One aspect of mental ill-health which is all too often overlooked is the responsibility and pressure that is placed on the carer. Headtorch, an innovative group founded by Amy McDonald, have created a performance that helps to combat this lack of consideration. After receiving funding from NHS Greater Glasgow and Clyde and Care Information Scotland, Headtorch collaborated with GAMH to create The Guessing Game, an interactive drama that addresses the need to shift focus towards the role of the carer.

The Guessing Game tells the story of wife and mother, Jane, whose mental health issues worsen as the performance continues. Derek, her husband, introduces the play with the statement that: “It could be anyone’s story”, automatically highlighting to the audience that they too could find themselves in either Derek or Jane’s position. It also alludes to the idea that no one’s story is experienced individually, and that although it’s Jane’s mental health that is affected directly, the suffering can affect anyone around her. As the performance continues, we see Derek’s struggle as he tries to navigate through this difficult time.

The piece advocates the importance of a shift from the traditional linear model in our treatment of mental health issues towards, the Triangle of Care. This is a more holistic approach, which creates an interconnection between the service user, professional, and carer. The model is intended to promote safety and a greater support system for all those involved. As the story unravels, we are introduced to the six key concepts of the Triangle of Care:

1. Carer identification – the need to identify the carer and their essential role as early as possible.

2. Carer awareness – staff can engage with and educate the carer on their role.

3. Confidentiality – policy and practice protocols are clearly defined in regards to information sharing.

4. Carer introduction to the staff and service.

5. Carer support services are available.

6. Defined posts/positions responsible for carers are in place.

In adopting this model, the experience of all parties involved can be made easier. Not only can the difficulty of the carer’s work be dramatically reduced, but having a carer who is well-trained and fully aware of how to best look after their loved one can have huge benefits for those suffering from the mental ill-health, and subsequently make the professional’s job a lot easier.

From the onset of the The Guessing Game, we are met with Derek’s cry for help as he watches his wife’s mental state deteriorate. He uses an analogy which describes the situation quite accurately: when you go to the doctor with a broken arm, you are told to rest and give it time to heal, however no such guidance is offered in the situation of his wife’s illness.

Of course, mental illness is often a lot more complex than a broken bone, and no individual experiences issues in the same way, but his cry simply demands for some kind of guidance as to how he can best care for Jane. He states that after having had many jobs: “Being a carer is the hardest job I’ve has ever had.” This seems completely plausible, when a carer’s work involves on average 60 hours of unpaid work a week. Mental health carers can also be negatively impacted by stigma, financial issues, lack of respite, and the subsequent effect on their own mental health.

The Guessing Game also addresses the role of the professional within The Triangle of Care, at one point engaging the audience by allowing them to interrupt the scene and state how they would alter the nurse’s actions. The points of critique offered regarded her treatment of both Jane and Derek. She treated Jane in an extremely clinical manner, with a lack of eye contact or empathy, and what seems to be an attempt to brush her off with the advice to get “employee counselling at work.”

With regard to Derek, the nurse fails to disclose any information about the steps he should take, based solely on “confidentiality”. In this sense, Jane leaves the office with little direction as to the action she needs to take to get better, and the finger is pointed at Derek as the nurse tells him he should “pay her some attention”.

The audience is also given the chance to intersect and get an insight into the internal thoughts of the characters. This is particularly effective as it allows us to see not only what is going through Derek’s head, as his behaviour becomes increasingly aggressive, but also into the doctor’s head, as the time pressure she is under causes her to try to end the meeting swiftly.

One of the main issues in Jane and Derek’s story is the lack of communication, and the play replicates the reality of being torn between doing the “morally correct” thing and obeying the thin lines of confidentiality in the professional world. However, through having the ability to intervene and change the action of the play, we have the chance to alter the outcome of the situation and can see the difference in, for example, a nurse taking the time to talk to and explain the situation to the carer, rather than leaving them completely out of the loop
One audience member noted the harmfulness of the language often used to with regard to mental illness. The power of language can be seen, ranging from the way we, as outsiders, discuss mental health, to the way GPs or professionals treat their patients and those patient’s carers. For example, when trying to confide in a friend, Derek is advised to tell his wife to “pull herself together”. This highlights the stigma and stereotypes surrounding mental health issues that are still so prominent in our culture today.

Towards the end of the play, Derek outlines what seems to be one of the most important messages for anyone involved in the life of someone suffering from mental health issues. He states, regarding the doctor, that: “Morally, they should see I am struggling and offer me help.” This goes back to the idea of the disconnection in the client-patient-carer relationship, and the need for communication and involvement, in order to come up with the best solution to reduce the suffering of all of those involved.

by Taylor Gardner