- Email: [email protected]
The role of the community psychiatric nurse
Old age psychiatric services
The role of the community psychiatric nurse
What’s new? • The publication of the National Institute for Health and Clinical Excellence (NICE) and the Social Care Institute for Excellence (SCIE) Dementia clinical practice guideline 42 (NICE/SCIE, 2007) provides an authoritative evidence-based review of care and treatment regimens, incorporating a critical synthesis of both quantitative and qualitative studies. In addition, there have been two reviews of mental health nursing in England13 and Scotland14 that both promote a ‘recovery’ approach to mental health nursing, although the place of ‘recovery’ within the dementia care field has yet to be fully explored, tested and evaluated. The new ways of working for everyone: progress report12 challenges community psychiatric nurses and other mental health service providers working with older people to think and act creatively in their approach to practice, including the development of supplementary prescribing responsibilities.
John Keady
Abstract This is a time of great social, political and demographic change in dementia care. Part of this change is fuelled by a combination of factors, such as an ageing mental health workforce, a reorientation of traditional care values and an increasing demographic profile in the numbers of people with a dementia living in the UK: currently 683,579, rising to 1,735,087 by 2051. Recent reviews of mental health nursing in both England and Scotland have highlighted the need for mental health nurses to target the most complex and challenging cases and work within a recovery approach, although this approach is yet to be fully explored, tested and evaluated by community psychiatric nurses (CPNs) working in dementia care. The role of the CPN in dementia care is well established, with recent published examples of supplementary prescribing, assertive outreach and care coordination. Additionally, a recent study drawn from the care practices of CPNs working with people with dementia and their families with the most complex needs, indicates that the role is broken down into four domains: ‘being with’ with the person, their family and support network; providing emotional support; providing practical support; and undertaking reminiscence and orientation techniques. The study also suggests that in approximately 40% of cases, CPNs provide one or more of the following interventions: education; coping strategy enhancement; and developing problem-solving skills. To continue to develop the CPN role, an increase in the quality and provision of dementia training is required in both pre- and post-registration nursing course curricula.
own home (63.5%) and just over one-third live in a care home (36.5%), with a diagnosis of Alzheimer’s disease accounting for 67% of all those living with a dementia.1
Role attributes of the community psychiatric nurse Against such a backdrop, the National Institute for Health and Clinical Excellence (NICE) and the Social Care Institute for Excellence (SCIE) have produced their Clinical Practice Guideline 42.2 This clinical guidance promotes a biopsychosocial model of dementia and outlines nine ‘key priorities’ for attention (Table 1), underpinned by a set of ‘principles of care’ that range from person-centred approaches, to the preferred support option of community-based care, and on to respecting diversity, equality, ethical treatment and the impact of dementia on relationships. In working within the preferred support option, community psychiatric nurses (CPNs) have often been cited as an integral and valued component of primary care and specialist practi tioners in the community support of people with dementia and their families.3,4 Whilst competing service models exist, CPNs are usually integrated into community mental health teams for older people, and provide a range of advanced and supportive interventions, including cognitive assessment/screening, care co ordination and a range of psychotherapeutic approaches, such as cognitive–behavioural therapy,5 psychosocial intervention6 and postdiagnostic counselling and support.7 Depending upon local need and older persons’ service configurations, CPNs may carry either a ‘functional’ or a ‘dementia’ caseload, or a combination of the two. Alternatively, a CPN may form part of a memory assessment and treatment service providing home-, or clinic-based, cognitive and behavioural assessment ‘screening’, and, with suitable training and agreement through a clinical management plan between the doctor, patient and nurse, undertake supplementary and independent prescribing responsibilities.8 Traditionally, CPNs have exercised their role through longterm and family-focused relationships, seeing ‘support’ and
Keywords community psychiatric nurse; dementia; education; intervention; recovery approach
According to the most recent prevalence and economic cost figures issued by the Alzheimer’s Society,1 there are estimated to be 683,579 people with dementia in the UK, representing one person in every 88 of the UK population. The financial cost of dementia to the UK is estimated at £17.03 billion per annum, a figure that takes into account the contribution of family members to the care process, but excludes the care costs attributed to younger people with dementia. Moreover, the numbers of people with dementia in the UK is predicted to rise to 940,110 by 2021 and 1,735,087 by 2051. At present, two-thirds of people with dementia live in their
John Keady PhD RMN RNT is Professor of Older People’s Mental Health Nursing, The University of Manchester/Bolton, Salford and Trafford Mental Health NHS Trust, UK. His main research interests are the experience of dementia, family care and the role of nursing in dementia.
