Table Of ContentProfessional 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
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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
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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
