Trust in mental health
Dementia assumptions need to be challenged
PEOPLE WITH DEMENTIA and their family caregivers will benefit from new research into the levels of awareness of those with mild to moderate dementia. Improving the understanding, care and support of those with early stage dementia is just one of the potential outcomes of this three-year study. “Developing dementia and receiving the diagnosis is extremely challenging not only for the person with dementia but for family members as well,” says researcher Professor Linda Clare. “And it seems that the increasing numbers of people in this position may not always receive a great deal of help and support in coming to terms with the diagnosis and managing their situation.” The study focused on the level of awareness of people with early stage dementia. ‘Awareness’ refers to the accuracy with which a person appraises his/her situation and current abilities. It has often been assumed that people with dementia are simply ‘not aware’ and that their frequent failure to acknowledge the difficulties they face is merely a symptom of the condition. But study findings show that is untrue. Researchers studied 100 people
with early stage dementia together with a spouse, partner or family member, at initial, 12-month and 20-month time points to see how people perceived the changes that were happening to them as well as the family members’ perspective, and how these two perspectives related to each other. “While we found huge variability in awareness, we also found that people
were frequently much more aware than was assumed,” says Professor Clare. Findings indicate that while changes in memory and thinking ability may certainly affect the ability to appraise one’s situation, other reasons may also affect the levels of awareness shown. For example, a person who is depressed or frightened of the consequences of dementia (will they put me in a home?) may be unwilling to admit their difficulties, particularly to a medical professional. “We mustn’t assume ‘no awareness’ even when a person appears not to acknowledge any changes,” says Professor Clare. “Instead, we need to help a person express how they are experiencing their situation.” The research team has developed
and piloted information and training materials based on their findings and conducted workshops for people with dementia and carers, and training sessions for practitioners in health and social care. “Where the perspectives of people with dementia and family members differ, this can lead to a lot of tension and stress within the family. It’s important to find ways to open up conversations and help family members and people with dementia develop more of a shared perspective on what’s happening,” concludes Professor Clare. n
i Contact Professor Linda Clare,
University of Bangor Email
l.clare@
bangor.ac.uk Telephone 01248 388178 ESRC Grant Number RES-062-23-0371
SPRING 2012 SOCIETY NOW 7
LOW LEVELS OF TRUST between mental health patients and professionals can lead to poor communication which generates negative outcomes for patients, including a further undermining of trust, says a new study. Researchers used qualitative methods to explore the influences on, and influences of, service- users’ trust in mental health services. The particular focus was on the effects of trust on service-users’ engagement with psychosis services.
Findings show that trust can play a significant role in facilitating service- users’ initial and ongoing engagement with services, the openness of their communication, and the level of co- operation with, and outcomes from, treatment/medication. Trust also enabled professionals to respond to users’ needs and facilitate positive outcomes. “Our findings have significant policy implications in that they show how current institutional and organisational policy with its accent on risk assessment tends to mitigate the development of trust relations between practitioners and their clients,” says researcher Professor Michael Calnan. “This indicates the need for a shift in emphasis in mental health service policy in England. Prioritising trust, rather than risk, would assist services in meeting patients’ needs as well as managing risk.” n
i
Contact Professor Michael Calnan, SSPSSR, University of Kent, Canterbury Email
m.w.calnan@
kent.ac.uk Telephone 01227 823687 ESRC Grant Number RES-000-22-3535
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