Become increasingly important there is some evidence

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become increasingly important. There is some evidence that people with mania from black and minority ethnic groups can present late and in a more severe episode of illness, so are disproportionately detained formally (Kennedy et al., 2004; Lloyd et al., 2005). There is a particular need to work with such families to build trust and to intervene earlier in the course of bipolar episodes so that admission and formal detention are less necessary. 4.2 REVIEW OF THE EVIDENCE 4.2.1 Review strategy Carers of people with serious mental illness may have shared experiences and concerns regardless of the service user’s diagnosis (for example, bipolar disorder or schizophrenia). For this reason, the GDG wished to investigate ways to improve the experience of caring for people with bipolar disorder by considering a wide body of evidence about caring for people with serious mental illness. Reviews for this guideline were thus undertaken in conjunction with a NICE guideline being developed at the same time, Psychosis and Schizophrenia in Adults (NCCMH, 2014; NICE, 2014), which includes the full methods and results of those reviews. The studies included in these reviews included carers of people with bipolar disorder, and the results are directly relevant to this guideline. Before making any recommendations, the GDG were presented with the evidence and draft recommendations made by the Psychosis and Schizophrenia in Adults GDG. The method of incorporation and adaptation (see section 3.7) was followed to ensure that the recommendations were appropriate for people with bipolar disorder. Further information about shared recommendations and the reason for incorporating or adapting each one can be found in the next section. The GDG judged that the
Bipolar disorder (update) 79 evidence and recommendations developed in Psychosis and Schizophrenia in Adults would be relevant to carers of young people with bipolar disorder, as well as adults. 4.2.2 Summary of findings A thematic synthesis of qualitative studies identified five themes that carers of people with severe mental illness believed would improve their experience of health and social care services and reduce carers’ burden. These were: (1) building trusting relationships with healthcare providers; (2) valuing the identity and experience of the carer; (3) sharing decision making and involvement; (4) providing clear and comprehensible information; and (5) access to health services. Carers in the included studies valued carer-focused interventions such as a self-management toolkit, group psychoeducation and carer support groups as useful means of receiving information. Group psychoeducation and carer support groups were also considered to be useful for sharing experiences with others. A systematic review of interventions to improve the experience of caring for a person with serious mental illness found limited evidence that psychoeducation may be effective in reducing carers’ burden and these effects are maintained at long -term follow-up. Furthermore, evidence suggests that although no immediate benefit can

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