PSYCHIATRY 7:2
70
© 2007 Elsevier Ltd. All rights reserved.
Old age psychiatric services
• provide comprehensive packages of therapeutic interventions to enable people with dementia to return home from hospital sooner than would otherwise be possible. Instead of the ‘high numbers’ seen on most CPN caseloads, in this pilot study the average was six cases, and focus was placed upon the immediacy of the referral criteria, such as: deterioration in the client’s mental health and/or increasing cognitive impairment; aggressive or disruptive behaviour; evident risks; carer struggling to cope; poor compliance with medication; and the client resisting service input. The evaluation demonstrated that a ‘high proportion’ of problems were met by the team and that intervention was between 12 weeks (the ideal) to 18 weeks. The team predominantly undertook five main interventions with the person with dementia, which they described as: ‘being with’; emotional support; practical support; and reminiscence and orientation. In approximately 40% of cases, CPNs also provided one or more of the following interventions: education; coping strategy enhancement; and developing problem-solving skills. The second account was provided by Ryan et al.11 who reviewed the Community Dementia Support Service as an innovative, relationship-centred approach to community provision in a major city in the North of England with a remodelled CPN role as a linchpin of the service. Ryan et al.11 found that the remodelled CPN role was to provide training and case supervision to non-professionally qualified staff and NVQ-level care staff. Such a reorientation brought about a heightened sense of autonomy for the CPN and integrated new skills of negotiation, sharing core skills, staff empowerment and supervision in their day-to-day work. Such a reorientation of values and skills is seen to be increasingly important as the mental health workforce is challenged to find more creative and reflexive ‘new ways of working’12 that break down the traditional service models of old and embrace role change and boundary blurring.
NICE/SCIE: nine ‘key priorities’ for implementation • Non-discrimination: i.e. the need not to exclude people with dementia from any service because of their diagnosis, age or coexisting learning disabilities • Valid consent: i.e. for health and social care professionals to always seek valid consent from people with dementia, and if capacity is compromised, the provisions of the Mental Capacity Act, 2005, are to be followed • Carers: i.e. the need to ensure that the rights of carers to receive an assessment are conducted, and that psychological therapy is offered to carers who are experiencing psychological upset and distress • Coordination and integration of health and social care: i.e. the necessity for joint planning, policy, procedures and reviews. Joint planning should include the involvement of local service users and carers • Memory services: i.e. the recommendation that memory assessment services (either through a dedicated clinic or through a community mental health team) should be the single point of referral for all people with a possible diagnosis of dementia • Structural imaging for diagnosis: i.e. the use of MRI as the preferred modality to assist in establishing an early diagnosis • Behaviour that challenges: i.e. early assessment should be offered to pinpoint the likely factors that may generate, aggravate or improve such behaviour • Training: i.e. the requirement that all staff (including voluntary staff ) working with people with dementia to have access to dementia care training consistent with their roles and responsibilities • Mental health needs in acute hospitals: i.e. the need for acute and general hospital trusts to plan and provide services that address the needs of people with dementia who use acute hospital services
Conclusion Within the past year there have been two separate national reviews into mental health nursing, one in England13 and the other in Scotland.14 What links these reviews is the emphasis placed on a ‘recovery approach’ as a way of framing mental health nursing practice (Table 2), and an emphasis placed on personal self-growth and the engenderment of hope for the individual experiencing mental health needs. Recovery in this way
Source: NICE/SCIE. Dementia: supporting people with dementia and their carers in health and social care, 2007.2
Table 1
‘monitoring’ as legitimate professional roles and activity.9 However, there is now a move to redirect such CPN–client relationships into time-limited, psychosocial interventions, providing help to people with dementia and their families with the most complex needs. This redirection can be illustrated through two recent studies. The first by Cantley and Caswell10 outlines the role of the CPN in an assertive outreach initiative, provided through the Intensive Community Treatment Team in Hull and East Riding Community Health NHS Trust. Independently evaluated by Dementia North, the aims of the project were to: • provide timely, realistic and coordinated packages of care • maximize the individual’s wellbeing, independence, choice and dignity • prevent admissions to hospital or care homes; to facilitate a planned approach to necessary admissions as a means of ensuring the best possible outcome for people with dementia and their carers
PSYCHIATRY 7:2
The recovery approach The recovery approach is based around a number of principles that stress the importance of: • working in partnership with service users (and/or carers) to identify realistic life goals and enabling achievement • stressing the value of social inclusion • stressing the need for professionals to be optimistic about the possibility of positive individual change Adapted from: Department of Health. From values to action: the Chief ursing Officer’s review of mental health nursing, 2006.13 N
Table 2
71
© 2007 Elsevier Ltd. All rights reserved.
