As easy as ABC?
Social Work Interventions in
mental health & mental capacity
practice with older people
Jill.manthorpe@kcl.ac.uk
presentation
• Worldwide and local interests in mental health in
later life
• Listening to experiences and to practitioners
• Uncertainty over social work roles, practice
• Huge opportunities
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Abuse
Better
Care Homes
Decisions
End of Life
Mental health in later life
• Rising interests in
dementia
• What about people
with MH problems
that continue with
ageing?
• Mental health
problems facing
carers
Overshadowing of depression by
dementia - but serious
‘When depression hits me the last thing I
want to do is to see the doctor, because it
seems hard to define anything as ‘wrong’.’
UA Fanthorpe 1996
An ordinary city: Bristol
• Number of people aged 65+ likely to have
dementia 4,140
• Number of people aged 65+ likely to have
depression 6,000 – 9,000
Energy is gradually returning and with it
increased focus and perhaps a self- confidence
that it is repairing itself. My depression could be
worse, my demon more angry. Yet I remain
fragile and need my refuge. There is
nevertheless a desire to move out of my existing
victim status…Doom does not overwhelm me,
but remains my back-drop every hour of the day.
M Eastman 2005
Why more interest in dementia?
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Tell me !
Political recognition eg Dementia Strategy
Popular culture
Social work interest – making decisions
Media spotlight
Pharmaceutical and care industries
Cure hopes
In contrast, depression
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Contagion thesis ?
Negativism
Moral failing
Easy to miss
Hard to help
Less popular, political interest
Fewer pressure groups
Reclaiming the past?
• Neglected of history
of medical social work
and psychiatric social
work with ‘chronic and
incurables’
• Depression and social
work: a call for
evidence, action, &
engagement
A Abuse
• Social work role in
construction
• Research around
prevalence and risk
factors
• Practice often around
assessment and
intervention
• Very little on practice of
safeguarding
• Especially around
‘perpetrators’
B Better
• Upping the social
work game
• Almost impossible to
work out where social
workers are and what
they do in research
• Very little on user
produced outcomes
but promising area
C Care Homes
• Social work shady history
– taking for a ride
• ‘Failure’ of community
care
• Liberation or reclaim care
homes!
• What do residents and
supporters and staff want
• Some developments but
need capturing
D Decisions
• Newly emerging area in
which practice in later life
can be key
• In assessing capacity and
promoting this
• In best interests decision
making
• In working with conflict
and complexity
• England – renaissance
through Mental Capacity
Act 2005
E End of Life
• Not always predictable
• Distress, stress, anger,
but work that is rewarding
and skills needed
• Capitalising on hospice
social work
• Social work as bridge
between medical
specialities, family and
individual, and case
managing death at home
• 'My husband wanted to
die at home but the
nurse convinced me
that he would be better
cared for in the
hospice. I regret that
decision now, I feel
guilty, he had no choice
or control at the end‘
(SCIE)
Concluding comments
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The potential for innovation is huge
Capturing it is important
No shame in cost-effectiveness
Great scope for education, practice, team
working, managing and leadership
• As easy as ABC