Defining what a 'carer' is and the role they play in in-patient mental healthcare: A focus group study with patients, carers and clinicians.

Background: The value of carer involvement has been extensively researched and promoted. However, the field lacks exploration of conceptual issues, which might help to explain why there are widespread difficulties in putting policy into practice in this area, as implementation rates remain low internationally.

Aims: This qualitative study explored patients', carers' and clinicians' perspectives on the role of carers in mental healthcare, particularly with regards to in-patient settings.

Method: Sixteen focus groups were conducted with patients, carers and clinicians who have current or previous experience of in-patient settings. A thematic analysis was conducted on the transcripts, exploring two key domains: (a) what a 'carer' is, and (b) how the 'carer' role is described within the context of the hospital environment.

Results: Participants diverged in their opinions of what the 'carer' role entails, and the perceived helpfulness of it. Issues unique to the in-patient setting were identified, such as the role of the hospital environment in enabling or being a barrier to carer involvement. These differing perspectives and contextual factors had an impact on the position of carers in the hospital setting, as they could be viewed as helpful, a hindrance or as passive visitors, depending on the perspectives of clinicians.

Conclusions: More clarity and agreement is needed between patients, carers and clinicians in terms of how the 'carer' role is defined. This has the potential to improve carers' experience of involvement in hospital settings.