Partners in Depression:
Supporting those who care

Presenter: Tania Ewin, Senior Project Officer
Additional Authors: Emma Cother, Katie McGill, Dr Deanna Pagnini, Elena Terol
A mental health initiative of….
Program funded by….
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Some facts and stats

Depression affects one million Australians every year

Estimated that up to 20% of Australians will at some stage experience
depressive symptoms in their lifetime (ABS 2007; DoHA & AIHW 1999)

When a person is unwell, generally family and friends provide the majority
of routine day to day emotional and practical support to those in the
community.
Symposium Overview
1.
What do we know supports carers
of people with depression?
2.
Partners in Depression:
Not just a group education program
3.
Does the Partners in Depression program help?
4.
Success stories and lessons learned: national dissemination & local
implementation
3
What do we know supports
carers of people with
depression?
What is “caring”?

Helping to manage the illness

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
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Providing practical or functional assistance


Identifying symptoms
Working out symptom management strategies
Facilitate access to treatment
Taking on increased household or financial responsibilities such as housework,
childcare, and paying bills
Or providing ongoing emotional support


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Being available to listen
Organising mutually enjoyable activities
Letting the person know they are loved
5
“The Partners in Depression program was
excellent. I didn’t realise I was a carer and I
didn’t realise the impact caring was having on
me until I attended the group.”
6
Review of the evidence
In the research examined:

Primary interventions that have been developed : Psycho-educational
group programs

No reports about the relevance or effectiveness of peer support groups,
respite, other interventions providing practical support or individual
counselling

High attendance in group programs, positive feedback and high
satisfaction ratings suggest that carers of people with depression are
interested in receiving information about depression and how to
enhance their own coping skills
7
Impact of depression & the caring role

12 focus groups of partners of
people with depression :
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
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there is a significant and
unrelenting burden of providing
support to a person with
depression
this burden can contribute to
strain on relationships and
jeopardise the mental and
physical wellbeing of the carer
involvement with support groups
and agencies is important
(Highet, McNair, Davenport & Hickie, 2004)

Data analysis from Partners in
Depression has also highlighted
the positive aspects of caring:

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A sense of purpose
Strengthened connection with
the person they are caring for,
including improved
communication
Opportunity to increase
knowledge
(diagnosis & health system)
Subjective & Objective Burden
Objective burden relates to the disruption to every day life which may include:
•
•
•
Changes to household roles and responsibilities
Changes to social & recreational activities
Financial strain
Subjective burden relates to the carers’ perception of their situation
and their emotional response which may include:
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Worry
Fear
Hyper vigilance
Frustration
Anger
Resentment
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Variables affecting burden
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Type and severity of illness
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Stigma associated with diagnosis
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Phase of caring

Relationship of the carer to the person with the mental illness

E.g. partner, child, parent, sibling, friend

Lack of information and skills to deal with the situation
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Absence of emotional support & respite breaks

Financial support
10
Coping strategies

Coping strategies may include:

Increasing knowledge of the illness

Reassess their expectations of their loved one in light of their
increased awareness

Taking care of carer’s own health

Seeking social, family and professional support

Setting boundaries to allow a loved one to take more
responsibility

Carers who used a variety of physical, emotional and social
strategies reported more positive outcomes
11
Partners in Depression:
not just a group education
program
Partners in Depression Program Specifics

6 x 2 hour weekly group education sessions for people who support a
person with depression (‘carers’, ‘loved ones’, ‘partners’, family or friends)

Run by 2 health or community professionals with mental health
knowledge and group work skills

For groups of between 4 and 12 participants

Aims to address the information and support needs of those who care
for a person with depression.

