My Practice

    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

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