Jill.manthorpe@kcl.ac.uk

1. As easy as ABC? Social Work Interventions in mental health & mental capacity practice with older people Jill.manthorpe@kcl.ac.uk

2. 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 • Abuse • Better • Care Homes • Decisions • End of Life

3. Rising interests in dementia What about people with MH problems that continue with ageing? Mental health problems facing carers Mental health in later life

4. 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

5. 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

6. 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

7. Why more interest in dementia? • Tell me ! • Political recognition eg Dementia Strategy • Popular culture • Social work interest – making decisions • Media spotlight • Pharmaceutical and care industries • Cure hopes

8. In contrast, depression • Contagion thesis ? • Negativism • Moral failing • Easy to miss • Hard to help • Less popular, political interest • Fewer pressure groups

9. 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 Reclaiming the past?

10. 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’ A Abuse

11. 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 B Better

12. 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 C Care Homes

13. 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 D Decisions

14. 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) E End of Life

15. Concluding comments • 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