I have already mentioned that M’s diagnosis of Vascular Dementia led to discharge from the Memory Service. To a certain extent we have felt cast adrift: left to find our own way on our journey with dementia. Only this morning it sunk in the difficult position we may have been in. Fortunately, M’s GP is excellent and his care has been first class. He is now the focal point for the monitoring of M’s overall condition. To a large extent M has had a very lucky escape as she is outside mental health provision: let me explain.
Early on in the assessment of M’s condition Care Coordinators from the Memory Service said they could help if she felt low in her mood. They told her it was very understandable that her mood might be low with the things that had recently happened in her life. Their onslaught, and that is what it seemed, continued for some time. The deal on the table was quite clear take the tablets and you can stay on the books – if not we are off. Such behaviour is insidious and patently dishonest.
The efficacy of antidepressants for mild to moderate depression has been called into question by Kirsch and others. In fact the evidence provided by Kirsch was so strong that NICE changed their guidelines on the prescription of antidepressants. There has also been widespread media attention on the over prescription of antidepressants over the last few years . Anyone who looks at the figures would be concerned that there are either fundamental problems with the mental state of the nation or the prescription pad is being overused.
Any witness to the behaviour of the Care Coordinators on that day would have been concerned. Firstly, by the assertion that they could help with low mood. Secondly, by absence of any diagnostic technique. They presented like a Sales Team who did not even understand their product or its potential to create havoc for a patient with dementia. The court is out on how medication is metabolised when dementia is present. I also recall research that urges caution when introducing a cocktail of drugs for patients with dementia.
Why all this focus on mental health you might ask? Quite simply because that is the umbrella under which dementia is placed. That is where we are going wrong in my opinion: dementia is not about mood it is about brain damage. So we have to get through a maze where staff are pushing medication that simply does not work. In fact it may well do harm.
We have to find our way through the maze if we are to deal with changes in M’s presentation. We could seek a mental health review of her condition. What would be the point? M has dementia and seeing it as a mental health condition is misleading and totally unhelpful. Depression and anxiety are a natural reaction to her condition: they are not evidence of mental illness. The most sensible approach to changes in her presentation is a review of her environment. In fact the focus needs to change from her to me.
Questions need to be raised about my ability to cope with changes in M’s presentation. The issue is how can I create a supportive environment as her dementia progresses? Do I have the skills, capacity and resources to cope as her dementia marches forward at a relentless pace?
