What the National Dementia Strategy forgot: providing dementia care from a psychodynamic perspective

Abstract

The 2009 National Dementia Strategy exhorted the National Health Service to raise the profile of dementia in the UK and to make the diagnosis in 75% of sufferers within a few years. While this aspiration is commendable in the sense that ideologically it is an attempt to improve things for dementia sufferers, it is likely to have other consequences which may not be so well understood or considered. Raising expectations in a vulnerable population is fine if those peoples’ lives can be improved even a little by making a diagnosis. It is, however, a lot to ask services to deliver at the same time that the country is experiencing one of the worst economic crises of our generation. This paper sets out what a pathway into dementia diagnosis might look like using a psychodynamic framework, including giving a dementia diagnosis and offering aftercare. The author considers some of the thoughts and feelings in the sufferers, carers and the staff who offer the service; the challenges posed by a diverse group and how to deliver best practice. The services described are from within community psychiatric settings: those used to delivering not only dementia diagnoses, but also managing delusions, hallucinations and mood disturbances associated with dementia. Mental health services do not exclusively provide memory clinics and the author is not extending these observations to services delivered by neurologists or physicians in medicine for the elderly.

Keywords::

• dementia
• NHS
• psychodynamic
• older adults
• memory

Notes

^1. The Health and Social Care Act 2012 which achieved Royal Assent this year took the commissioning role to CCGs and announced new joint ‘Health and Wellbeing Boards’, giving them responsibility for public health matters and delivering aspects of social care too.

^2. The QIPP programme is a large-scale programme developed by the UK Department of Health to drive forward quality improvements in NHS care, at the same time as making up to £20 billion of efficiency savings by 2014–2015.

^3. CCGs are NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHSs in England, replacing PCTs, which ceased to exist in April 2013.

^4. Founded in 1911 by Douglas Macmillan, Macmillan Cancer Support is the largest cancer care and support charity in the UK.