want it to be shared with his mum.
Mental health
The social work role with carers in adult mental health services has been described as: intervening and showing professional leadership and skill in situations characterised by high levels of social, family and interpersonal complexity, risk and ambiguity (Allen 2014). Social work with carers of people with mental health needs, is dependent on good practice with the Mental Capacity Act where practitioner knowledge and understanding has been found to be variable (Iliffe et al 2015).
- Carers Trust (2015) Mental Health Act 1983 – Revised Code of Practice Briefing
- Carers Trust (2013) The Triangle of Care Carers Included: A Guide to Best Practice in Mental Health Care in England
Video
Tool
- Tool 1: Triangle of care: self-assessment for mental health professionals – Carers Trust (2013) The Triangle of Care Carers Included: A Guide to Best Practice in Mental Health Care in England Second Edition (page 23 Self-assessment tool for organisations)
Mental capacity, confidentiality and consent
Social work with carers of people with mental health needs, is dependent on good practice with the Mental Capacity Act where practitioner knowledge and understanding has been found to be variable (Iliffe et al 2015). Research highlights important issues about involvement, consent and confidentiality in working with carers (RiPfA 2016, SCIE 2015, Mental Welfare Commission for Scotland 2013).
- Beddow, A., Cooper, M., Morriss, L., (2015) A CPD curriculum guide for social workers on the application of the Mental Capacity Act 2005. Department of Health
- Bogg, D. and Chamberlain, S. (2015) Mental Capacity Act 2005 in Practice Learning Materials for Adult Social Workers. Department of Health
- Department of Health (2015) Best Interest Assessor Capabilities, The College of Social Work
- RiPfA Good Decision Making Practitioner Handbook
- SCIE Mental Capacity Act resource
Tool
- Tool 2: Making good decisions, capacity tool (page 70-71 in good decision making handbook)
Young carers
A young carer is defined as a person under 18 who provides or intends to provide care for another person. The concept of care includes practical or emotional support. It is the case that this definition excludes children providing care as part of contracted work or as voluntary work. However, the local authority can ignore this and carry out a young carer’s need assessment if they think it would be appropriate. Young carers, young adult carers and their families now have stronger rights to be identified, offered information, receive an assessment and be supported using a whole-family approach (Carers Trust 2015).
- SCIE (2015) Young carer transition in practice under the Care Act 2014
- SCIE (2015) Care Act: Transition from children’s to adult services – early and comprehensive identification
- Carers Trust (2015) Rights for young carers and young adult carers in the Children and Families Act
- Carers Trust (2015) Know your Rights: Support for Young Carers and Young Adult Carers in England
- The Children’s Society (2015) Hidden from view: The experiences of young carers in England
- DfE (2011) Improving support for young carers – family focused approaches
- ADASS and ADCS (2015) No wrong doors: working together to support young carers and their families
- Carers Trust, Supporting Young Carers and their Families: Examples of Practice
- Refugee toolkit webpage: Children and informal interpreting
Video
- SCIE (2010) Supporting carers: the cared for person
- SCIE (2015) Care Act Transition from children’s to adults’ services – Video diaries
Tools
- Tool 3: Young carers’ rights – The Children’s Society (2014) The Know Your Rights pack for young carers in England!
Young carers of parents with mental health problems
The Care Act places a duty on local authorities to assess young carers before they turn 18, so that they have the information they need to plan for their future. This is referred to as a transition assessment. Guidance, advocating a whole family approach, is available to social workers (LGA 2015, SCIE 2015, ADASS/ADCS 2011).
