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  • 14th March 2016 | By David Jolley

    Tuesday was our first outing under the Conversations banner of Dementia Pathfinders. We had the use of Bowdon Vale Methodist Church schoolroom and the warm hosting of the chapel, their stewards Jane and Sarah, and the committed involvement of the Reverend Ros Watson. Cakes and liquid refreshment (tea, coffee – Fairtrade – with and without caffeine, and juice). Balloons to mark the way – including blue, red and green as in the Pathfinders Logo. Car parking arranged.

    Phew – Can we play a CD? No problem.

    Who will come? There have been emails, telephone calls and words of mouth - but will anyone come? Maybe there will be more than we have room and refreshments for.

    Keep Calm – This is important but DON’T PANIC

    The leading article in the current Bowdon Church newsletter is headed: ‘Are you listening to me?’ Catherine Cleghorn, the Ordinand, shared her pleasure at being in receipt of careful listening from a friend: ‘something that I certainly don’t experience all the time’. This gave us a firm and apposite steer to have confidence to offer people time and space to share their thoughts, take them back and rearrange them; to use the time and company to be fearlessly creative.

    A quote from the previous Minister at the humbly located Bowdon Vale Chapel took us further down that road (or path!): ‘reaching into the community, seeking to fill the gaps which remain between elements of existing provision: fill a gap where nothing is provided – ‘Mind the gaps’

    Those of us who have travelled by tube recognise the refrain – It is good to find how helpful it is in this different context.

    We had a lovely afternoon of talk and thought. We have listed things which are sound and identified areas of uncertainty and weakness and will look at these carefully and plan actions.

    Today is warm and we have sunshine. How strengthening the change is as we emerge from so many days of cold and wet. How extraordinary that the crocuses can shake off the damp and stand so proud and radiant to such a short timescale.

    Walking with Tilly our Whippet, I lingered to look up at a knobbled old tree bathed in sunshine. Pleased enough to dwell on the shapes, colours and shadows, I was given more as a Nuthatch worried about in search of insects under the bark. She had not made a sound. I might have missed her if I had been walking at pace.

    My wife says that this is a lesson in living.
     

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    07th March 2016 | By David Jolley

    The Guardian newspaper has run a series of articles about health and health services, including mental health and mental health services over the past two weeks.

    By Thursday of this week niggling between medical practitioners and clinical psychologists had gripped the correspondence columns.

    David Enoch, a venerable and wonderful man, now in his nineties wrote: ‘I declare from 60 years as a physician in psychological medicine, that the medical approach has been extraordinarily successful. I experienced the old regime of the 1940s and then the golden era of psychiatry, with the discovery of successful antipsychotic, antidepressant and anti-anxiety drugs and the establishment of ‘talking cures’.

    He was taking exception to the claim by Richard Bentall, a psychologist, that a narrow medical approach has been ‘extraordinarily unsuccessful’

    A narrow approach is likely to have weaknesses and limitations but the medicine and psychiatry which David Enoch describes, and is illustrated by his own impressive career, has been broad church and is robust – hence the good outcomes which we should not easily deny or dismiss.

    We have seen the closure of mental hospitals because fewer people are left damaged by untreated major illnesses. We have seen a reduction of suicide rates, especially in older people. We are in the midst of further efforts to counter stigma and ignorance of mental illness and to encourage a reasonable share of resources to be directed to the care of mentally ill people of all ages.

    Improvements have depended upon the charisma and energetic devotion of people like David Enoch, harnessed with the equally determined passions of other professionals and ordinary people who have been touched by mental illness.

    Andrew Spooner, a GP in a small town, writes a personal view in the BMJ March 5th

    ‘I am besieged by rules in the form of guidance from NICE, professional bodies, specialist colleagues, pharmacy advisers and many others’

    ‘I no longer feel as though I have the autonomy to offer guidance suited to individual requests’

    ‘Recently the system requires me to recommend care which I think is wrong’

    ‘Informing patients that a guideline or requirement is wrong would be professionally dangerous’

    ‘When I strive to follow system requirements, patients become unhappy and I am blamed for not delivering personalised care’

    ‘Other professionals can substitute for me only if they follow tight protocols, further reducing the patient’s autonomy'

    David Enoch retired from clinical practice only very recently. I doubt he ever let rules prevent him from providing what he considered to be the most appropriate care for an individual. Neither should we or anyone else. The danger of the plethora of guidelines and their adverse effects singly or in combination should be recognised and the virtues and value of independent clinical practice recognised and celebrated.

    This coming week will see the first ‘Conversation’ under the auspices of Dementia Pathfinders at Bowdon Vale for Rev Ros Watson and me. First steps into another world. Wish us well.

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    Old Friends 01 March 2016 | Comments (0)

    29th February 2016 | By David Jolley

    I have been pleased to have sight of the January issue of the newsletter produced by the Faculty of Old Age in the Royal College of Psychiatrists

    http://www.rcpsych.ac.uk/pdf/Old%20Age%20Psychiatrist%20(64)%202016.pdf

    The Faculty, through its origins as the (Special Interest) Group and Section, has been my lifeblood from the early 1970s and still provides friendship and kindred thoughts which sustain me.

