Risk Assessment and Management for Living Well with Dementia (Bradford Dementia Group – Good Practice Guides)

Citation

Ring, C. (2011), "Risk Assessment and Management for Living Well with Dementia (Bradford Dementia Group – Good Practice Guides)", The Journal of Mental Health Training, Education and Practice, Vol. 6 No. 4, pp. 212-213. https://doi.org/10.1108/17556221111194563

For potential readers whose first reaction (like mine) to seeing the title is a feeling of inadequacy or despondency, my advice as a reviewer is “do not act on this”. This book is quite short, and although it is hard work at times, contains some real treasures. It is a suitable length for practitioners and merits the attention of a wide variety of professionals and others concerned with dementia care. It contains and elaborates some key concepts which together provide an extensive “map” of the territory, linking values, principles, policy, and practice. It successfully analyses the nature of risk in the context of dementia care, examines its contested nature, recognises the need to incorporate risk assessment and management in an overall, positive philosophy of dementia care, and yet still manages to present an appealing and manageable framework for professional use. Potential readers will hopefully find the reviewers comments an indication of the scope and limitations of the book.

The text's authority derives from the authors' clinical backgrounds and their extensive research experience as evidenced by reference to other research and to evolving principles and practice in dementia care. While it does incorporate the perspective of dementia people with dementia and their relatives, including them (explicitly) as authors as well as informants, would help to explain and develop the concepts described. Drawing on the knowledge and insights of other professionals (social workers and legal specialists) would also have enhanced coverage of the law (a significant omission), the role of advocacy, and recent developments such as telecare (Kerr et al., 2010).

A significant strength is the authors' willingness to engage with issues of risk and personhood at some depth without losing the reader or insulting their intelligence. Reference to other writers (such as Titterton, 2005) on risk theory and person‐centred dementia care, encourages the reader to consult the original writings. There is welcome emphasis on maintaining a sense of personhood and purpose, so that discussions of risk do not dominate care practice. Some illuminating concepts are introduced to help the practitioner reframe their own experience, and that of the person with dementia. An example is the “contested territories” of everyday living which are central to an individual's personhood, tends to expose them to risk, and so are liable to become a battleground (“contested territory”) between them and those with informal or formal caring roles.

There is a welcome exploration of different perspectives on risk and its management, and an emphasis on “risk communication”. In contrast, insufficient examination of the legal framework is a conspicuous gap – the overall effect of the (2005) Mental Capacity Act, incorporating the assumption of mental capacity unless proven otherwise, is to shift power and responsibility for decision making towards the individual. This aspect of the Act, together with its clear guidelines and boundaries on professional discretion, demand much more discussion in such a text. Another of the book's few weaknesses is the relatively sparse use of case examples to illustrate the concepts and methods explained.

Overall, the authors set out several valuable approaches to risk assessment and management for practitioners to develop and apply, clearly based upon the foundations constructed throughout the text. The conclusion incorporates a welcome emphasis on quality of life, wellbeing, and the changing societal context in which dementia is experienced, which seeks to avoid its construction as a catastrophe, without underplaying the suffering and dismay it entails.

This positive approach taken by the authors throughout is a major strength of the work. However, there is no discussion of specific strategies to bring about the organisational and cultural changes required for the positive practices espoused to flourish, and this is a significant omission for readers with managerial responsibilities. None the less as a good practice guide the book provides a sound basis for those from a wide range of practice backgrounds to start to reconstruct their own practice, and pursue the cultural transformation required for this to bear fruit.