Older Mind Matters

How can we put the kindness back into care?

Over the past month I have been writing up the analysis of a BMA grant funded project ‘Users and carers living with a diagnosis of dementia: an analysis of the therapeutic effect of producing a narrative’ (our report to the BMA can be found here). I have greatly enjoyed this work so far, as it involved listening to the stories of people (and carers) living with a dementia. It has led me to reflect on identity and how our concept of ourselves changes over time. I have found Sabat’s three selves offer a helpful structure: Sabat has described Self 1 - the self of personal identity, how a person expresses their own identity; Self 2 – the self of mental and physical attributes eg appearance, life achievements etc; and Self 3 – the socially constructed selves eg husband, father, teacher etc. (Sabat’s book ‘The Experience of Alzheimer's Disease: Life Through a Tangled Veil’ is always worth re-reading – see it on amazon here.)

I have been privileged in this project to meet people who talked about the losses involved in their dementia AND people who talked about the gains. The latter had become involved in various new activities, including campaigning for third sector organisations, advocating for people with dementia and their families, and training health and social care staff. Despite taking on a diagnosis of dementia, these individuals had not accepted the limitations of a socially constructed self of ‘patient with dementia’ but had forged new roles for themselves. I was humbled by their courageous pragmatism whilst living with the uncertainty and inevitability of their illness. Kitwood’s concept of ‘malignant social psychology’ has been around for a number of years but it’s still alive and kicking (‘Dementia Reconsidered: The Person Comes First (Rethinking Ageing)’ was first published in paperback in1997 – see it on amazon here). How often in health and social care do we talk the talk of personhood while at the same time we disqualify the very people we purport to support?

It’s hard to maintain understanding, empathy and compassion when the message being given to staff is that care is a business and the most important requirement is for the books to balance. No wonder we have events like those that led to the Mid Staffordshire NHS Foundation Trust Public Inquiry. No wonder we have worrying reports on core aspects of care (see the Care Quality Commission’s findings on dignity and nutrition in acute hospitals). I believe the partnership between health and social care staff and the people they serve must be at the heart of care.

How can we put the kindness back into care? 

1 comment (Add your own)

1. Dave Jolley wrote:
This is the issue of kindness in our professional work.

I remember feeling bruised when a much respected professor warned us away from the temptation to become purveyors of ‘medicated kindness’. The same professor urged us to become experts in aspects of psychiatry rather than experts in the geography and history of our locality and its people.
In appointing colleagues to work with us his advice was that academic qualifications were the first essential and only then to take into account the personal qualities of an individual.

I hope I am kind as well as properly informed when prescribing interventions, pharmaceutical or otherwise.
I hope I am knowledgeable about my subject, but practising with knowledge of the context is more satisfying and more effective when I know about the place and its people.
I know that good people are worth their weight in gold and that paper qualifications are modest complements rather than essentials in teamwork.

In our work at the Gnosall memory clinic, Ian Greaves makes no bones about it that the aura of kindness: listening and staying a while, are the features most appreciated by patients and families. The way things are done there is a model which can be repeated throughout the healthcare system. It is effective. It is not costly and it makes best use of all resources.
www.gnosallsurgery.co.uk/website/M83070/files/gnosall_memory_clinic.pdf

I have recently met others kindred spirits through working at Willow Wood Hospice www.willowwood.info/
and by attending courses at The Terence Burgess Educational Centre of Queenscourt Hospice in Southport www.queenscourt.org.uk/index.php?option=com_content&view=article&id=15&Itemid=80

The approaches demonstrated and taught in these settings should be applied throughout the care system. This will save the world

And finally to be pleased that The Royal College of Psychiatrist has found fit to publish: ‘Intelligent Kindness: reforming the culture of healthcare’ – by John Ballatt and Penelope Campling (2011)

Kindness is back

Tue, February 28, 2012 @ 10:47 AM

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