Right. Should dementia be classified within mental health or physical health?
And what difference does it make?
Memory services in this country diagnose, support and “treat” people living with dementia. And memory services are by and large provided by mental health trusts.
So dementia is mental health.
Dementia, on the other hand, results from disease of the brain, physical disease. It’s not about memory loss due to ageing or stress or medications or (usually) other conditions.
Dementia results from physical disease.
“Memory” clinic as a name suggests dementia is just about memory. Wrong. Dementia is the generic name for difficulties with perception, physical capabilities like speech and swallowing, memory, recognition, understanding, word finding…
Memory is just one piece of the jigsaw, the one that most people know about.
So dementia is about living, about occupational therapy, about using your “facilities” as often as possible so you don’t lose them. And occupational therapy is provided by physical healthcare providers usually.
I looked at the Shropshire Health and Wellbeing Board’s priorities for the next year. And there, at number one, is improving mental health, including dementia.
Why does this matter?
Well, as most people know, mental health care has been underfunded since year dot. So, if dementia is classified as mental health, care for those living with dementia is likely to be underfunded.
And it is underfunded.
Second, mental ill health has been regarded since year dot as something to be hidden away, in asylums, in the community, not talked about. Some languages and cultures have no word for dementia because it is a disgrace to the family. It is not spoken of. We are only a few steps ahead of this in most of Britain.
Third, because there is no cure and because the incidence of dementia is increasing as we live longer, (and possibly because our lifestyles become less healthy,) people are frightened of dementia.
It’s the new Cancer.
And, fourth, if it were cancer, or acute kidney injury, or heart disease, and was therefore classified as a physical health condition, it would receive the funding and priority support and treatment that cancer gets.
Which it does not.
But, no, dementia is put into the mental health category, so it can be underfunded, under-talked-about, and misunderstood.
And of course, while people living with dementia progressively need more support from health and occupational therapy experts hosted by different organisations, coordinating access to these people and services gets progressively more complex.
And where there are joins there are cracks.
And where there are cracks there are holes.
And where there are holes there are trips and falls.
People get lost in the holes. They don’t re-emerge intact. They lose their functions, their social contacts. They become isolated, lonely.
We really need to decide whether we value people sufficiently to want to provide them with the best support we can so they can live as well as possible in their communities.
Because at the moment we don’t.
And that, as I have said before, is a disgrace.