1. Psychological Wellbeing in Dementia A Northern Ireland Perspective Dr Frances Duffy Consultant Clinical Psychologist Northern Health and Social Care Trust

2. Strategic Context Dementia Strategy (DHSSPS, 2011)
Transforming your care (DHSSPS, 2011)

3. Dementia Strategy objectives
Raise awareness of dementia.
Provide early assessment and diagnosis.
Approach diagnosis in a sensitive manner.
Provide high quality, accessible information to people living with dementia and their families.

4. Transforming your care
More joined up assessment of needs.
Better education and care close to home.
Early intervention and earlier treatment.

5. Standards
NICE Guidelines to secure consistent high quality evidence based care (NICE, 2011)
Memory Services National Accreditation Programme (MSNAP, Royal College of Psychiatrists, 2012)

6. Demographics We are living longer.
1 in 14 people over the age of 65 have dementia.
1 in 6 people over the age of 80.

7. Demographics
Currently 19,000 people living with dementia in Northern Ireland.
Expected to rise to 60,000 over the next thirty years.
How do we ensure our services continue to develop so that people live well with dementia?

8. Impact of Dementia
Dementia is among the most feared diseases associated with getting older.
Life changing diagnosis.
“unbearable at times”

9. Treatment
No cure – medication is helpful for some people with some sub types of dementia.
Care is important.
Psychosocial interventions can significantly improve quality of life and help people to live well with dementia.

10. Dementia Journey Society Person/FamilyNotice Changes
Assessment and Diagnosis
Support GP

11. Advantages of Timely Diagnosis
Better adjustment.
Slowing of progression.
Making choices and planning ahead.
Health economy savings: reduced hospital admissions, prolonged independence and delayed long-term care.
Early diagnosis and intervention is cost-effective
(Bamford et al., 2004).

12. Multi disciplinary and multi agency approach.

13. Partnerships Dementia Strategy Implementation Group
Integrated Care Partnerships
Dementia Together NI
Dementia Innovation Lab
Regional Dementia Improvement Collaborative

14. Regional Dementia Improvement Collaborative
Demand and Capacity
Memory Service Models
Post diagnostic support

15. Voluntary/Community Sector
Alzheimer’s Society
Age NI
Carers groups
Dementia NI

16. Single point of Access Memory Service
Community Mental Health Teams for Older People
Memory Service
Specialist Outreach/Dementia Home Support
In-patient
Services
Voluntary/
Community

17. Clinical Psychology
Specialist clinical psychology service in dementia first commissioned in 2001.
Currently 10 clinical psychologists working in older adult specialty across Northern Ireland.

18. What do clinical psychologists do in NI
Work with managers and other senior clinicians to ensure services support the psychological wellbeing of people living with dementia.
Work with people before and after diagnosis.
Provide consultation, supervision and training to other professionals involved in assessment and therapy with people living with dementia.

19. Innovative practice lead by clinical psychology

20. Psychology at Memory Clinics
Development and clinical leadership.
Training and supervision of multi-disciplinary team
Consent and pre diagnostic counselling
Assessment
Specialist neuropsychological assessment.

21. Information at Diagnosis
You have been diagnosed with dementia. What now?
Your relative has been diagnosed with dementia. What now?

22. Impact of Diagnosis “it’s like stepping off a cliff”
Post diagnostic support “ needs to be personal rather than a clinical experience”
“peer support is essential”

23. Impact of Diagnosis
Depression is common following diagnosis. “Need hope not all focus on decline” “See the person beyond the label of the diagnosis”

24. Psychology post diagnosis

25. Role of Psychology
Specialist knowledge of changes in thinking and reasoning, mental health, adjustment, rehabilitation……..
Develop psychosocial interventions to help people understand and adjust to the impact of dementia on their relationships and activities of daily living.
Supervision and consultation in the delivery of these interventions.

26. “Need to understand where you’re at and what might be coming next”

27. Living Well after Dementia group
6 week dementia education group, up to 7 people recently diagnosed with dementia and a family member or friend.
Content based on themes requested by service users.
 Aim is to understand more about their diagnosis, and the practical and emotional consequences of the diagnosis.

28. Living Well after Dementia group
Group discussions and exercises.
Opportunities to chat with the other participants and group leaders.
Ipads used by group leaders to share innovative ideas around dementia apps and reminiscence.
An information pack containing several booklets developed in WHSCT is given to all participants.

29. Living Well after Dementia
High quality, evidenced based dementia training programme is offered routinely to people with dementia and their carers post diagnosis.
Partners from the voluntary and community sector (Alzheimer’s Society, DEED) trained to co facilitate programme with the memory service team.

30. Post diagnostic support
Information leaflets
Individual therapy
Group therapy
Carers groups

31. Training

32. “Fear of what you don’t understand stops you seeing the person.”
“Person with a life and a passion.”

33. People are people
When we see a person living with dementia we should see a person, just like us, who experiences the same needs and challenges as we do everyday. The person living with dementia may experience these challenges more frequently because of changes in thinking associated with dementia.

34. Normalising
We all make mistakes, get lost in unfamiliar places, go into a room and forget what we’ve gone in for…….
We all get frustrated sometimes.

35. Maslow’s Hierarchy of Needs
Self
actualisation
Esteem
Love & Belonging
Safety
Physiological

36. Behaviour and Psychological Symptoms of Dementia (BPSD)
Behaviour that family and carers find difficult to understand. ‘Behaviour’ of any kind is a form of communication and is often driven by ‘need’.
© Northern Health & Social Care Trust All rights reserved. No part of this may be reproduced without permission. For more information, please contact

37. CLEAR Dementia Care

38. CLEAR Dementia Care - Outcomes
Greater understanding of people living with dementia.
Greater engagement, ownership and joint accountability.
Overall outcome is reduced distress and greater quality of life for the person living with dementia.
© Northern Health & Social Care Trust All rights reserved. No part of this may be reproduced without permission. For more information, please contact

39. Engagement and Change
Changing their behaviour and the way they do things can be an integral part of living well with dementia. This is true for both the person with dementia and their families.
Success depends on engagement with services and the motivation to change.

40. Engagement and Change
Psychological intervention is driven by models of change and theories of engagement.
Clinical psychologists are well placed to support, not only people living with dementia and their carers, but also other members of the multidisciplinary team to increase engagement and motivation to change.

41. Outcomes
How do we know our services are effective and efficient?

42. Northern Ireland is setting standards for quality care in dementia.

43. Moving forward

44. How do we ensure psychological well being in dementia?
MLAs continue of make it a priority for government.
Commissioners continue to include provision for clinical psychology in service developments.
Managers continue to recognise the important role clinical psychologists play. Working directly with people living with dementia and their families and indirectly through education, support, supervision and training other professionals.

45. Reducing Stigma
“Dementia threatens to send the NHS into meltdown” or “We all live well with dementia in Northern Ireland”

46. Thank You Frances.Duffy@northerntrust.hscni.net