Meaningful Psychological interventions

Last week the British Psychological Society (BPS) Dementia Advisory Group launched a new report, ‘Psychological dimensions of dementia:  Putting the person at the centre of care’  you can find it here. http://beta.bps.org.uk/news-and-policy/psychological-dimensions-dementia-putting-person-centre-care .

Peter Kinderman, current President of the BPS, launched the paper at the Welsh Senedd in Cardiff and I was fortunate enough to be present. He  mentioned how the report aims to shine a ‘light on how psychology (and psychologists) can help to promote wellbeing and increase the likelihood of people with dementia living full lives in their local communities’

Well it certainly does that and puts across a strong case for psychological involvement throughout the course of a person’s experience of living with dementia. It left me with the question: ‘Why then is it not the case that all dementia services are not routinely led by Psychology teams?‘ In fact the subsequent discussion at the launch centred around the limited resources on the ground and a real sense of insecurity amongst psychologists around the UK.   – So incongruent with the powerful content of this report.

A few reflections and questions on the report content.

I love the phrase used, ‘psychological support must be based on a formulation of individual needs and circumstances’, but I have to ask how confident are people of assessment becoming a practical reality?

Psychologists are best positioned to carry out the necessary psychological approaches.

… but how accessible are they? How widespread is the regular and meaningful input of psychology in the service response to dementia? ‘Not very’ is the answer to that which is why there is a need to properly equip both front line staff and families themselves to carry a lot of this work out. It’s like with the situation of Admiral Nurses. Less than 200 nationwide means a need for more innovative approaches adopted across disciplines.

Who else is in such a good position? Throughout the UK dementia support worker roles in various forms are in ideal positions to adopt and promote new approaches. They must, however, guard against being little more than signposts – such a disappointment! (‘Go with me, please. Don’t just point me somewhere else’).  I feel there is a huge untapped workforce on the front line. Historically those with most contact with people with dementia are usually the least qualified. Let’s equip the front line!

The report advocates recovery-based approaches. Absolutely. But how widely understood is this across services and to what extent is the definition of recovery, when talking about dementia, framed in terms of recovery of role, status, identity and place for all those working within dementia care services? If it’s not adopted by all it will be undermined so easily at any moment by outmoded old culture attitudes.  – a brilliant blog on the meaning of recovery is here http://dementiawithoutwalls.org.uk/2017/01/continuing-to-be-me-recovering-a-life-with-a-diagnosis-of-dementia/

The report acknowledges the impact of dementia upon whole family networks but perhaps is not explicit enough in identifying specific ways to work with both sides of the caregiving relationship together. Traditionally we have focussed on the person with dementia and the carer and their own particular set of difficulties in splendid isolation of each other. To what extent are services able to address the interdependence?

So we need to equip families as a whole to live well and better with the presence of a dementia. Important as we all may be, the reality is that most people spend their time NOT in our services – but under each other’s feet, falling into the many traps that dementia sets within the dynamic of those close relationships.

If current older peoples service models were adopted within children’s services, there’d be a national outcry. Imagine – ‘Send your child away for 2 weeks and have a break. We will do nothing to equip you as a family to get on better in the meantime’. Why should we tolerate such an approach in older people’s care? Ageism is the only conclusion I can come to.

I have posed several questions along the way, not as hypothetical questions, but because I feel that the relationship-centred Getting Along approach can go a long way to filling what is often a fairly sparsely populated post diagnostic gap. Indeed Getting Along can form part of diagnostic involvement long before the diagnostic process is complete (or even begun!). For more information on Getting Along; the adoption of a system wide Getting Along approach; and how Getting Along matches key elements of national policy, then you can contact me. You can see the film we made of the pilot of Getting Along at http://www.innovationsindementia.org.uk/videos_gettingalong.htm

In the meantime

I believe Psychologists should blow their trumpet with a lot more conviction and wave this report around until we can get to the point where non-psycho-social approaches are seen as the quaint alternative rather than the norm.

Damian Murphy at Innovations in Dementia CIC M:  07927 405 854 E-mail damian@innovationsindementia.org.uk  Website: www.innovationsindementia.org.uk

 

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