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Template Presentation. Welcome and Introduction. [Insert name and affiliation of presenter]. Today’s goal. Heighten awareness of the perspective of family caregivers Increase understanding of how serious mental illnesses affect the entire family - PowerPoint PPT Presentation

Transcript of Template Presentation

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Welcome and Introduction

[Insert name and affiliation of presenter]

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Today’s goal

• Heighten awareness of the perspective of family caregivers –Increase understanding of how serious mental illnesses affect the

entire family

–Communicate the hopes, frustrations and experiences of caregivers with regard to their loved one’s mental health treatment

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Today’s agenda

• Introduction and overview [local advocate - moderator]

• WFMH mission/role of family caregiver [WFMH representative]

• Caregiver survey findings [local advocate - moderator]

• Family caregiver/advocate story [local caregiver]

• Contexualizing the findings [psychiatrist]

• Question & Answer session   [local advocate - moderator]

• Closing remarks [local advocate - moderator]

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Insert name of WFMH representative

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Who we are

• WFMH is an international NGO governed by an elected volunteer board of directors from 17 countries

• WFMH represents all mental health professional disciplines, consumers/patients, family members/caregivers and citizen advocates from more than 100 countries

• WFMH’s World Mental Health Day network is comprised of 4000 organizations and individuals in 180 countries

• WFMH has NGO consultative status with the United Nations, World Health Organization, UNESCO, International Labor Office and the World Bank

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World Federation for Mental Health mission

• Promote the advancement of mental health awareness, prevention, advocacy and best practice recovery

• Improve the care, treatment and recovery of people with mental disorders

• Heighten public awareness about the importance of mental health through gaining understanding and improving attitudes

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Keeping Care Complete

• In 2005, in partnership with Eli Lilly, WFMH embarked on Keeping Care Complete, an extensive survey that captured the perspectives of close to 1,000 family caregivers in eight countries

• Keeping Care Complete is the first survey of its scope to shed light on the relationship between family caregivers and individuals with serious mental illness in areas such as treatment and long-term wellness

• Family caregivers have always been an important part of WFMH

• We are excited to share our findings with you today and hope you can help increase the world’s understanding of the toll mental illness can take on families

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About the illnesses

• Keeping Care Complete surveyed family members of individuals with schizophrenia, schizoaffective disorder and bipolar disorder

– These are debilitating biological disorders of the brain

– They know no cultural, racial or economic boundaries – They are devastating—one in ten individuals with these illnesses will die by

suicide

– These mental illnesses currently do not have a cure, but there are treatments available that can help people live with their illnesses

– People with serious mental illnesses can, and do, live productive and fulfilling lives

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About schizophrenia

• Schizophrenia is characterized by

– Acute episodes of delusions (false beliefs that cannot be corrected by reason)

– Hallucinations (usually in the form of voices)

– Long-term impairments, such as diminished emotion, lack of interest and other depressive symptoms

Twenty-four million people suffer from schizophrenia

worldwide

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• Bipolar disorder is characterized by debilitating mood swings, which fall into broad categories of mania and depression

– Signs of mania include euphoric or extremely irritable mood, distractibility, accelerated or disorganized thinking, decreased inhibitions and increased physical activities and risky behaviors

– Signs of depression include severe feelings of emptiness, guilt and self-hatred, impaired thinking, inability to experience joy, diminished energy and preoccupation with death

About bipolar disorder

Twenty-seven million people suffer from bipolar disorder

worldwide

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About schizoaffective disorder

• Schizoaffective disorder is characterized by a combination of symptoms of schizophrenia and an affective (mood) disorder

• To be diagnosed with schizoaffective disorder an individual needs to exhibit: – primary symptoms of schizophrenia such as delusions, hallucinations and

disorganized behavior

– a period of time when he or she also has had symptoms of major depression or mania

Schizoaffective disorder may range from 0.2% to 0.5% of the population

and may account for 25% or 30% of all individuals with schizophrenia

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The shadow of mental illness

• More than 50 million people suffer from serious mental illness worldwide–These are parents, brothers, sisters, children, spouses and

grandparents

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Introduction to Keeping Care Complete and survey findings

[Insert name and affiliation of presenter]

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Why survey family members?

