Let’s Respect (Again)™ Nadine Schofield, Founding Director, Let’s Respect CIC Ltd. +448452733873 Let’s Respect (Again) Copyright

Let’s Respect (Again) Copyright Nadine Schofield (2013)

Let’s Respect (Again)™

Nadine Schofield,Founding Director,

Let’s Respect CIC Ltd.

www.letsrespect.co.uk

+448452733873


Aims for today:

• To share the experience, strength and hope gleaned from our work in the UK and beyond around later life mental health.• To encourage participants to identify (rather than compare) with key elements of

our work and what it may mean for theirs.• To network and ‘pay it forward’ – technological advances make this easier and

realisable, even though we are quite literally a world away!• To identify some of the differences (and commonalities) between the UK and

Australia in terms of later life mental health. • To facilitate discussion and debate and generate consensus.• To outline the work of the campaign going forward, alongside resources available

and the opportunities for getting involved – wherever on the globe you may be!


A story to begin:• One day a farmer’s donkey fell down into a

Well. The animal cried piteously for hours as the farmer tried to figure out what to do. Finally, he decided the donkey was old and the Well needed to be covered up anyway; it just wasn’t worth it to retrieve the donkey.

• He invited all his neighbours to come over and help him. They all grabbed a shovel and began to shovel dirt into the well. At first, the donkey realized what was happening and cried horribly. Then, to everyone’s amazement he quieted down.

• A few shovel loads later, the farmer finally looked down the well. He was astonished at what he saw. With each shovel of dirt that hit his back, the donkey did something amazing. He shook it off and took a step up.

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• As the farmer’s neighbours continued to shovel dirt on top of the animal, he would shake it off and take a step up. Pretty soon, everyone was amazed as the donkey stepped up over the edge of the Well and happily trotted off!

Life is going to shovel dirt on you, all kinds of dirt. The trick to getting out of the well is to shake it off and take a step up. Each of our troubles is a steppingstone. We can get out of the deepest Wells just by not stopping, never giving up! Shake it off and take a step up.


Remember 5 simple rules to be happy• Free your heart from hatred – forgive• Free your mind from worries – most never happen• Live simply – appreciate what you have• Give more• Expect less

NOW……enough of that……

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• The donkey later came back and bit the bottom of the farmer who had tried to bury him

• The gash from the bite got terribly infected – he couldn’t work and lost his farm – his neighbours and friends deserted him

• The farmer eventually died in agony from septic shock


The moral of this story

• When you do something wrong and try to cover your ass, it ALWAYS comes back to bite you!!

We have done too much ass covering in the past – time is running out for us to improve care and services for this area.


Where am I from?


Who am I?

I am• Not an expert – although I have

plenty of personal and professional experience• No longer the National Lead –

although I have the benefit of that perspective.• Not in it for the money – Let’s

Respect was and remains not for profit

I’m not• Here to lecture you on dementia • Here to give you ‘answers’• A fortune teller or mystic• A fan of cricket• Wedded to any particular

organisation or profession


What I personally believe

• Knowledge isn’t power – only potential power• There are just two ways to get the tallest building in town• Learning is nothing more than pattern recognition• The power of the mind – RAS (Reticular Activating system)

• Identify rather than compare – plan rather than project• ‘Intelligent’ vs ‘Positive’ thinking –

• See things as they are – not worse than they are!• See things as they could be – have a vision• Be the change you want to see and work towards that vision

• ‘I’ll believe it when I see it….’ Perhaps you’ll see it when you believe it?• The lessons from war time reconnaissance• You can’t change the wind• Sense-making – when you are lost, any map will do• Berwick’s Escape fire – let’s build one together


About Let’s Respect (Again)™Let’s Respect is founded as a not for profit community interest company, (CIC), dedicated to improving the quality of care for those with mental health needs in later life through education, demonstration, research and the practical application of known best practice both in the UK and internationally.


Let's Respect

Life Story Work

Let's Respect Network

ActualVirtual

Care Home Assessment

Tools

Partner campaigns

Mini Collaboratives

Training

Care HomesHospital

Website & Resources

Primary Care


We will promote age inclusivity and challenge age-based discrimination to improve the quality of care in later life. We will work to mainstream later life mental health issues within all care and support services, regardless of the place of that

care. Responding to every challenge therapeutically


Our conceptualisation of care

Let’s Respect adopts a conceptualisation of caring that transcends professional, cultural and organisational boundaries and was so eloquently articulated by Roach in 1992. Fundamentally care requires:

• Compassion• Competence• Confidence• Conscience• Commitment

Our work must of course remain contemporary to the challenges we face.