- SCIE (2012) At a glance 55: Think child, think parent, think family: Putting it into practice
- SCIE (2008) Research briefing 24: Experiences of children and young people caring for a parent with a mental health problem
- SCIE (2008) SCIE Research briefing 29: Black and minority ethnic parents with mental health problems and their children
- Carers Trust (2015) The Triangle of Care for Young Carers and Young Adult Carers: A Guide for Mental Health Professionals
- ADASS and ADCS (2011) Working together to improve outcomes for young carers in families affected by enduring parental mental illness or substance misuse
- Ofsted (2013) What about the children? Joint working between adult and children’s services when parents or carers have mental ill health and/or drug and alcohol problems
- Mental health foundation (2010) MyCare The challenges facing young carers of parents with a severe mental illness
- Children’s Commissioner (2012) Silent voices: supporting children and young people affected by parental alcohol misuse
Video
Tool
- Tool 5: Family model for assessment
- Tool 6: Engaging young carers of parents with mental health problems or substance misuse
Young carers and education/ employment
Transition moments are highlighted in the research across the life course (Blythe 2010, Grant et al 2010). Complex transitions required smooth transfers, adequate support and dedicated professionals (Petch 2010). Understanding transition theory remains essential in social work practice (Crawford and Walker 2010). Partnership building expertise used by practitioners was seen as particular pertinent to transition for a young carer (Heyman 2013).
- TLAP (2013) Making it real for young carers
- Learning and Work Institute (2018) Barriers to employment for young adult carers
- Carers Trust (2014) Young Adult Carers at College and University
- Carers Trust (2013) Young Adult Carers at School: Experiences and Perceptions of Caring and Education
- Carers Trust (2014) Young Adult Carers and Employment
- Family Action (2012) BE BOTHERED! Making Education Count for Young Carers
The Triangle of Care
Carers Included: A Guide to Best Practice
in Mental Health Care in England
The Triangle of Care is a therapeutic alliance between service user, staff member and carer that promotes safety, supports recovery and sustains wellbeing…
Capacity Tool
Good decision-making
Practitioners’ Handbook
The Capacity tool on page 71 has been developed to take into account the lessons
from research and the case CC v KK. In particular:
- that capacity assessors often do not clearly present the available options (especially those they find undesirable) to the person being assessed
- that capacity assessors often do not explore and enable a person’s own understanding and perception of the risks and advantages of different options
- that capacity assessors often do not reflect upon the extent to which their ‘protection imperative’ has influenced an assessment, which may lead them to conclude that a person’s tolerance of risks is evidence of incapacity.
The tool allows you to follow steps to ensure you support people as far as possible to make their own decisions and that you record what you have done.
Tool 3: Know Your Rights
Young Carers in Focus
This pack aims to make you aware of your rights – your human rights, your legal rights, and your rights to access things like benefits, support and advice.
Need to know where to find things out in a hurry? Our pack has lots of links to useful and interesting resources that can help you – and help raise awareness about young carers’ issues!
Know Your Rights has been produced by Young Carers in Focus (YCiF), and funded by the Big Lottery Fund.
Tool 4: Vision and principles for adults’ and children’s services to work together to support young carers
You can use this tool to consider how well adults’ and children’s services work together, and how to improve this.
This is based on ADASS and ADCS (2015) No wrong doors: working together to support young carers and their families
Tool 5: Family model for assessment
You can use this tool to help you consider the whole family in an assessment or review.
What are the risk, stressors and vulnerability factors?
How is the child/ young person’s wellbeing affected?
How is the adult’s wellbeing affected?
What are the protective factors and available resources?
This tool is based on SCIE (2009) Think child, think parent, think family: a guide to parental mental health and child welfare
Tool 6: Engaging young carers
Young carers have told us these ten things are important. So we will do them.
- Introduce yourself. Tell us who you are and what your job is.
- Give us as much information as you can.
- Tell us what is wrong with our parents.
- Tell us what is going to happen next.
- Talk to us and listen to us. Remember it is not hard to speak to us we are not aliens.
- Ask us what we know and what we think. We live with our parents; we know how they have been behaving.
- Tell us it is not our fault. We can feel guilty if our mum or dad is ill. We need to know we are not to blame.
- Please don’t ignore us. Remember we are part of the family and we live there too.
- Keep on talking to us and keeping us informed. We need to know what is happening.
- Tell us if there is anyone we can talk to. Maybe it could be you.