‘Dad’s got his smile back, and it’s a joy to visit now’

AMONG the rustling old trees of Heaton Village in Bradford sits a large detached house with an interesting garden where wooden picnic tables and benches sit awaiting a spell of decent weather. A woman wrapped up snugly in woolly jacket, scarf and trousers walks round and round the edge of the lawn, lost in her thoughts and apparently enjoying the brisk, chilly air.

The front door is kept wide open all day. A beaming man in a stripey sweater steps forward, with: “...It was raining cats and dogs earlier....funny thing to say that – ‘cats and dogs’. Of course there were no cats and dogs.”

He’s called Stephen Sarraff, a former university lecturer. Several times during my visit to Spring Mount, a care home for people of all ages with dementia, Stephen pops up with a little quip about the English language. He clearly finds great amusement in linguistic oddities.

In the smaller of two lounges half a dozen residents are enjoying moving about to music, and therapist Natalia encourages them to get into the rhythm using a giant red ball. Multicoloured sensory lighting lends a hint of disco fever. The participants throw themselves into it, and everyone looks alert and interested. Activities tend to happen in an adhoc way, as and when people feel like doing them.

Elsewhere on the ground floor, a few more of the 22 residents are watching TV, a couple are having a late breakfast, and several are simply moving about – up and down the hallway, in and out of the garden.

One slightly agitated woman tells me about her mum, who has “lost her baby, lost her baby”. The atmosphere here is one of friendly, bustling life. Out in the hallway Stephen is listing a few words that have a silent “p” at the start. “Psalm, psychiatrist...”

Julian Shears, the manager at Spring Mount, says: “Dementia is a physical defect of the brain, therefore we see it as a physical thing rather than a psychiatric one.”

Spring Mount is registered as a home for people with physical disability, to fit in with this ethos. Its owners, the mother and daughter team Janet Bell and Jackie Smith, believe dementia should be demedicalised, and what has marked out this home as being different to most others is that it cares for people with dementia without what Bell and Smith call “the dehumanising effects created by the administration of sedating medication (commonly called antipsychotic drugs).”

Janet Bell, an experienced psychiatric nurse, worked in the mainstream and didn’t like what’s been called the “liquid cosh” that she says was used to dampen down the mood and behaviour of patients. “We believe that people with dementia will function at a higher level and their intellect will remain accessible if tranquillisers are not used...We enable them to learn to live with their dementia in a positive way, regaining dignity and self-respect.”

Spring Mount can sometimes get noisy, says Shears. “Most people who come here are on a cocktail of drugs including antipsychotics they’ve been taking while living elsewhere. Families bring them here because the care hasn’t worked out elsewhere and they feel they’ve ‘lost’ dad or mum due to the drugs that are given to them.

“We wean them off those drugs and they change dramatically. Everyone here is feeling what they’re feeling, and if feeling what they’re feeling means they cry, then they get a cuddle. They might shout sometimes, too, but that’s okay.”

Staff at Spring Mount don’t have a magic wand. Aggressive behaviour still happens, but there’s a higher ratio of staff here than in homes in general and they are carefully trained in a certain way of doing things. They receive induction training and study for modular qualifications in the on-site training block.

Staff don’t wear uniforms, everyone’s encouraged to think of the home as a family, and Julian says there are few problems that can’t be sorted out with a quiet word, a little time and space to calm down and a cup of tea.

Len Speed is visiting his wife Sylvia. “She’s come here for day care for the past 18 months and I’ve seen a massive difference in her from how she was the previous place,“ says Len. “It’s so relaxed and she seems much happier.”

Nigel and Diane Shaw, who are visiting Nigel’s father David, an 82-year-old retired welder and great walker, moved David here because they were unhappy at how aggressive and withdrawn he had become at another place – despite the use of antipsychotics.

“He escaped from the other home a few times,” says Nigel. “We knew he just wanted to be able to go out, but the doors there were locked and he was frustrated – although there were a couple of carers who’d take him for a little walk sometimes. We brought him here for a day to see if it was the right move, and he didn’t want to leave. He was weaned off the drugs and we’ve seen a huge change in him. He can go out in the garden when he wants, and until he had an illness recently we could take him on long walks. He’s got his smile back and it’s a joy to visit him now. Before we used to dread it, as we didn’t know what we’d find.” Spring Mount gets enquiries from the whole country, and even one from New York recently. “We get pressure to explain how and why our philosophy works for us,” says Bell. “We have no magic formula – the whole team sees what they do as common sense or just good sense.”

Recently Professor Alistair Burns, the National Clinical Dementia Advisor to the government visited Spring Mount to see for himself how a dementia care home can look after people in a drug free environment. As a result staff from have been invited to speak to Parliament at the invitation of crossbench peer Victor Abedowale and at a national care conference in London in October. Prof Burns’s instant response to his visit was that Spring Mount “...are doing fantastic work and have a fantastic team.”

Care services minister Paul Burstow has pledged to cut the number of people with dementia who are prescribed antipsychotic drugs by two thirds.

A spokesman for his department said: “We know that there are over 140,000 people with dementia being prescribed antipsychotics inappropriately and this is resulting in as many as 1,800 unnecessary deaths per year.

“This is simply unacceptable... As an important element of its work, the Health and Care Champion Group, set up as part of the Prime Minister’s Dementia Challenge, is looking at what more can be done to reduce the inappropriate use of antipsychotic medication. Spring Mount is a great example of good practice in this challenging area.”

Janet Bell has been running Spring Mount according to her principles for 24 years. “We’ve had waves of interest in our philosophy before, but they’ve gone away again. Let’s hope this time it comes to something. We want to see more people cared for our way – even if it means competition.”

The growing evidence of over-subscribing of antipsychotic drugs for dementia

A REVIEW for the Department of Health by Professor Sube Banerjee in 2009 stated that around 180,000 people with dementia in the UK were being prescribed antipsychotic drugs.

Increasing concerns by carers, patient organisations and academics about the appropriateness and safety of prescribing these drugs to people with dementia has led to several reviews of the evidence which concluded that the majority of prescriptions were inappropriate.

Prof Banerjee’s review found that of the total number of prescriptions overall, 140,000 were inappropriate. The All Party Parliamentary Group on Dementia found that over-subscribing was a significant problem in care homes. An Alzheimer’s Society report on dementia care in general hospitals found that antipsychotic drugs were used to treat people with dementia in hospitals, and a quarter of nurses surveyed felt this use was inappropriate, citing reasons such as harmful side-effects which can rob the individual of quality of life as well as causing dizziness, unsteadiness which can lead to falls and injury, tremors and rigidity, social withdrawal and accelerated cognitive decline.

The Department of Health review found that these drugs contributed to 1,800 deaths a year, for example death from pneumonia.

The national audit of anti-psychotics prescribing will report its findings later this year.