Respite care for caregivers and people with severe mental illness: literature review

Study Aim/Purpose: To review research literature on respite for people affected by severe mental illness and identify implications for nursing practice. 

Summary of Methods: An initial literature search was undertaken using the key words ‘respite’, ‘short-term care’, ‘shared care’ and ‘day care’ for literature published in English between 1967-2002 in PsycINFO, CINAHL, Sociological Abstracts, APAIS (Australian Public Affairs Information Service) Health, Pre-MEDLINE, MEDLINE, EMBASE and EBM Reviews. The authors conducted a closer examination for the literature from 1993-2002 on respite care for people affected by severe mental illness. 

Summary of Results: Based on the broader literature search the authors conclude that, “There is a significant lack of controlled empirical studies examining the effectiveness of respite care services. In particular, no evaluative literature on respite care for people with SMI and their families was found.” They did find several studies documenting the need for respite care among caregivers of people with severe mental illness. Because of the absence of evaluative studies on respite for persons with severe mental illness, the authors summarize some key findings from the literature on respite in the elderly population, which primary focused on respite for caregivers of persons with dementia and Alzheimer’s disease. They conclude that “provision of respite services is found to increase caregivers’ satisfaction with respite programs and there is an increasing demand for them.” They summarize that studies on the impact of respite care focus on three outcomes: impact on informal family caregivers, impact on recipients of care, and impact on long-term institutionalization of care recipients. However, the authors’ review of these studies finds that “evidence on their effectiveness is inconclusive.” The authors also summarized selected studies that focused on the role of nurses in the provision of respite care. They cite some studies that found little involvement of nursing staff in working with family caregivers than other health professionals and one study which found that “the way nurses interacted with caregivers influenced the quality of caregivers’ experiences with respite care services, and hence benefits.” Other studies cited explored the nurse family relationship and nursing roles in both the assessment of families respite needs and how caregivers were involved in receiving respite care. 

Limitations of Studies Reviewed (as cited by the authors): They state that despite the large number of studies on respite for caregivers of persons with dementia and Alzheimer’s disease, “Studies examining outcomes and effectiveness of respite series are either scarce or lack rigor.” The authors stress that the differences in respite care needs between carers of people with SMI and those with dementia have not been adequately addressed in respite care research to date. 

Authors’ Discussion/Conclusions: The authors discuss several key implications of their literature review for nursing practice. They emphasize that “health care workers, and especially nurses, can help caregivers overcome some of the barriers and problems associated with the provision, access to and use of respite services” for persons with severe mental illness. They include specific recommendations for nursing practice to address these issues.