    The new issue of the newsletter is the first to be edited by Helen McCormack, Sharmi Bhattacharyya and Anitha Howard. They have taken over from Claire Hilton who has been an inspirational editor, leading the newsletter out of the wilderness and into the light – producing good quality and interesting articles from a range of backgrounds and to a predictable time-table. It is established as a ‘must read’ within the sea of competing possibilities for attention.

    As befits a first edition, this is a blockbuster, dominated by a series of short essays which reflect people’s thoughts and feelings about giving their lives ‘in service of old age’ (Tony Whitehead). Every piece has depth and value and is worth reading and thinking about.

    I am pointing, though, to the articles from Alistair Burns and Susan Benbow.

    Alistair’s support of the newsletter is wonderful. He is established as the national and international face of dementia care and has widened his role to include other mental disorders of later life. Brilliant.

    Here he modestly draws attention to the recently published report of the Mental Health Task Force:

    https://www.england.nhs.uk/mentalhealth/taskforce/

    Worthy as this is, in my unconstrained life of semi-retirement, I found it long and lacking in the fire needed to make me seize it as the banner to be used in leading toward a better life.

    Alistair points much more engagingly to his three current foci – (he claims not to be a Methodist lay preacher, but uses their formula of threes) – depression: with statistics and clinical illustration, loneliness: depression in another language, and Ageless Mental Health Services – the vote being overwhelmingly for special services for older people.

    So we know what we are about and have ideas on how we might do it.

    Susan Benbow brings together a career in mainstream Old Age Psychiatry with a long-term affinity for Psychotherapy – Not a mix to be come across often, but certainly exemplified by Don Williams and a few notable others in the past. Not a question of either/or – but of bringing to bear relevant skills and attitudes to the spectrum of human experiences which we encounter. 

    For people in general, patients and practitioners she quotes Antonio Machado:

    ‘There is no path: You make the path as you walk’ 

    What could be a better fit in our Pathfinders project?

    Keys for Susan Benbow’s illumination and sustainment are: patients, families, complexity and colleagues. We might find these secure fellow-travellers too. In the freedom of ‘retirement’ she explores further through therapy, teaching, safeguarding and research – with clinical sessions at Gnosall ensuring here steer is secured in reality

    Must Read

    Please

     

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    22nd February 2016 | By David Jolley

    February 17th was a red letter day for Dementia Pathfinders with the publication of Pippa Kelly’s article on page 38 of Society in the Guardian. It tells a positive tale of learning and training to improve the lives of people who develop dementia when they are young.

    The full report of Pathfinder’s work which lies behind this is an impressive review which considers the experiences and needs of families and individuals from onset, through life with the condition, to dying, death and beyond http://www.youngdementiauk.org/sites/default/files/approaching_an_unthinkable_future_lr.pdf

    There is no doubt that individuals who develop dementia in their 50s or even earlier, have very special needs and require bespoke responses from those providing care and therapy. These are outlined and considered in some detail. It is a great thing that the work of Pathfinders has been showcased in this way and encouragement given that young people with dementia can expect better care and wider respect and recognition.

    The principles of care and understanding championed here are applicable across the age bands, gender, faith and social class, with or without multiple co-morbidities. I hope these principles can be applied in local groups drawing together families of people with dementia and similar conditions all around the country.

    Straying around the page, we were drawn to the stresses experience by professionals in their efforts to help people – stresses intrinsic to work with people who are unwell and disadvantaged, but made more difficult by lack of resources and service/management structures that do not always fit the needs and lack flexibility. Coaching, mentoring, supervision, knowledge transfer – all these are mentioned as approaches to the healing of the healers.

    Candace Imison holds out for the positive advantages which might come from digitalised data/the paperless world.

    I am not convinced. I see colleagues required to spend hours ‘feeding the beast’ of computerised records, studying on line to feed another beast of appraisal (sitting alone with a computer terminal). Who cares or who knows that what is really important is person to person contact: patient/carer/profession and other professionals. Nothing is as effective as continuity of a therapeutic or collaborative relationship between individuals who know each other – You cannot produce this by cobbling together bites of information across the ether.

    The reverse page (37): Dawn Foster gives the lie to the headlines of the week that more people are in work than for a decade: 47,728 households were removed from their homes by bailiffs during 2015 – the highest number since records began in 2000.

    Peter Beresford writes that remodelling of services to make them relevant and affordable will require involvement of people who need the services. Well fancy that! A conclusion which chimes sweetly with Pathfinders and Pippa Kelly’s article.

    But page 37 is dominated by an etching of ‘The Grim Reaper’: Stewart Dakers, who is older than I am, reflects on the impotent anger with which faithless devotees of modern culture address death. Surely this is not allowed! There must be a mistake!

    There is no mistake. This is life.

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