Old age psychiatric services
of thinking is not necessarily about returning to the state of wellbeing experienced before the onset of the illness. Both reports mention the applicability of the recovery approach to dementia care nursing, although additional evidence is required to explore, test and evaluate this notion. Arguably, within CPN practice in dementia care, additional emphasis should be placed on reconstructing, reconnecting and reconfiguring existing abilities of the person with dementia and their family, recovering capacity from within this paradigm. Positive and sustained change across all professional groups will materialize only through a more informed and capable workforce. How we prepare all health and social care professionals to meet the challenges and opportunities presented by people with dementia and their families will be a testament to our values as a society. To this end, a recent UK survey15 of higher education provision related to dementia care revealed patchy coverage of ‘dementia’ within the mental health branch of preregistration nursing programmes, and under developed provision of post registration opportunities. This deficit needs urgent redress because the future work of CPNs in dementia care will depend on a more inclusive and comprehensive educational cornerstone being cemented firmly into place. ◆
Buckinghamshire: Open University Press/McGraw Hill Publications, 2007. 5 Ashton P. Cognitive-behavioural interventions in dementia. In: Keady J, Clarke CL, Adams T, eds. Community mental health nursing and dementia care: practice perspectives. Buckinghamshire: Open University Press/McGraw Hill Publications, 2003. 6 Iliffe S, Wilcock J, Haworth D. Delivering psychosocial interventions for people with dementia in primary care. Dementia: The International Journal of Social Research and Practice 2006; 5: 327–38. 7 Steeman E, Dierckx de Casterlé B, Godderis J, Grypdonck M. Living with early-stage dementia: a review of qualitative studies. J Adv Nurs 2006; 54: 722–38. 8 Page S. Nurse prescribing and the CMHN: assuming new responsibilities in dementia treatment. In: Keady J, Clarke CL, Page S, eds. Partnerships in community mental health nursing and dementia care: practice perspectives. Buckinghamshire: Open University Press/McGraw Hill Publications, 2007. 9 Keady J, Clarke CL, Adams T, eds. Community mental health nursing and dementia care: practice perspectives. Buckinghamshire: Open University Press/McGraw Hill Publications, 2003. 10 Cantley C, Caswell P. Assertive outreach and the CMHN: a role for the future? In: Keady J, Clarke CL, Page S, eds. Partnerships in community mental health nursing and dementia care: practice perspectives. Buckinghamshire: Open University Press/McGraw Hill Publications, 2007. 11 Ryan T, Nolan M, Enderby P, Reid D. ‘Part of the family’: sources of job satisfaction amongst a group of community-based dementia care workers. Health Soc Care Community 2004; 12: 111–18. 12 Department of Health. Mental health: new ways of working for everyone: developing and sustaining a capable workforce. Progress report. London: HMSO, 2007. 13 Department of Health. From values to action: the Chief Nursing Officers review of mental health nursing. London: HMSO, 2006. 14 Scottish Executive. Rights, relationships and recovery: the report of the national review of mental health nursing in Scotland. Edinburgh: Scottish Executive, 2006. 15 Pulsford D, Hope K, Thompson R. Higher education provision for professionals working with people with dementia: a scoping exercise. Nurse Educ Today 2007; 27: 5–13.
References 1 Alzheimer’s Society. Dementia UK. London: Alzheimer’s Society, 2007. www.alzheimers.org.uk/downloads/Dementia_UK_Full_Report.pdf (accessed 23 November 2007). 2 National Institute for Health and Clinical Excellence/Social Care Institute for Excellence. Dementia: supporting people with dementia and their carers in health and social care. NICE clinical practice guideline 42. London: National Institute for Health and Clinical Excellence, 2007. 3 Royal College of Psychiatrists. Community psychiatric nursing. Occasional Paper OP40. London: Royal College of Psychiatrists, 1997. 4 Keady J, Clarke CL, Page S, eds. Partnerships in community mental health nursing and dementia care: practice perspectives.
PSYCHIATRY 7:2
72
© 2007 Elsevier Ltd. All rights reserved.