• In recent decades, the trend away from long-term institutional care for people with mental illnesses has led to the transferring of care out of inpatient hospitals and into communities

With this shift—largely made possible by more effective medications and increased community-based mental health services— family members are playing a greater role in day-to-day care

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Fulfilling an unmet need

• The profound impact on the families of individuals with these illnesses may be comparable to that of family members of persons with illnesses such as Alzheimer’s disease or cancer

• To date, there has not been much research conducted that captures the feedback of family members

• Employers, the broader public, and even caregivers themselves may not consider the enormity of the challenges faced on a daily basis by family caregivers, especially when relapse occurs

Keeping Care Complete was created to help fill this unmet need for information

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Combined findings across countries 

• Keeping Care Complete International Findings – The percentages in the following slides represent answers across all

countries surveyed and a total number of respondents (982), unless noted otherwise.

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About the caregivers surveyed

• The caregivers represented a wide range of family roles: – 31% of caregivers are the mother or father of the individual living with

mental illness

– 24% are the son or daughter

– 17% are the husband or wife

– 16% are the brother or sister

• These caregivers are very involved in their family member’s treatment: – 69% accompany their family member during visits with doctors

– 58% say they are the primary caregiver

– 56% are involved in treatment decisions

– 30% administer medication

– 53% spend more than 10 hours per week caregiving

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About their family members

• Their family members’ diagnosis was broken down into the following: – 49% of caregivers said the diagnosis of their family member had

schizophrenia

– 45% answered bipolar disorder

– 6% answered schizoaffective disorder

• 48% say that their family member has been diagnosed for more than 10 years

• The family members’ living situation –46% live with the surveyed caregiver and 30% live in their own

apartment or house

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62%

22%

6%

7%

3%

Strongly agree

Somewhat agree

Neither agree nordisagree

Somewhat disagree

Strongly disagree

Their thoughts on stigma

Stigma is still a barrier.

84% of caregivers say that stigma and discrimination make it harder for their family member to be well

Base: All respondents (982)

QH7. To what extent do you agree that stigma or discrimination against people with mental illnesses make it harder for your family member to be well?

84%

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Their thoughts on stigma (cont.)

63% agree that stigma in society about mental illnesses may influence relative's decision to stop taking his/her medication

41%

22%

11%

13%

14%

Strongly Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Strongly disagree

63%

Base: Caregivers whose relatives stopped taking medication (502)

QD4. To what extent do you agree that stigma in society about mental illnesses may influence your relative's decision to stop taking his/her medication?

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The quest for the right medication

• Finding the right medication can be a difficult and lengthy process

• Many people try different medications for years before they find the one that works

• Of the 756 caregivers who say that their relative is satisfied with their current medication: – 56% say it took two years to find a medication that works– 85% say that their relative tried more than two different medications before

finding the one that works – 36% say their relative had to try more than five medications

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Treatment priorities

Caregivers view effective medication as a top treatment priority.

91% of caregivers say that efficacy is their primary concern when considering treatment options for their family member.

Base: All respondents (982)

QF10. How much do you agree or disagree that efficacy defined as symptom control and management that enables one to move forward with their life is your primary concern when considering treatment options for your family member?

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Treatment priorities (cont.)

– 90% say that an effective medication is needed to control the symptoms of the family member's condition before the patient’s overall well-being can be properly addressed

• Caregivers also want treatment teams to pay more attention to the physical health of their loved ones– 58% of caregivers said that their loved one’s healthcare treatment team

has never made them aware that people with severe mental illness are more susceptible than the general population to physical illnesses

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Consequences of Relapse – patient

73%

72%

69%

65%

48%

34%

22%

20%

His/her relationships withothers suffered

He/she was unable towork

He/she was hospitalized

He/she became hostile

He/she became violent

He/she talked aboutcommitting suicide

He/she tried to commitsuicide

He/she was incarcerated

Relapse can lead to hospitalization, suicide and imprisonment of the individuals with severe mental illness.

QF4. Which of the following have happened as the result of your family member experiencing a relapse?

Base: Caregivers whose family members experienced relapse (838)

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Consequences of Relapse — caregiver

61%

56%

54%

26%

20%

It disrupted my lifesubstantially

I became more fearful aboutfamily member's condition

and well-being

My mental and physicalhealth worsened

My financial situationworsened

I was worried for my safety

QF5. How did your family member's relapse impact you personally?

