Whether we at the DSDC are facilitating carers workshops or providing workforce training, the issue of supporting distressed behaviour always arises. A colleague and I recently finished a large project which centred on training for social care leaders, and supporting individuals with distress was a major theme of many of our discussions. This is a very complex issue for services.
In order to support a person with dementia who experiences distress, a service must address a number of issues:
Front line staff, and sometime leaders as well, want to immediately address more effective interventions to use. Something that works when the offer of a cup of tea doesn’t distract the individual from their anxiety, or frustration, or agitation. But in order to identify effective interventions there is work that must first be done. Good support for people living with dementia does not happen by happy accident, it is the result of a leader who has prioritised staff understanding of what behaviour really means, has helped them understand their role in the support process, and has actively defined the systems that support good practice.
A number of years ago I was working as a dementia consultant for an organisation that ran social service settings which supported people living with dementia. The most common thing that I was asked to consult on was how to support people who were extremely distressed. Usually I wasn’t called in until a service had reached the point where they were feeling unable to meet the needs of an individual. However, once the current crisis had been unpicked a bit it would usually become clear that the problems stemmed more from a lack of understanding by staff of what the distressed behaviour was communicating or the lack of a system outlining the who, what, where, when and how of supporting that distressed individual.
The first step to becoming a service that can meet the needs of a distressed individual with dementia is to address attitudes and beliefs about why distressed behaviour is occurring. I have written before on this blog about the importance of recognising behaviour as communication. Behaviour is a primary way in which we communicate with one another. Distressed behaviour is very often a communicator of an unmet need. However, to identify what is being communicated the team needs to see the behaviour as communication. This may involve reframing what the support team believes about a person and about their behaviour. Until a team recognises what lies at the heart of a behaviour, it is nearly impossible to provide the type of support that enhances wellbeing and identity.
The second step to improving support is to address the systems in place to support someone who becomes distressed. Many services have never created any kind of formal system, or they may use tools that staff have not been trained on or understand the purpose of. It isn’t easy because any type of system needs to be flexible enough to recognise and accommodate the uniqueness of each individual. Systems which are inflexible do not support person centred approaches. For an issue that is so central to our services, most of the approaches that services use for stress and distress are reactive. Good practice grounded in person centred approaches compels us to be proactive in understanding and meeting the needs of those we support.
When those two steps have been appropriately addressed within a service, then a generic list of interventions is no longer useful. Together the team can create strategies to ensure they are meeting needs before the need becomes problematic, and effective interventions are easier to identify because there is an understanding of the need that is being expressed, and how that need might be met in the moment.