The role of the community psychiatric nurse
What’s new? • The publication of the National Institute for Health and Clinical Excellence (NICE) and the Social Care Institute for Excellence (SCIE) Dementia clinical practice guideline 42 (NICE/SCIE, 2007) provides an authoritative evidence-based review of care and treatment regimens, incorporating a critical synthesis of both quantitative and qualitative studies. In addition, there have been two reviews of mental health nursing in England13 and Scotland14 that both promote a ‘recovery’ approach to mental health nursing, although the place of ‘recovery’ within the dementia care field has yet to be fully explored, tested and evaluated. The new ways of working for everyone: progress report12 challenges community psychiatric nurses and other mental health service providers working with older people to think and act creatively in their approach to practice, including the development of supplementary prescribing responsibilities.
John Keady
Abstract This is a time of great social, political and demographic change in dementia care. Part of this change is fuelled by a combination of factors, such as an ageing mental health workforce, a reorientation of traditional care values and an increasing demographic profile in the numbers of people with a dementia living in the UK: currently 683,579, rising to 1,735,087 by 2051. Recent reviews of mental health nursing in both England and Scotland have highlighted the need for mental health nurses to target the most complex and challenging cases and work within a recovery approach, although this approach is yet to be fully explored, tested and evaluated by community psychiatric nurses (CPNs) working in dementia care. The role of the CPN in dementia care is well established, with recent published examples of supplementary prescribing, assertive outreach and care coordination. Additionally, a recent study drawn from the care practices of CPNs working with people with dementia and their families with the most complex needs, indicates that the role is broken down into four domains: ‘being with’ with the person, their family and support network; providing emotional support; providing practical support; and undertaking reminiscence and orientation techniques. The study also suggests that in approximately 40% of cases, CPNs provide one or more of the following interventions: education; coping strategy enhancement; and developing problem-solving skills. To continue to develop the CPN role, an increase in the quality and provision of dementia training is required in both pre- and post-registration nursing course curricula.
own home (63.5%) and just over one-third live in a care home (36.5%), with a diagnosis of Alzheimer’s disease accounting for 67% of all those living with a dementia.1
Role attributes of the community psychiatric nurse Against such a backdrop, the National Institute for Health and Clinical Excellence (NICE) and the Social Care Institute for Excellence (SCIE) have produced their Clinical Practice Guideline 42.2 This clinical guidance promotes a biopsychosocial model of dementia and outlines nine ‘key priorities’ for attention (Table 1), underpinned by a set of ‘principles of care’ that range from person-centred approaches, to the preferred support option of community-based care, and on to respecting diversity, equality, ethical treatment and the impact of dementia on relationships. In working within the preferred support option, community psychiatric nurses (CPNs) have often been cited as an integral and valued component of primary care and specialist practi tioners in the community support of people with dementia and their families.3,4 Whilst competing service models exist, CPNs are usually integrated into community mental health teams for older people, and provide a range of advanced and supportive interventions, including cognitive assessment/screening, care co ordination and a range of psychotherapeutic approaches, such as cognitive–behavioural therapy,5 psychosocial intervention6 and postdiagnostic counselling and support.7 Depending upon local need and older persons’ service configurations, CPNs may carry either a ‘functional’ or a ‘dementia’ caseload, or a combination of the two. Alternatively, a CPN may form part of a memory assessment and treatment service providing home-, or clinic-based, cognitive and behavioural assessment ‘screening’, and, with suitable training and agreement through a clinical management plan between the doctor, patient and nurse, undertake supplementary and independent prescribing responsibilities.8 Traditionally, CPNs have exercised their role through longterm and family-focused relationships, seeing ‘support’ and
Keywords community psychiatric nurse; dementia; education; intervention; recovery approach
According to the most recent prevalence and economic cost figures issued by the Alzheimer’s Society,1 there are estimated to be 683,579 people with dementia in the UK, representing one person in every 88 of the UK population. The financial cost of dementia to the UK is estimated at £17.03 billion per annum, a figure that takes into account the contribution of family members to the care process, but excludes the care costs attributed to younger people with dementia. Moreover, the numbers of people with dementia in the UK is predicted to rise to 940,110 by 2021 and 1,735,087 by 2051. At present, two-thirds of people with dementia live in their
John Keady PhD RMN RNT is Professor of Older People’s Mental Health Nursing, The University of Manchester/Bolton, Salford and Trafford Mental Health NHS Trust, UK. His main research interests are the experience of dementia, family care and the role of nursing in dementia.