Base: Experienced relapse

Relapse can have devastating consequences for caregivers as well.

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Relapse and treatment disruption

Treatment disruption due to change in medication and discontinuation are major causes of relapse.

Of the 502 caregivers who say their family member stopped taking his/her medication despite his/her doctor’s advice, as a result 91% say their loved ones experienced relapse (cont. on second slide)

QD2. Did medication discontinuation ever lead to relapse, defined as worsening of symptoms and/or acute return of symptoms after apparent and/or partial recovery?

Base: Caregivers whose family members stopped taking medication (502)

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Relapse and treatment disruption (cont.)

Treatment disruption due to change in medication and discontinuation are major causes of relapse (cont.).

Of the 455 caregivers who say their family member’s medication was changed based on a decision made in cooperation with a doctor, as a result 56% say that this led to relapse.

QE2. Did change in medication ever lead to relapse, defined as worsening of symptoms and/or acute return of symptoms after apparent and/or partial recovery?

Base: Caregivers whose family members’ medication was changed (455)

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Relapse and treatment disruption (cont.)

• Of the 502 caregivers who say their family member stopped taking his/her medication despite his/her doctor’s advice, as a result:

71% say their loved ones had to be hospitalized

.

71% strongly agree that their family life was disrupted

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Relapse and treatment disruption (cont.)

• Of the 455 caregivers who say their family member’s medication was changed based on a decision made in cooperation with a doctor, as a result:

64% say that family life was disrupted

53% say that their family member seemed even lesslike their old self

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Impact of Successful Treatment - patient 

81%

79%

78%

74%

48%

42%

38%

Re-engage with family and friends

Was able to perform daily tasks moreindependently

Was less hostile

Was able to stay out of the hospital

Was able to learn a new skill or attend a class

Hold a steady job/volunteer

Was able to live on their own

QB5. What was your family member able to accomplish while being treated successfully?

Base: Caregivers whose family members are satisfied with medication (756)

Caregivers believe that effective treatment has enabled their family members to perform daily tasks more independently among other tasks.

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Impact of Successful Treatment - caregiver

• The improvement of the family member’s symptoms improved the quality of life of the caregiver

76% Decreased my stress

levels

How did your loved one’s ability to find an effective treatment

affect your own life?

72% Decreased my

interpersonal tension

71%Increased quality time spent with

family

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Raising the bar

76% of caregivers say doctors should focus on long-term care rather than managing crisis situations

QG3. Is the following statement true or false for you? 'I would like my family member's doctor to focus more on long-term care rather than managing crisis situations.'

Base: All respondents (982)

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Raising the bar (cont.)

• 98% of caregivers say that the goal of treatment should be to maintain wellness, defined as the condition of both good physical and mental health

• 84% of caregivers agree that wellness programs are valuable in helping their family member manage their symptoms

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Caregiver Story

[local caregiver]

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[local advocacy group] introduction if appropriate

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Insert a photograph of caregiver and a family member.

Please consult local rules andregulations for sharing personalinformation with the public.

Insert a quote from a familymember that represents how thatcaregiver feels about the task of caregiving.

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Why is this survey important?

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Relapse

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Effective medication/Successful treatment

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What can we do?

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Next on: [local psychiatrist]

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Contextualizing Keeping Care Complete

Findings

[local psychiatrist]

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Key findings: treatment disruption

• Keeping Care Complete reveals the devastating consequences of relapse, which can occur due to treatment disruption

–For individuals with severe mental illness, relapse can lead to hospitalization, attempted suicide, and/or incarceration

–For caregivers, family members’ relapse can lead to deteriorated health and financial situation

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Consequences of relapse on caregiver

• 54% of the caregivers surveyed said that their physical and mental health worsened following a loved one’s relapse

• Other studies have shown this link –Rates of caregiver depression have been estimated to range from

38% to 60%. Caregivers of persons with a higher number of symptoms and level of cognitive impairment experience more depression

–Similarly, the more severe a loved one’s symptoms, the greater the number of infectious illnesses, such as respiratory illnesses, contracted by the caregiver

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Reasons for treatment disruption

•Caregivers say that relapse often occurs due to treatment disruption

•Treatment disruption can be a result of:•Treatment discontinuation (when a patient decides to stop taking a medication)

