The approved social worker (ASW) is one of the few remaining generic roles in social care. The Mental Health Act 1983, under which the ASW is "approved", covers the entire spectrum of ages, although in practice children under 16 are rarely detained.

Assessments made under the act often conjure up images of dramatic situations: police removing doors and people being dragged off to psychiatric hospitals. The reality, of course, is often different.

I was surprised to find on my ASW training that, within my rural patch in Somerset, about half of assessments were carried out on over 65s, of which about two-thirds had dementia. Thus, I have had to improve my knowledge and skills in working with people with dementia to be able to carry out my legislative duties.

This area of ASW practice causes me the greatest soul-searching. Dementia is such an awful illness.

Take 85-year-old Stan Varney.* His wife of 53 years died a year ago and he now lives on his own. He was diagnosed with Alzheimer's disease in 2002. Since his wife died his ability to look after himself has reduced, and he has started to wander long distances at night. I was asked to co-ordinate a Mental Health Act assessment with a colleague after neighbours, finding Stan in a confused state six miles from his home at 8pm on a cold winter's night, had expressed concerns to his GP.

We met Stan at his home and spent time talking to him about the concerns of his GP and others. An intensely proud man with a distinguished military career, Stan could not see what the fuss was about: his version of his "walk" was very different from everyone else's. But he had no knowledge, recollection or understanding of his diagnosis of dementia.

In broad terms, the act serves to protect people who are, as a result of a mental disorder, putting their own or others' health or safety at risk. But it is the nature and the degree of the mental disorder that determines whether somebody should be compulsorily admitted into hospital.

Stan was putting himself at risk by walking about the countryside at night in a confused state. But when we saw him we felt that the proportional risk posed to himself was not enough to warrant detention under the act. These are tough decisions that can be argued either way. As it was, Stan was willing to accept a creative package of additional support to try to prevent him wandering late at night.
Alzheimer's is often most difficult and distressing for family and friends, but it is also difficult for the professionals that are involved in their health and social care. Perhaps it is also about my own fears of growing old, my own morbidity.

*Not his real name

Mark Sloman is a social worker, community mental health team, Somerset