PSYCHIATRY 7:2
70
© 2007 Elsevier Ltd. All rights reserved.
Old age psychiatric services
• provide comprehensive packages of therapeutic interventions to enable people with dementia to return home from hospital sooner than would otherwise be possible. Instead of the ‘high numbers’ seen on most CPN caseloads, in this pilot study the average was six cases, and focus was placed upon the immediacy of the referral criteria, such as: deterioration in the client’s mental health and/or increasing cognitive impairment; aggressive or disruptive behaviour; evident risks; carer struggling to cope; poor compliance with medication; and the client resisting service input. The evaluation demonstrated that a ‘high proportion’ of problems were met by the team and that intervention was between 12 weeks (the ideal) to 18 weeks. The team predominantly undertook five main interventions with the person with dementia, which they described as: ‘being with’; emotional support; practical support; and reminiscence and orientation. In approximately 40% of cases, CPNs also provided one or more of the following interventions: education; coping strategy enhancement; and developing problem-solving skills. The second account was provided by Ryan et al.11 who reviewed the Community Dementia Support Service as an innovative, relationship-centred approach to community provision in a major city in the North of England with a remodelled CPN role as a linchpin of the service. Ryan et al.11 found that the remodelled CPN role was to provide training and case supervision to non-professionally qualified staff and NVQ-level care staff. Such a reorientation brought about a heightened sense of autonomy for the CPN and integrated new skills of negotiation, sharing core skills, staff empowerment and supervision in their day-to-day work. Such a reorientation of values and skills is seen to be increasingly important as the mental health workforce is challenged to find more creative and reflexive ‘new ways of working’12 that break down the traditional service models of old and embrace role change and boundary blurring.
NICE/SCIE: nine ‘key priorities’ for implementation • Non-discrimination: i.e. the need not to exclude people with dementia from any service because of their diagnosis, age or coexisting learning disabilities • Valid consent: i.e. for health and social care professionals to always seek valid consent from people with dementia, and if capacity is compromised, the provisions of the Mental Capacity Act, 2005, are to be followed • Carers: i.e. the need to ensure that the rights of carers to receive an assessment are conducted, and that psychological therapy is offered to carers who are experiencing psychological upset and distress • Coordination and integration of health and social care: i.e. the necessity for joint planning, policy, procedures and reviews. Joint planning should include the involvement of local service users and carers • Memory services: i.e. the recommendation that memory assessment services (either through a dedicated clinic or through a community mental health team) should be the single point of referral for all people with a possible diagnosis of dementia • Structural imaging for diagnosis: i.e. the use of MRI as the preferred modality to assist in establishing an early diagnosis • Behaviour that challenges: i.e. early assessment should be offered to pinpoint the likely factors that may generate, aggravate or improve such behaviour • Training: i.e. the requirement that all staff (including voluntary staff ) working with people with dementia to have access to dementia care training consistent with their roles and responsibilities • Mental health needs in acute hospitals: i.e. the need for acute and general hospital trusts to plan and provide services that address the needs of people with dementia who use acute hospital services
Conclusion Within the past year there have been two separate national reviews into mental health nursing, one in England13 and the other in Scotland.14 What links these reviews is the emphasis placed on a ‘recovery approach’ as a way of framing mental health nursing practice (Table 2), and an emphasis placed on personal self-growth and the engenderment of hope for the individual experiencing mental health needs. Recovery in this way
Source: NICE/SCIE. Dementia: supporting people with dementia and their carers in health and social care, 2007.2
Table 1
‘monitoring’ as legitimate professional roles and activity.9 However, there is now a move to redirect such CPN–client relationships into time-limited, psychosocial interventions, providing help to people with dementia and their families with the most complex needs. This redirection can be illustrated through two recent studies. The first by Cantley and Caswell10 outlines the role of the CPN in an assertive outreach initiative, provided through the Intensive Community Treatment Team in Hull and East Riding Community Health NHS Trust. Independently evaluated by Dementia North, the aims of the project were to: • provide timely, realistic and coordinated packages of care • maximize the individual’s wellbeing, independence, choice and dignity • prevent admissions to hospital or care homes; to facilitate a planned approach to necessary admissions as a means of ensuring the best possible outcome for people with dementia and their carers
PSYCHIATRY 7:2
The recovery approach The recovery approach is based around a number of principles that stress the importance of: • working in partnership with service users (and/or carers) to identify realistic life goals and enabling achievement • stressing the value of social inclusion • stressing the need for professionals to be optimistic about the possibility of positive individual change Adapted from: Department of Health. From values to action: the Chief ursing Officer’s review of mental health nursing, 2006.13 N
Table 2
71
© 2007 Elsevier Ltd. All rights reserved.
