Mental Health Practitioner – Korsakoff’s Syndrome

My current role is as a Mental Health Practitioner in a rehabilitation team that provide therapy input for elderly community patients with physical disabilities e.g. broken bones from falls. The role is to provide support for health professionals who work with individuals with mental health problems, but my role is also to assess for early onset dementia. In the last two years there has been a steady increase in elderly patients coming into community services with alcohol problems. The difficulty that occurs is that often problematic drinking in the elderly further isolates them socially from others. Often problematic drinking results in little support from family with activities of daily living e.g. shopping, cleaning, laundry. This then puts a weight on public services to provide that care but additionally, most alcoholics chose to spend their money on alcohol, not on having carers coming in to help them. There’s a percentage of elderly patients who die from self-neglect; alcohol is a main feature (from my experience – I don’t know if this is fact). This could potentially be because the Mental Health Act and Mental Capacity Act generally have safeguards in place for others who self-neglect however neither Acts cover those intoxicated!! An ordinary older person would not self-neglect unless severe mental health or dementia present – of which services have the legal backing to prevent further decline. However self- neglect does not come under safeguarding nationally in England which means social services do not need to intervene.

In my job, alcohol in the elderly is as damaging and destructive as from my experiences working in high secure and the effects of alcoholism has on an individuals life and central to the crimes they commit. In my job also, I find that those with Korsakoff’s are often outcasted from services. Memory Services generally do not pick up referrals for an individual who continues to drink alcohol – so a patient would need to be clear of alcohol for 3-4 months before psychiatric assessment. Community Mental Health teams generally would not pick up someone who does not require input for a “severe and enduring mental illness”. Which alcoholism isn’t a classified mental illness that would be treated under the MHA. (I’d look into that properly though).

Recently we had a chap (aged 75) that seems to be like pin ball in a machine that seems to bounce from service to service – all unable to meet his needs. He has a long history of abusing alcohol, alongside a long history of violent behaviour including criminal convictions for arson, GBH and breach of the peace. He attends A&E twice a week following a fall (from being intoxicated), he cannot afford to pay for the falls prevention equipment in his property, he cannot afford and does not want the carers, he cannot afford food etc. He uses his money for alcohol which is his choice however health services cannot continue to provide free care services that’s purpose is for crisis management. Therefore he is discharged from services (often because he declines input) then within no time, he will bounce back in. Social Services assess an individual’s capacity and if they have capacity but the patient does want to pay or accept support – then Social Services stop/ remove their input leaving health as the only agency involved.

I have worked with extremely wealthy “well to do” families who only recently discovered their mother/father have had a life long history of serious alcohol abuse. Only as their parents lose grip on reality with alcohol induced dementia – do they then discover the bottles and bottles of spirits in the recycle bin as they gradually become more involved in the everyday care of the patient. One lady was 94 and was admitted to hospital following a fall. She had three sons who lived their own lives but due to the fall became more involved in looking after her. They discovered from friends of the family that their mother had had an alcohol problem and that had been concealed by their father and since his death her inabilities to carry out normal tasks at home became more apparent. Sometimes in these circumstances its about future management of behaviour that helps the situation. For the 94 year old lady who would “kick off” at the same time on an evening – why was that? Was it because with her evening meal she would usually have a glass of wine? Should the care home replicate that and what’s their duty of care to continue to provide alcohol to someone who has clearly been so damaged by it? At that age its about quality of life, respecting the decisions about what she would have wanted if she did have capacity and about choice (which was to drink), and although it would increase falls risks – its not like its going to make a great deal of difference. Or is it about finding the wine with the lowest alcohol content, or giving her a glass of shloer in the hope she doesn’t read the label. I think it all comes down to liberty and choice but where possible most would go with the second option.

Female, 30, Occupational Therapist – Mental Health Practitioner, Yorkshire