Professional Care for the Elderly Mentally Ill PDF
Preview Professional Care for the Elderly Mentally Ill
Professional Care for the Elderly Mentally III Professional Care for the Elderly Mentally III Edited by Liz Matthew Directorate Manager, Services to Older People with Mental Health Problems, Department of Psychiatry, Tameside and Glossop Community and Priority Services NHS Trust SPRINGER-SCIENCE+BUSINESS MEDIA, B. V. First edition 1996 © Springer Science+Business Media Dordrecht 1996 Originally published by Chapman & Hall in 1996 Typeset in Times 101l2pt by Saxon Graphics Ltd, Derby ISBN 978-0-412-58990-4 ISBN 978-1-4899-3015-6 (eBook) DOI 10.1007/978-1-4899-3015-6 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright Designs and Patents Act, 1988, this publication may not be reproduced, stored, or transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of the licences issued by the Copyright Licensing Agency in the UK, or in accordance with the terms of licences issued by the appropriate Reproduction Rights Organization outside the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publishers at the London address printed on this page. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. A catalogue record for this book is available from the British Library Library of Congress Catalog Card Number: 95-074637 § Printed on permanent acid-free text paper, manufactured in accordance with ANSIINISO Z39. 48-1992 and ANSIINISO Z39.48-1984 (Permanence of Paper). Contents Contributors vii Introduction xi Liz Matthew 1 Square pegs in round holes: the social context of the lives of older people 1 Laraine Chaisty 2 Advocacy, empowerment and carers 15 Deborah Cavanagh 3 Assessment of an older person with mental health problems 32 Elaine Stott 4 Risk and decision making 60 Steve Pugh 5 From factory to free range: managing change in caring practice 82 Carol Dawn Noble 6 Purposeful activity as a treatment medium 95 Carol Ainsworth 7 Dance movement therapy: a group therapy approach for older people with mental health problems 119 Bonnie Meekums 8 Group grief therapy 137 Bob Spall and Hazel Smith 9 Sexuality and the older adult 158 Andrew Yates I ________________ VI 1~ CO__Nm_ N_ T_ S _ _____________~ 10 Cultural issues in the care of mentally ill Asian elders 182 Anupreeta Kumar 11 Flying towards Neverland 205 John Casson 12 Abuse directed towards older people 217 Steve Pugh 13 Shaping the cutting edge: strategy development for nurse managers 242 Liz Matthew Index 261 Contributors Carol Ainsworth DipCot, SROT Carol is interested in exploring the benefits of using activities in therapy and is currently involved in designing balanced activity programmes in hospital settings. She has spent the last ten years working with older people who have mental health difficulties. John Casson MA, RDth A UKCP psychotherapist, John has worked as an NHS therapist in adult psychi atry since 1984. In his capacity as Arts Therapist Coordinator for Tameside and Glossop Community and Priority Services NHS Trust, he founded the Guide Bridge Theatre Project for people with long-term mental illness. He established Dramatherapy North West and is a founder member of the Institute of Dramatherapy. John is responsible for many innovations and developments in good practice, and has run training workshops in the UK, in former Yugoslavia and in India. Deborah Cavanagh DipN, RMN Deborah is at present a Discharge Coordinator with Tameside and Glossop Community and Priority Services NHS Trust, a role which involves the plan ning and coordination of discharge arrangements for patients with complex needs on general and psychiatric wards. The previous six years were spent working in acute psychiatry with patients under and over 65 years. Laraine Chaisty RMN, RGN. BSc (Hons) At present Laraine is a clinical nurse specialist. After qualifying she was employed as a social and recreational nurse for older people with long-term mental health problems. Her work with older people as a community psychiatric nurse gave Laraine a different perspective on care issues. Anupreeta Kumar BA (Sociology) Anupreeta is a postgraduate student in the Department of Community Studies, Manchester Metropolitan University. As a result of action-research experience gained while working on a development project for MIND, she helped to set up the Asian Community Mental Health Team for Tameside Social Services. She I LI __________ VIII C_O__NTR_I BV T_O_R_S_ ________- -.J has trained in counselling, psychodramatic approaches to practice and group psychotherapy, worked in a specialist mental health team, conducted training programmes, workshops and seminars, and has been advocate for ethnic issues at mental health conferences. Liz Matthew MA, RMN, RGN, CPN Cert Liz is Directorate Manager for Services to Older People with Mental Health Problems for Tameside and Glossop Community and Priority Services NHS Trust. She has trained in general and psychiatric nursing, maintains client contact by retaining a small community caseload and has experience in both in patient and community clinical settings. Bonnie Meekums MPhil A leading dance movement therapist, Bonnie manages the arts therapies team for Tameside and Glossop Community and Priority Services NHS Trust. She has lectured in the UK and the USA, published widely, sits on the advisory board for 'The Arts in Psychotherapy' and