Old age psychiatric services
of thinking is not necessarily about returning to the state of wellbeing experienced before the onset of the illness. Both reports mention the applicability of the recovery approach to dementia care nursing, although additional evidence is required to explore, test and evaluate this notion. Arguably, within CPN practice in dementia care, additional emphasis should be placed on reconstructing, reconnecting and reconfiguring existing abilities of the person with dementia and their family, recovering capacity from within this paradigm. Positive and sustained change across all professional groups will materialize only through a more informed and capable workforce. How we prepare all health and social care professionals to meet the challenges and opportunities presented by people with dementia and their families will be a testament to our values as a society. To this end, a recent UK survey15 of higher education provision related to dementia care revealed patchy coverage of ‘dementia’ within the mental health branch of preregistration nursing programmes, and under developed provision of post registration opportunities. This deficit needs urgent redress because the future work of CPNs in dementia care will depend on a more inclusive and comprehensive educational cornerstone being cemented firmly into place. ◆
Buckinghamshire: Open University Press/McGraw Hill Publications, 2007. 5 Ashton P. Cognitive-behavioural interventions in dementia. In: Keady J, Clarke CL, Adams T, eds. Community mental health nursing and dementia care: practice perspectives. Buckinghamshire: Open University Press/McGraw Hill Publications, 2003. 6 Iliffe S, Wilcock J, Haworth D. Delivering psychosocial interventions for people with dementia in primary care. Dementia: The International Journal of Social Research and Practice 2006; 5: 327–38. 7 Steeman E, Dierckx de Casterlé B, Godderis J, Grypdonck M. Living with early-stage dementia: a review of qualitative studies. J Adv Nurs 2006; 54: 722–38. 8 Page S. Nurse prescribing and the CMHN: assuming new responsibilities in dementia treatment. In: Keady J, Clarke CL, Page S, eds. Partnerships in community mental health nursing and dementia care: practice perspectives. Buckinghamshire: Open University Press/McGraw Hill Publications, 2007. 9 Keady J, Clarke CL, Adams T, eds. Community mental health nursing and dementia care: practice perspectives. Buckinghamshire: Open University Press/McGraw Hill Publications, 2003. 10 Cantley C, Caswell P. Assertive outreach and the CMHN: a role for the future? In: Keady J, Clarke CL, Page S, eds. Partnerships in community mental health nursing and dementia care: practice perspectives. Buckinghamshire: Open University Press/McGraw Hill Publications, 2007. 11 Ryan T, Nolan M, Enderby P, Reid D. ‘Part of the family’: sources of job satisfaction amongst a group of community-based dementia care workers. Health Soc Care Community 2004; 12: 111–18. 12 Department of Health. Mental health: new ways of working for everyone: developing and sustaining a capable workforce. Progress report. London: HMSO, 2007. 13 Department of Health. From values to action: the Chief Nursing Officers review of mental health nursing. London: HMSO, 2006. 14 Scottish Executive. Rights, relationships and recovery: the report of the national review of mental health nursing in Scotland. Edinburgh: Scottish Executive, 2006. 15 Pulsford D, Hope K, Thompson R. Higher education provision for professionals working with people with dementia: a scoping exercise. Nurse Educ Today 2007; 27: 5–13.
References 1 Alzheimer’s Society. Dementia UK. London: Alzheimer’s Society, 2007. www.alzheimers.org.uk/downloads/Dementia_UK_Full_Report.pdf (accessed 23 November 2007). 2 National Institute for Health and Clinical Excellence/Social Care Institute for Excellence. Dementia: supporting people with dementia and their carers in health and social care. NICE clinical practice guideline 42. London: National Institute for Health and Clinical Excellence, 2007. 3 Royal College of Psychiatrists. Community psychiatric nursing. Occasional Paper OP40. London: Royal College of Psychiatrists, 1997. 4 Keady J, Clarke CL, Page S, eds. Partnerships in community mental health nursing and dementia care: practice perspectives.
PSYCHIATRY 7:2
72
© 2007 Elsevier Ltd. All rights reserved.