The Recovery Model and Dementia

by cb

Thursday, March 25, 2010 at 06:47 AM EDT

Every week, in supervision with my student, we pick a theory, article, piece of legislation or policy, to discuss at length. Last week, we spoke briefly about the recovery model in mental health services and she asked that we discuss it in more depth this week and particularly if and how the model can be used when working with people who are suffering from a deteriorating dementia, particularly when there are organic causes.

Recovery is about ‘getting better’, ‘functioning better’ and how can this allay with an illness that is chipping away at cognition.

It was an interesting question and one that I’ve looked at in various ways at different stages. I did a brief literature search and found a couple of useful articles that both seemed to suggest a similar approach.

Recovery is not necessarily about ‘cure’. ‘Getting better’ can have lots of meanings and it doesn’t always mean getting back to place where one was before diagnosis or deterioration. It shows though how narrowly sometimes the models are perceived and how some of the workings within older adult services are ignored or bypassed when they might not ‘conveniently’ fit.

Recovery then in this sense can be used to work towards an optimum – but that figures as it should be what we are doing in any situation!

The article that we were able to discuss was ‘Recovery Approach to the care of people with Dementia’ (Martin G ‘Journal of Psychiatric and Mental Health Nursing’ (16:7 2009) which unfortunately is not available free but can be accessed through university journal collections or libraries.

It linked the recovery model to the person-centred approach which is more commonly used in different format and worked the model into where a person is at, empowerment through advocacy (and much broader advocacy than the legal provision of IMCAS (and IMHAS)) and talked a lot about the models presented in Kitwood’s ‘’Dementia Reconsidered’ which emphasises the importance of ‘personhood’ and retaining an individual and personal approach to people who have dementia (which shouldn’t be coming as a surprise as this is a basic tenet of human dignity which is so often forgotten in some care settings).

I wonder how much it is an attempt to fit a group who have not traditionally been able to meet the criteria of ‘recovery’ in some of the most obviously apparent settings into a hole and whether it is a fair jump to make from ‘recovery’ in the sense of putting the person at the centre of their own care and decisions to moving to the issues that arise when that person lacks capacity.

There are useful lessons to be taken. I think social work sometimes suffers by trying to fit all situations into previously presented ‘models’ and that sometimes is at odds with the need to think creatively and individually. That is partly a reason for my preference for postmodern models and strengths-based perspectives on social work theories.

It doesn’t matter what area you are working with, you can find strengths to draw on and that allows for a more individual approach.

In some ways, links can be made (and were in the article) between medical and social models with the medical models seeming to put the disease around the person and the social models putting the person in the centre with a corner of disease. In some ways, this can be paralleled as far as perceptions of dementia are concerned and can be seen clearly in the NHS’ new campaign to show individuals with dementia and emphasise the personhood rather than the disease – the tagline being ‘I have Dementia, I also have a life’.

I think it’s interesting to see how the move towards the social model or perhaps, in this context the ‘recovery’ or person-centred model is now being broadened to a media campaign and likewise to a move towards individual budgets.

To those who say that theory has no place in social work training, which should be ‘practical’ or those who may say that the theory is ‘out there’ and not used in day to day practice – I present two very real examples of ways that a theoretical model and approach affect our day to day working – obviously we would hope that it happens on an individual basis but the extension of Individualised budgets (in an ideal world, in any case) which put the person rather than the ‘need’ at the centre of support planning and the campaigns which focus on personhood, we can see the practical implications of shifting paradigms and uses of theoretical bases.

Incidently, I had a copy of Kitwood’s book knocking around in the office. I hadn’t opened it for a while, but I came back to it when preparing for the supervision session. I can’t recommend it highly enough – since first picking it up, I’ve come across lots of books about ways of working with dementia, approaches etc. I haven’t come across anything that comes close to it though. Maybe (and I still am reading it!), I will come back to a full review at some point.