maintains a varied clinical caseload. Bonnie is at present engaged in research into women's perceptions of arts ther apy groups for adult survivors of child sexual abuse. Carol Dawn Noble RMN Carol is a manager in a day hospital. Most of her experience has been with older people, and mainly in continual care in a large psychiatric hospital, a district general hospital and in a community purpose-built modern unit. Steve Pugh MA, BSocSc, CQSW Steve is a team leader with Tameside, following post-qualifying experience with Trafford Social Services. He has worked primarily with older people and adheres firmly to anti-oppressive practice and the rights of service users. In common with all the contributors, Steve continues to learn and contribute to the learning of others, the major influences which have brought about these chap ters. Hazel Smith RDth A registered dramatherapist and founder member of the Institute of Dramatherapy, Hazel has worked in the NHS at Tameside General Hospital for over ten years. She has carried out groupwork with the elderly and training sessions in assertiveness, reality orientation, grief transition, dramatherapy and introducing dramatherapy to nurses. Bob Spall BSc (Psychology), MSc (Clinical Psychology) Bob is a consultant clinical psychologist with the North Staffordshire Combined Healthcare NHS Trust and a member of the management committee and the personnel and professional purposes sub-committee of the Bereavement Care Centre, Hanley, Stoke-on-Trent. He is a recognized teacher in the Clinical I C_O_N__TR_ I_ B_U_T O _R_S_ _________________~ I IX L-__________________ Psychology Department, Liverpool University, and has recently taught a mental health option for the MA course in Gerontology, University of Keele. His initial experience in the field of adult mental health led to specializing in work with older people. Bob gained experience of running grief therapy and transition groups with Hazel Smith, has conducted individual therapy for various forms of loss and has extensive experience in running workshops on coping with loss. Elaine Stott DipCot, SROT Elaine is a senior occupational therapist and a member of the Forest House team working with older persons with mental problems at the Royal Oldham Hospital. She is at present studying part-time for an MSc in applied psychology. At the time of writing, Elaine was working at Tameside General Hospital with older persons suffering from organic and functional disorders. Andrew Yates BA (Hons), RMN, DipN (London), RNT Andrew is a lecturer/practitioner at Tameside General Hospital and Manchester College of Midwifery and Nursing. His specialist area of practice is in the mental health/psychiatry of older age. Prior to taking up his present post, Andrew was a community psychiatric nurse with elderly services. Introduction Services to older people with mental health problems have gone through radical change in recent years. Legislation has had a profound effect by dictating how care to older people is delivered both within hospital and within the community. The recent government agenda emphasizes cost effectiveness, value for money and accountability. This, too, is an important driving force in re-evaluat ing the service, although not everyone would agree with many of the proposed strategies and there are clearly different views as to the appropriateness of many of the services. One thing is certain, however - the move towards interdiscipli nary working is here to stay. Not all change has been led by legislation, and many innovations have been founded in the day-to-day practices in the care of older people with mental health problems. A service, of course, does not become integrated merely by imposing joint working on a number of professionally based disciplines, and in many ways this may not be desirable. At its worst it produces duplication, where people from different background are all doing the same job. This is not the intention of joint-working, instead it should attempt to improve the quality of service by a rich mix of skills and experience from a number of related disciplines. Each discipline brings with it a uniqueness and philosophy based on particu lar experiences, which at its most effective provides a synergy which results in a value greater than the individual contributions. The key to effective manage ment of such work is to harness these positive aspects and develop their poten tial. The intention of this book is to support this progress. In looking at my own area of work, it soon became clear that there were a number of initiatives worth sharing with others. These were illustrations of good practice which could be applied in other areas. It is not my intention that the reader should slavishly accept these premises; they should view them criti cally and apply them when appropriate. I have tried to include examples from a variety of disciplines, which I think illustrate these points. It is also common practice to work in isolated pockets where the quality and value of what is being done are not recognized by those involved until they read of a similar project elsewhere and exclaim, 'But we're doing that!'. There can also be an adversarial aspect to working across different areas of professional work which engenders a culture of defensiveness. We can no
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