•Switching (when a physician decides to move a patient to a different medication)

•Patients stop taking their medication because of poor response to treatment, poor tolerability or insufficient insight into their illness

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Moving from relapses to stabilization

• To reduce the chance of relapse, it is important for individuals to adhere to the treatment plan prescribed by their physician– However, doctors, patients and caregivers should closely monitor progress

and recognize when changes to a treatment plan may be needed

• Often caregivers feel that they are excluded from treatment decisions – Communication between the doctor, patient, and the caregiver – the

therapeutic alliance – is critical to achieving the long-term wellness goals of the individual with severe mental illness

• Caregivers need to be informed about each treatment option so that they may be in the best position to help their family members make best treatment decisions

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Finding and staying on effective treatment

• As this survey shows, sometimes it takes years and numerous medications before finding the treatment that works

• When considering switching a patient to a new medication, doctors have to weigh the risks and benefits of each treatment option before finding the one that is safe, efficacious and acceptable for an individual

• Many patients forced to switch medications will fail by going into a psychiatric crisis and requiring emergency room admission followed by a lengthy hospitalization during this terrifying downward spiral

• Restricting access is not in the interest of the individuals with severe mental illness, as this can ultimately lead to increased hospitalizations and utilizations of other services and can also negatively impact a patient’s quality of life.

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Long-term wellness

• Individuals with mental illnesses can lead productive and fulfilling lives and have successful relationships and meaningful jobs when these illnesses are effectively treated

• Proper treatment can relieve symptoms, prevent or delay relapse and break the “revolving door” cycle

• Proper treatment can also help reduce the frequency and severity of episodes and can help individuals maintain a good quality of life and achieve substantial stabilization of symptoms

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Efficacy matters

• Nearly all caregivers surveyed agree that an effective medication is needed to manage psychiatric symptoms, before overall well-being and health can be properly tackled

• Studies have shown that early effective treatment and social functioning is linked to long-term improvement of subjective well-being of patients with severe mental illness

• Scientific advances have enabled us to develop effective medications and improve treatment practices compared to years ago, as well as to be able to move people from institutions into communities. This has become more evident in the past 10 years with the advent of newer drugs for the treatment of severe mental illness

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Complete Care

• Medication cannot succeed in a vacuum

• Family support and social support, talk therapy, exercise, having responsibilities and a stable schedule are among key factors that help keep their family member well – Doctors must recognize the importance of wellness as a whole, not just

symptom-control

• Doctors should help individuals with severe mental illness follow a healthy diet, avoid/reduce alcohol and street drugs, limit caffeine intake, exercise regularly with a gradual start, and go for regular medical check-ups

• Caregivers can help make sure this happens

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Questions and Answers

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Closing Remarks

[moderator]

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What’s next?

• In order for family members to provide support to individuals with severe mental illness and help them become productive citizens–We must provide them with support–We must allow them the chance to be heard

• Our hope is that, with increased awareness of the needs for access to psychiatric services, medications and wellness programs among legislators, medical professionals and the greater public, we will help alleviate the burden that these devastating illnesses can have on families

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[local advocacy group] and caregiver survey

• [local advocacy group] aims to actively support access to care and wide range of services for those with serious mental illness and their family members and promote the efforts of local advocacy associations across the world.

• Keeping Care Complete serves as an important tool to help accomplish these goals by providing:–Mental health professionals, policy makers and the broader public

with clearer picture of caregivers and their efforts, hopes and needs.

–Advocacy associations with better information on how to support caregivers and fight for improved care and access.

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What can you do?

• Help us spread the word and fight against reduced access to treatment and support services by:

–Reporting on the survey results

–Encouraging people to bring mental illnesses out of the shadows

–Visiting www.wfmh.org and [URL of local advocacy group, if appropriate] to view the survey materials online and learn more about efforts to improve the quality and accessibility of mental health services around the world

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And finally, a word of thanks

• Thank you to the many caregivers of individuals with bipolar disorder, schizophrenia or schizo-affective disorder who participated in this survey

• Thank you to the approximately 50 associations around the globe that helped with recruitment for this survey

• And thank you to you for attending this presentation and for helping us share the perspective of the caregiver with your audiences