Police Forces throughout the UK are facing a growing challenge from an unexpected source: the elderly.
One bonus of living in a prosperous society is the expectation of a longer life, though unfortunately this is accompanied by a higher risk of developing some form of dementia. In 2012 it was estimated that there were 800,000 people with the disease in the UK (Lakey et al, 2012). Given our aging population, and the fact that the prevalence rates of dementia in people aged 60+ runs at between 5-7% (Abbott, 2011), this number is set to increase.
To the known population of dementia sufferers, we should also add the number of undiagnosed cases estimated in 2011 to be 371,327 (Mapping the Dementia Gap, 2012). These people will only receive appropriate care if they or someone else draws their predicament to the attention of the authorities, or some event has the same effect.
The 1959 Mental Health Act marked the movement from treating mental health separately from other forms of illness by abolishing the distinction between specialist psychiatric hospitals and others. It reflected the slow shift in public attitudes from fear to gradual understanding and recognition that people with mental illness should also have rights. Enlightenment has been a continuous, albeit at times a slow process both in terms of treatment options and the breaking down of stigma, but these days care in the community, as outlined in the National Health Service and Community Care Act 1990, is seen as the preferred option. As far as possible people with dementia are supported and receive treatment that allows them to remain in their own home environment.
At the Dementia 2012 Conference, the Prime Minister, Mr David Cameron issued his challenge to deliver major improvements not only in dementia care, but also in the creation of dementia friendly communities. The Prime Minister’s Challenge requires good communications and collaboration between the multiple agencies, including the police, and with the public.
Perhaps the best way to find out how to make life in the community easier for people with dementia is to find out what they would like to change. Lakey et al, 2012, did just this in their work with people with these diseases. Findings from their study record that better understanding of the problem was seen by 25% of respondents as one of the best ways to accomplish a more accommodating society. Furthermore, within this group 54% identified the need for greater understanding by the police (Lakey 2012).
According to Simon Cole, the Chief Constable of Leicestershire, police encounters with dementia predominantly occur at times of crisis such as when a person goes missing, is involved in some form of crime, or is in a state of distress (Cole, 2012). Police staff are trained to deal sensitively with people with dementia, but the training is in no way on a par with that of hospital or care staff. In the case of a missing person, the primary concern is to ensure that the individual is found and taken to a place of safety. After that the best results rely on referral to the appropriate agency for continuing support.
One of the less obvious symptoms of dementia is a compulsion to walk. Coupled with their problem with orientation this provides an explanation for the number of people with dementia who set out on a walk with purpose, become confused and inadvertently stray. This is particularly a problem for those in the earlier stages of dementia where there is a balance between risk and maintaining independence. Restricting an individual’s movements may be regarded as a breach of their rights so it is not taken lightly. It is therefore inevitable that some get lost.
As there appears to be no central agency collating details of missing persons, it is difficult to calculate the number of people with dementia who go missing. However, Biehal et al, 2003 analysed 2,000 case records from the National Missing Persons Bureau, and 114 questionnaire responses filled out by previously missing persons. Their report ‘Lost From View: A Study of Missing Persons In the UK’ recorded that the majority of adults who went missing unintentionally were over 60 years of age and were suffering from dementia. People with other forms of mental illness made up the remainder of the unintentionally missing adults.
There have been a number of initiatives aimed at speeding up the process of tracking and returning people with dementia who have strayed. Simon Cole made specific mention of his own Force (Leicestershire Police) working with the community to create safe places in places such as libraries, and Thames Valley Police which has a Neighbourhood Return System in which volunteers assist in searching for missing people. Meanwhile over three years Devon and Cornwall Police made 600 callouts to the Dartmoor Rescue Group to help their searches (BBC News Devon). Greater collaboration with the voluntary sector may well be part of the solution.
Sussex Police tried a slightly unorthodox approach using GPS tagging technology previously associated with wrongdoers as an effective way of locating missing people with dementia. Although given guarded approval by the Alzheimer’s Society, the scheme attracted considerable adverse criticism for being ‘barbaric’ or a breach of human rights. It is obviously difficult to get the balance right.
The extent of police involvement with people with dementia is determined not only by policy and the size of the affected population, but also by the expectations and provisions of other agencies.
As great a problem for the police as the missing person with dementia is the individual who is not on the missing list, but whose behaviour raises concerns about their mental faculties. The police have limited options available to them for dealing with such a case. This is possibly best illustrated through the case of Mr Hipolit Konrad Legowski an 87 year old Polish man who got lost whilst on a journey in his car.
Police became concerned about his welfare after stopping him for driving erratically. They called an ambulance but were advised that Mr Legowski was medically fit so they detained him under Section 136 of the Mental Health Act.
Once in custody the duty police surgeon was called, and he determined that whilst Mr Legowski had early dementia it did not justify his continued detention. He had called the Approved Social Worker and left a message on their answerphone. In the absence of a response his recommendation was that Mr Legowski should be returned home some miles away and in another Force area.
The custody sergeants attempted without success to contact the out of hours Social Services in both Force areas before deciding that they had no grounds for detaining Mr Legowski further. Having unsuccessfully tried to persuade him to stay in an hotel overnight Mr Legowski was directed to the motorway that would take him home.
Unfortunately Mr Legowski did not make it home: he died near his abandoned car.
The case of Mr Legowski was investigated by the IPCC which, amongst other things, noted the absence of assistance from health and social care agencies which might have been better placed to provide the support needed.
In 2008 the IPCC produced a report called ‘Police Custody as a “Place of Custody”: a National Study Examining the Use of Section 136 of the Mental Health Act 1983 (Docking et al, 2008). This collated data from all 43 police forces on the use of Section 136. Their key findings included the fact that 11,500 people were detained under Section 136 in 2005/06 compared with 5,900 people in hospital.
Police officers are not immune to the distress caused when the system fails the individual with dementia. The Health and Safety Executive Management Standards Indicator Tool recognises that work demands that cannot be fulfilled, lack of support, lack of clarity on duties and responsibilities, and a lack of understanding as to how work fits into the overall aim of the organisation produce a stressful environment. If the multiple agencies responsible for responding to Mr Cameron’s Challenge do not have the structures in place to communicate and collaborate effectively it is not only the people with dementia who will suffer, it will also be the very people who are charged with helping them.
Abbott, A. (2011). Dementia: A problem for our age. Nature Outlook, Vol 475, Issue 7355, 14 July, S2
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Dr. K.M.McIvor © 2013