Mental illness in later life

• Arbitrary cut off of 65 years• Dementia is a mental illness as defined within ICD and DSM systems• In UK subject to Mental Health Act• Organic / functional divide• Prisoners and people with mental disability and dementia –

chronological age view is problematic• Three most common conditions (3 d’s)

• Depression• Dementia• Delirium


Depression in later life

• Loss of appetite, loss of volition, memory problems (particularly short term)• Self-neglect• Sleep disturbance• May be accompanied by anxiety• Nocturnal variation• Up to 40% people in care homes• Older people & suicide – highest for females, second highest for males• Ratio of attempted to completed to suicides 1:4• Suicidal behaviour – medication, food and drink refusal


Dementia:

• A chronic, organic and degenerative clinical syndrome• Dementia is a mental illness as defined within ICD and DSM systems• Risk of other co-morbidity rises - physical (falls, cardiovascular) and mental

health (depression, delirium, suicide)• Around 100 types – most common

• Vascular• Alzheimer’s• Mixed• Lewy Body’s• Frontal lobe• Huntington’s Chorea• Pick’s Disease

Most prevalent


Delirium

• Heightened confusion / acute confusional state (often accompanied by hallucinations)• Hyperactive and hypoactive – critical differences in presentation• Incident and prevalent – relevance of distinction• Clouding of consciousness• Occurs in response to physical ill health, medication, UTI’s other infections,

constipation, pain, poor diet, dehydration• Usually rapid onset – worse at night• Sensory and cognitive impairment worsens impact• 8 times more common in people with dementia• Treatment of underlying condition and environmental measures


NHS Care and issues:

Generic care• 2/3 NHS beds occupied by people age 65 plus

• 2/3 will have / go on to develop a mental illness upon admission

• Paucity of MH training for both medics and nursing at pre + post registration levels

• Lack of training for unregistered staff

• Busy environments, temporary staffing and rapidity of throughput

• Bed management issues

• Primary / secondary interface

• Health and social care divide

Mental health• Disinvestment in later life services (ref)

• Different levels of investment between older and younger adult services (ref)

• Paucity of emphasis on 3d’s within MH training

• Sharp shift from public to private (profit sector) for longer term care (ref)

• No protected baseline investment to implement NDS and subsequent policy (ref)

• Bed management issues (ref)

• Primary / secondary care interface

• Health and social care divide


A warning about ‘later life’ - why do we retire at 65?• Otto Von Bismarck, German Chancellor

(1862-1890)

• Old age social insurance program (world’s first) in 1889

• Original age 70 years (nothing to do with Bismarck’s own age)

• Reduced to 65 years in 1916

• Every other developed nation adopted this approach and age

• Average life expectancy in Germany at that time was 49 years for women, 47 for men.


Political challenges

• Elections every 4 years• 3 main political parties• Government rules at the invitation of the

Queen, under the choice of the electorate• Separate Assemblies for Scotland, Wales

and Northern Ireland• Part of the European Union• Voting is optional• Multiple changes of Health Secretaries ‘in

term’• Local government vs National • Health & social care divide


Demographic challenges

• Declining birth rate• Increased life expectancy• Centenarians – the ‘old’ old• Effects of immigration and emigration (Europe and beyond)• Lower rates of mortality & morbidity• Information age• Consumers and customers – not patients


Economic challenges

• Global recession• Shift away from public services• Growth in the independent / not for profit sectors• Declining revenues for services• Reorganisation & restructuring – the architecture of health & social

care• More with less – maintaining standards, reducing costs• Costs of long term care


Legislative challenges

• European legislation• Purchaser / provider split – role of Monopolies Commission• Equalities Bill (2008)• Mental Health Act• Mental Capacity Act (2005)• Deprivation of Liberty Safeguards (2008)• Year on year increases in litigation against services that do not comply


Where next?

• National Dementia Strategy (2008)• Prime Minister’s ‘Dementia Challenge’• Roll out of training to front line services• Influencing pre and post registration education and training• Direction and strategy for mental health and dementia• Strategies for mental health promotion• Realising age equality and ending discrimination• Making the message systemic• Strengthening consensus and networks• Utilising technologies which HELP not HINDER• Realising the power of older people


Let’s Respect (Again)

• Evaluation and suggestions via www.letsrespect.co.uk• Building on the work of the Consensus and extant policy• Availability of resources (podcasts, presentations, learning

from collaboratives)• Supporting ‘international’ movements – DASNI, AZ

International

http://www.letsrespect.co.uk/


In conclusion

• Importance of linking our efforts to support those living with dementia to the ‘bigger agenda’• Tackling ageism and the negative effects of age discrimination• Education, health promotion and practical support• What works – what doesn’t work• Multi-agency and multi-disciplinary approaches• Care that it needs-led and person-centred• Regulation that works – holding people to account when it doesn’t.


Come and join us:

• www.letsrespect.co.uk• Establishing links – virtual and actual; transcending organisational and

cultural boundaries• Paying it forward• Feedback, feedback, feedback!

“Never doubt that a small group of committed citizens can change the world…indeed it is the only thing that ever has”

Margaret Mead, Social Anthropologist.

http://www.letsrespect.co.uk/

Let’s Respect (2006) NHS

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Let’s Respect (Again)™ Nadine Schofield, Founding Director, Let’s Respect CIC Ltd. +448452733873 Let’s Respect (Again) Copyright