5 Awareness of mental health, dementia and learning disability

Around one in four adults has at least one mental health need at any time, and in the next 20 years the number of British people expected to suffer from dementia will grow by 40 per cent. Even though you might not be working in a setting specifically caring for people with mental health conditions, dementia and learning disabilities, it is still important to have some awareness of the signs and symptoms. This will help you to show compassion and care when you observe any behaviour that seems unusual or difficult to understand, and to be aware of the need to consult more experienced staff about behaviours if necessary.

Activity 5

Timing: Allow about 30 minutes

The next video will raise your awareness of the needs of people with dementia. It explains certain features of the public space of a residential home especially designed for people with dementia. As you watch it, write down any points about the design that make life easier for the residents.

[This video is provided for use within the course only.]

Download this video clip.Video player: The Lodge: public space
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Transcript: The Lodge: public space

The Lodge is a purpose-built residential and nursing home, designed for dementia care.

Lorraine Haining, Head of Dementia Services, The Lodge
The main feature really is the shape of the building. It’s been built in a triangular shape so that it offers people the opportunity to walk right through the building. In the centre of our triangle we have a fantastic open plan garden space which is very secure, but it also offers people the opportunity to go out into the garden and use it independently. We have two communities on our ground floor and two communities on our upper floor, and in the centre of that we have a place where everybody comes together, called the Market Square, and that’s really about people joining together to enjoy life and, you know, to occupy themselves.

Wide, well-lit corridors are central to the dementia-friendly design.

We try to use natural light where we can. All round the outside of the building the windows are down to the floor so that, you know, anything that comes through the daylight is the best that we can get it, but the corridors down the middle of the communities don’t have any natural light, but we have them very well lit so that people can see, you know, where they’re going and they can see what’s around them, if you like. The space in the corridors as well, there’s sometimes they’re eight feet wide so it allows people to pass without any interactions. People often have spatial awareness issues that are in our nursing communities so they might not move out of the way when somebody comes, or they might walk into people so, because of the space there, we avoid most of those conflicts.
Lucy Ewbank, Care Assistant
When a resident gets agitated we often take them down the corridors because it’s a quiet place usually, you know just to have a walk down, and they have a sit down where like the birds are, and just sit in a different room. And it’s more quiet, and you can talk to them more easily if you just take them out of the noise and just sit down them somewhere quiet. It’s so much better to just get through to them and calm them down, and then take them back and they’re so much more relaxed.
Lorraine Haining, Head of Dementia Services, The Lodge
We’ve tried to go for plain coloured carpets, we’ve not got anything that’s got a pattern on it, and we’ve tried to run that through the building, you know, particularly in the communal areas. We have gone for some wooden flooring in the dining area, really for cleanliness reasons, and we’ve tried to minimise the connection between those two. We had silver gripper bars originally separating the two areas. However they were actually, people were finding them quite a hazard really. People were stepping over them, thinking it was a step up, so we actually did a little bit of research and we found that the gold-coloured gripper bars were less reflective, so we’ve actually replaced them, and people are having less problems with that. We very rarely find people trying to step up over it now. Although we have open plan areas each space is very distinct so you still know it’s a dining room, you still know it’s a lounge, you still know it’s an activity area. There are open plan book spaces between each area to make it distinct, but that then offers cues to people who are maybe sitting in the lounge, they see something happening in the activity area, and then they can actually, that draws them into the activities. So people actually can see all around them what’s happening.
Lucy Ewbank, Care Assistant
It’s brilliant to see what’s going on around you, and to make sure that, you know, the residents are safe. We can look after one resident but while we’re looking after one we can keep an eye on the rest of them, so that’s brilliant.
Lorraine Haining, Head of Dementia Services, The Lodge
There is some evidence to show that people with dementia don’t do well in an enclosed space with closed doors ‘cos they don’t always get up and look out, whereas if you actually have an open plan space people will actually get up and move into areas. It’s like visual cues so that they actually engage and interact with what’s happening in the environment.

Good design is not only about continuity, it’s also about contrast.

Lorraine Haining, Head of Dementia Services, The Lodge
Any toilet area in the whole of The Lodge has a bright yellow door. It’s just a colour cue that we find actually helps quite a lot of people with dementia. It doesn’t work for everybody but it does work for quite a few people, and we find it maintains independence and it also preserves dignity 'cos people can then find a toilet quite easy. In relation to doors that we don’t want people to use, like the sluice, we colour them the same as the natural walls that so it doesn’t draw people towards that. Everybody has their own front door, just like in an apartment block really. What we’ve done is we’ve sourced a different colour for every single apartment door in the building, and that was no mean feat. They also have a number plate on it that’s easy to see, it stands out, and some people have also, they’ve got little way-finders so they have little pots or things outside their front door, like you would have at home. When they see the little pot or the umbrella stand they remember that that’s where they live.
Lucy Ewbank, Care Assistant
For the residents to find their own way to their apartment is really good because their independence is boosted again, you know. They found their own room with their own furniture, with their own toiletries and stuff, their own clothes.
End transcript: The Lodge: public space
The Lodge: public space
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Comment

The building design is triangular and is based on evidence from research that people with dementia don’t do well in closed spaces, therefore it has features such as wide and well lit corridors which are a good place to walk if a resident is agitated, and in the centre is an open-plan garden space. To help the residents recognise rooms, the toilet doors are all painted bright yellow but all of their front doors are painted different colours. The dining area has a wooden floor and the carpets are plainly coloured without patterns.

The market square is good for people getting together and the whole area gives greater independence for residents, but is designed in such a way so that staff can still keep an eye on them.

The three most common types of mental health problem that you might encounter in your role are:

  1. depression: a common mental disorder that causes people to experience depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration, which can be mild or very severe
  2. anxiety: when people cannot control their worries
  3. dementia: a decline in mental ability which affects memory, thinking, problem-solving, concentration and perception. This includes Alzheimer’s disease and vascular dementia.

You are probably less likely to encounter psychosis, which is when a person interprets events differently from those around them, including experiencing hallucinations, delusions or flight of ideas (MIND, 2015). It is less common and might be part of bipolar disorder (a mood disorder also known as manic depression) or schizophrenia (a psychotic disorder where people interpret reality abnormally). You might also meet patients who have a learning disability, which is where people have a significantly reduced ability to understand new or complex information and to learn new skills (Department of Health, 2001).

If you think that someone is developing symptoms of a mental health problem or dementia, or if you think that the support needs associated with their learning disability need reassessing, you should record this information and pass it on. Who you inform and how will depend on your workplace guidelines and your role. For more information on mental health, dementia or end of life care, visit the short course for carers entitled ‘Caring for adults [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] ’.

Case study: Lynne

Lynne has been managed by mental health services for many years with a diagnosis of bipolar disorder, and it has been extremely important to her to have access to the right professionals and support throughout this time. She has been fortunate in having a consistent social worker contact to help her through, who stays in touch with her on a regular three-weekly basis. They have grown to know each other well and have developed a supportive relationship. A similarly supportive relationship with her consultant has allowed for consistency of care and an understanding of her history. Lynne says that maintaining a line between the professional and patient, whilst having mutual respect and understanding of each other has been an important feature of her care. Lynne also described being treated with dignity and being allowed to grow, rather than feeling restricted by her mental health issues. During one of her bouts in hospital with depression she gained great confidence from leading a group. This is a good example of a long-term mental illness being managed effectively whilst living largely in the community through person-centred care.

4 Basic life support

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