Reflections on dementia

With the increasing aging population worldwide, its not a surprise dementia cases are increasing as well. Eventually, all of us will end up being a caregiver at some point in our lives. 

The hardest hit would be on the 'Sandwich generation', a generation that takes care of their elderly parents while also trying to raise their younger generation. I would say the responsibilities are twice as heavy. 

I would also highlight that most of the caregivers are leaning towards the older age, its not uncommon these days to see a 60year old taking care of a 80 year old.. 

Hence, my highlight that caregiver themselves should be supported and evaluated throughout their caregiving journey. In all honesty, how often do we focus on caregivers?

As clinicians, once we diagnose dementia, we tend to focus on our patient as our whole entire universe. What can we do for a change to make our care extend towards caregivers?

-care giver assessment (screen for their physical and mental suitability). This includes screening caregivers for mental health issues and cognitive impairment. 

-educating care givers on the challenging journey ahead, preparing them on their role transitions and educating them on the basics of dementia

-mobilising their supports (genogram to understand family dynamics, atlas caremaps). 

-educating about burnout (ways to seek external help, community supports that are available)

-psychotherapies including family therapies. 

-grief work (ways to cope with deterioration due to progression of dementia and ultimately loss)

-addressing ethical dilemmas (autonomy vs safety, justice)

Having said all of the above, the most important intervention is having community support. As we can see the level of care for dementia highlights community involvement from level 1-3. Only level 4 is specialised care.

Without community cohesion, we will not be able to deliver dementia care which is comprehensive, hollistic and inclusive. Afterall dementia not only affects the person but it changes everyone. 

For more indepth information, kindly refer to the textbook titled family caregiver distress by dollores gallagher-thompson et al. 

My reflection on mental health crisis

Is mental health issues on the rise?

YES..

Is it tiring to work in a mental health setting?

YES

Ever wonder why mental health issues are rising?

YES.. all the time

How did this reflection of mine started? 

Well, it began because my boss mentioned about the decline of the fabrics of our society, the moving of collective communities into a single nuclear family.. and now, everyone is for himself mentality. Which leave the responsibilities of caring for the unfortunate to goverments and the state. 

Will goverments be able to take care of every mental health sufferer?

Hopeful is an optimistic word..

in the long run, i think its quite pessimistic

I had the joy of reading a book called 'Has medicine lost its mind?', written by Robert C Smith.. 

It was an illuminating discovery..

The issues highlighted were

1. We have been taught to seperate physical and mental health as seperate entities

-kindly read the book for a lengthy history of this. it puts things into perspective

2. The stigma exist even in the medical fraternity

-true, i've experienced first hand how other departments undermine by skills just because i'm in psych. Those insinuating comments that i can 'read the mind', 'cure people just by talking'

3. Dr's themselves have poor understanding on mental health issues

-true. i spent my medical school training with just 6 weeks of psychiatry out of 2.5 years in clinical years. i was trained in a traditional training system.

-i was lucky to get a psych case in my final year, i guess i was kind of interested..

-as medical student, psychiatry was facinating. however, there was  no continuity when i began entering housemanship.

-i had a steep curve when i was studying for my post grad exams as medical officer.. i had no clue about psych medications, let alone the topics out of depression, bipolar and schizophrenia

4. The overpowering emphasis on neurosciences

-medicine without science is quackery

-psych is a bridge between the mind and brain, over emphasizing on the brain alone kind of tip the scales.. 

-the drive away from psychoanalysis meant that talk therapies are declining, we resorted to a magic pill to solve our mental health issues..

5. Talk therapy is damn blood expensive

-trust me, therapy is time consuming. the billing is done per hour.. which leaves therapy only affordable for the rich.

-why is it so expensive? because its really draining for therapist.. please do not picture a couch and a patient laying on it. there's alot of analysis to be done by listening and selecting what to say to acheive the therapeutic effect. 

The way forward?

Mental health is everyone's business.

Holistic treatment is key.. there goes the rationale for biopsychosocial model

It's not going to be treated by magic bullets, fancy retreats or any fancy products 

My takeaway, it takes small steps, sometimes 2 steps forward and 1 step backwards, humility and constant drive to be a better human to acheive the perfect mental health. And that formula varies from each one of us.