Adult education program for people aged 16 years and over

Culturally sensitive but not culturally specific

Complete package provided
Partners in Depression Program Goals
1.
To increase knowledge about the symptoms, diagnosis and treatment of
depression
2.
To provide information about and improve communication skills and
strategies
3.
To increase awareness of the impact of depression on relationships
4.
To provide education about and to increase utilisation of self-care and
coping strategies
5.
To encourage help seeking behaviour in carers and people with
depression
6.
To increase awareness of and facilitate access to
available support services and resources
Partners in Depression Program Content
The program has a dual focus:

providing information relevant to supporting a person with depression:

what is depression

communication strategies

understanding suicide and self harm

encouraging help-seeking

promoting self-care and an opportunity to reflect on the care experience
Partners in Depression Session Overview
1.
Introductions; Building Awareness
2.
Insight into Caring and Support;
Understanding Depression and its Treatments
3.
The Caring and Support Experience
4.
Introduction to Cognitive Behavioural Therapy;
The Support Experience
5.
Suicidality and Self Harm; Communication Strategies
6.
Communication Strategies; Help seeking and
Support; Planning for the Future
We talk about…
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Treatments

Caring & support experience
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Carer Life Course Framework
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Grief & stigma
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Suicide & self-harm
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Communication

Help seeking & support

Self-care
“I think this has been the most
useful information I have ever
received regarding depression
& because it was a small
group I was able to tell my
story and get feedback.”
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Self Care

Caregivers are reluctant to prioritise their own needs alongside or
equal to those they care for and almost always presume that their needs
do not justify intervention (Muscroft & Bowl, 2000)

Outcomes for people with depression improve when the needs of the
family members for information, clinical guidance and support are met
(Dixon et al. 2001)
PID Initiative resources…
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Facilitator Manual and CD ROM provided
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Participant Guides provided (for each participant per group)
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Website with a dedicated Facilitator only area plus extensive resources
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Peer teleconferences
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Project Team’s assistance with problem solving
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Clinical governance management and support
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E.g. Summary reports sent to facilitators (eg K10 score changes, participant feedback)
Facilitator
Manual
Participant
Guides
Program Support Phase – Evaluation (a)

Independent evaluator: Dr Deanna Pagnini
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Extensive range of quantitative & qualitative data
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Data collection March 2010– May 2012
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Facilitator data sources:
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Training feedback forms (N=379)
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Program fidelity checklists after each group (800 checklists returned)
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Facilitator feedback forms (N = 105)
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Facilitator focus groups (2 x groups, 11 participants)
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Program Support Phase – Evaluation (b)
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Participant data sources:
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Group member baseline questionnaires (N=1220)
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Group member post-program questionnaires (N=959)
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Group member 6 month follow-up questionnaires (N=119)
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Group member focus groups (3 groups, 18 participants)
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Follow up phone interviews with group members (N=40)
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PiD team data sources:
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Project plans & changes/modifications
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Interviews with key staff
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Does the Partners in
Depression program help?
Who attended the program?
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Over 1200 people attended the program (during national roll-out)
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80% participants were women
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Average age 53 years
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75% born in Australia
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Many rarely disclose they are caring for someone with depression
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64% of the people with depression also have additional physical or
mental health problems
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Metropolitan, regional, rural and remote geographical areas –
from Broome to Brisbane, Alice Springs to Burnie
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Measuring psychological distress - baseline
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Key finding: Levels of psychological distress decrease
significantly after participation
• Level of
• Baseline
psychological
distress (K10)
• Program
end
• 6 month
follow-up
• Low (10-15)
• 30.0%
• 43.0%
• 48.7%
• Medium
(16-29)
• 57.6%
• 50.9%
• 43.4%
• High (30-50)
• 12.4%
• 6.1%
• 8.0%
• N
• 1220
• 872
• 113
Key Findings
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Quantitative data show that group members made improvements in
important areas:

Knowledge

Awareness of depression
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Improved communication skills
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Self-care and coping techniques
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Encouragement for help-seeking behaviours
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84% of group participants applied what they learned, including:
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Changing the way they communicated/reacted to situations
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Taking time for themselves
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Encouraging discussions about potential changes in treatment
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Disclosing their experience with depression to others
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“It was incredibly helpful to know we were not alone in trying to support
our loved ones.”
“It gave me hope to continue and the ability/skills to continue and enjoy
the ‘ride” (rollercoaster) and enjoy the good moments.”
“I’m more direct and upfront about where my boundaries are”
“Greater awareness = greater empathy = stronger relationship”
“It is more relaxing relating to them because I know I can only support
them, not make them better.”
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Key findings: Participants’ feedback
regarding content
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86% were very or extremely satisfied with the program as a whole
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The <1% who were extremely or somewhat unsatisfied felt it was too
rushed or too basic
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98% of participants would recommend it to others
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Nearly 2/3 of participants in the six month follow up have recommended
PiD to others
Interview with Liisa,
a participant
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Success stories & lessons learned:
national dissemination & local
implementation
In the beginning …

Local identified need?
Pilot Phase
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2007 – 2008
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Co-funded by beyondblue: the national depression initiative
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Consisted of 2 phases:
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Consultation
Implementation
National dissemination

Nib foundation grant to undertake national dissemination from Aug 2009 to
April 2012
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Stakeholder engagement phase (reference group, external evaluator,
meetings with key stakeholders)
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Training phase
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Program support phase
Challenges!!
1.
How do we find 400 facilitators?
2.
How do we ensure the fidelity of the program?
3.
How do we keep facilitators engaged when we aren’t paying them?
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How did we find our facilitators?

Aim was to develop a relationship with organisations across
Australia who:

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Identified their core business was working with families and
carers
OR
Could articulate that working with families and carers fit within
their current framework
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Training Phase
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400 health & community professionals recruited
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Successful applicants attended free 2-day facilitator training course
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Facilitators committee to delivering the program at least 3 times in 12
months-certification
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Provided with all participant resources and a range of clinical and
administrative support
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Not paid by project team to deliver the program
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Clinical Governance

How do we ensure that groups run across the country are delivered in line
with the principles of the program and in a consistent manner?
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Quality Assurance process
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Dedicated Senior Project Officer - Clinical Lead
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Interview with Neil,
a facilitator
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In conclusion…
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Community capacity building approach
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Adding to the evidence base
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Meeting a need!
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www.partnersindepression.com.au
pid@hnehealth.nsw.gov.au
“Caring for someone living with depression can be
frustrating. There were times I felt totally exasperated, not
knowing where to turn for help or support. Programs such
as Partners in Depression are vital in helping carers to be
more informed in providing support for their loved one and
also better prepare them to address their own needs. With
this help the family can learn to live, laugh and love again,”
Mrs Lucy Brodgen, Program patron
Thank you
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References
•
Dixon, L, McFarlane, W.R., Lefley, H.M. Lucksted, A., Cohen, M., Falloon, I., et al.
(2001)Evidence base practice for services to families of people with psychiatric disabilities.
Psychiatric Services, 52(7) 903-910
•
Government of South of Australia (2009) Mental Health Act
•
Hayman, F (2005) Helping Carers Care: An Education Program for Rural Carers of People with
a Mental Illness. Australasian Psychiatry, 13 (2), 148-153.
•
Highet N.J., McNair, B.G., Daverport, T.A. & Hickie, I.B. (2004) How much more can we
lose?:Carer and family perspectives on living with a person with depression. Medical Journal of
Australia, 181(7)
•
Jeglic, E., Pepper, C., Ryanchenko, K., Griffith, K., Miller, A. & Johnson, M. (2005). A caregiving
model of coping with a partner's depression. Family Relations. 51:1. 37-45.
Kim, H-W., & Salyers, M. P. (2008). Attitudes and perceived barriers to working with families of
persons with severe mental illness: Mental health professionals’ perspectives. Community
Mental Health, 44, 337-345.
Muscroft, J.& Bowl,R. (2000)The impact of depression on caregivers and other family members:
implications for professional support. Counselling Psychology Quarterly, 13(1), 117-134
Schofield, H.L., Bloch, S., Nankervis, J., Murphy, B. Singh, B.S. & Herrman, H.E. et al. (1999)
Health and well-being of women family carers: A comparative study with
a generic focus. Australian and New Zealand Journal of Public Health,
23(6)m 585-589.
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