Carers of those with mental health problems are said to carry the main burden of care, but exactly what this ‘burden’ constitutes varies from culture to culture and over time with changes to mental health legislation and services (Awad & Voruganti, 2008). The burden may be economic, physical or psychological, but it is invariably emotional. Evidence of the care-giving burden of carers from less developed countries tend to emphasize a lack of resources (Seloiwe, 2006; Chien et al., 2007) and carers’ feelings of shame and stigmatization (Chou et al., 2009; Huang et al., 2008). Carers feel excluded and marginalized (Gray et al., 2009; Jacobson & Severingson, 2006), although good social support has been found to reduce carers’ perceived burden (Chien & Norman, 2003). The theme of feeling excluded persists despite attempts in various countries to develop policy and guidance for family involvement in service users’ care (Health Department of Western Australia, 1999; Department of Health, 1999). In an Australian study (Wynaden & Orb, 2005), carers identifi ed that a lack of collaboration increased their level of distress, leaving them feeling frustrated and resentful. They identifi ed patient confi dentiality as one reason why health professionals were unwilling to collaborate with them. Similarly, in a Rethink survey (1999), carers reported that confi dentiality was the main reason given for professionals withholding information from them. In Western Australia (Kling et al., 2008), a scheme to employ carer consultants showed that there are diffi culties with staff attitudes to carer involvement. The diffi culties in the relationship between professionals and carers might be explained by the ambiguity around confi dentiality legislation. In Britain, legislation and guidance for e.g. the Data Protection Act 1998, Human Rights Act 1998, National Services Framework 1999, Carers (Recognition and Services) Act 1995 and Carers (Equal Opportunities) Act 2004, is plentiful but inconsistent. For example, the Data Protection Act 1998 might be contravened when contacting the nearest relative prior to a Mental Health Act 1983 assessment. However, without the patient’s consent, carers cannot be involved in care-planning discussions. Carers are entitled to a carer’s assessment (Carers (Recognition and Services) Act 1995) but an appointment with the professional telling them about their loved one’s condition, prognosis and how to help improve their quality of life may be what is wanted and more benefi cial. The authors (JL, LL), carers of their son who has a diagnosis of schizophrenia, carried out a survey of 217 fellow carers at a number of meetings, including the Rethink users’ and carers’ support groups in the UK. From 1,302 responses to two questions, 34 problems were identifi ed by the carers. The two questions were