When psychosocial interventions go wrong... Jill Manthorpe and Kritika Samsi

Working with puppets... Care home workers terrified dementia patients with horror handpuppets 'for fun‘ Daily Mail, 3rd December 2010 Two care home nurses are facing jail for using a glove puppet to bully elderly women as a joke. (They) were paid to look after the frail grandmothers - but instead the pair 'scared them for just for the fun of it'. (They) laughed while using a green goblin puppet to terrify women patients aged 87 and 91 in the home for the elderly.

Being playful... Jail for care trio who filmed their abuse of elderly at X nursing home Bradford Telegraph & Argus, 15th December 2010 Three care workers have been jailed after filming the “inhuman and degrading” abuse of two old people… Harrowing mobile phone footage of an 86-year-old man being bullied, baited and taunted and a 99-year-old woman sprawled, legs apart, on the floor pleading for help were played to a packed courtroom.

‘fooling around...’ (mitigation) Care workers filmed attacks on elderly Isle of Wight County Press, 26th February 2009 Two young women filmed their sickening abuse of old people to entertain their friends. A court was told how the two former care home workers tormented their victims, both suffering from severe dementia, pinching them, pulling and contorting their faces, pushing a mobile phone at one woman’s face and putting their fingers in the mouth of another.

Managing challenging behaviour? Carer pinned OAP down by his arms Rhyl Journal, 26th November 2008 A carer in a nursing home who held a 91-year- old resident down by his arms, wept as she was found guilty of ill-treatment. (she) claimed that she had been acting in self- defence as the man, who suffered from dementia, tried to punch her.

These are examples of convictions under the Mental Capacity Act They all relate to people with dementia and their treatment by paid care workers/nurses.

Our study – Evidem MCA We wanted to know if professionals in dementia care knew of this potential empowerment of people with dementia. Conducted interviews and survey with 250 staff working in dementia care. We found that most did not know – despite training, publicity and newspaper coverage. We therefore recommend greater attention to the rights of people with dementia not to be abused and their rights to have access to justice. In doing so, this may reduce the fear, stigma and dependency of dementia.

We conclude that psychosocial interventions needs to be supplemented by: Highlighting the value of recording so it may stop the abuse and provide better access to justice for vulnerable people (and staff) Whistleblowing (reporting concerns to outsiders but also to insiders) Promoting accountability to people with dementia above accountability to colleagues, employer or agency recognising that training does not itself safeguard and that interventions need to be ethical.

Thank you Disclaimer This report/article presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG ). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.