Jim Duffy: One Flew Over the Cuckoo's Nest cannot be the future of dementia care

Cases of dementia are expected to soar in coming years so we need to prepare now, writes Jim Duffy.

Scotland needs to prepare for rising cases of dementia
Scotland needs to prepare for rising cases of dementia

One of the best books and ultimately movies of my generation is one that handles mental health. It is brutal in its imagery and treatment of the subject, while causing us to consider the wider issues in care. One Flew Over The Cuckoo’s Nest, written by Ken Kesey in 1962, is a comedy drama set in an Oregon psychiatric hospital, focussing on the trials and tribulations of both the staff and patients. The main character in the movie – Randle Patrick McMurphy – played by Jack Nicholson is a complicated individual who is confusing to the powers that be.

Is he insane or is he faking it to get out of prison and into the cushy, comfortable hospital? The movie deals with the relationships between the patients, the power struggle between Nurse Ratched, played by Louise Fletcher in the film, and McMurphy, and the frailties of those patients who have mental illnesses.

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But, this movie is made all the more relevant for us all now as the rise in dementia becomes problematic for us as a society.

From feeling blue with low mood to suffering depression to schizophrenia to dementia, there is a massive mental health spectrum that we in Scotland need to plan for.

As the issue has become more prominent in the media, so to has our individual awareness of what it means to us and members of our families.

But, as we all live that bit longer due to healthier eating, better diagnoses, informed medical care and improved living standards, more of us will become prone to developing illnesses like dementia.

Getting old is just part of life. With that comes a deterioration of health both physical and mental. Our bones can become more brittle and we are susceptible to falls. Our skin loses its elasticity. We can develop type two diabetes and viruses like the flu can be life threatening. These are physical illnesses with symptoms that prompt us to go to our GP to get treated.

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But, when it comes to dementia, it’s a different ball game. Dementia is on the rise in Scotland. Alzheimer’s and dementia in general now account for more than one in every ten deaths in Scotland. This is more than double the rate just a decade ago. Data from the National Records of Scotland (NRS) showed a 15.8 per cent increase in deaths from Alzheimer’s in the first three months of 2017 compared with 2016. The number of deaths from dementia also rose by 12.3 per cent over the same period. In 2014, the Alzheimer’s Society’s Dementia UK report estimated that dementia would affected 850,000 people in 2015 at a cost of £26 billion a year. The report estimated that by 2051 there would be more than two million sufferers in the UK. These figures demonstrate that a shed load of care that will be needed to cope.

Scotland and the UK cannot simply open up ‘One Flew Over the Cuckoo’s Nest’ medical facilities where we lock people who have any form of mental illness away. This model, based on our atavistic fears and instincts, now appears out of date and inhumane. This is what the movie highlighted more than 40 years ago. A different approach is required and if we do not get to grips with what is coming down the line, then we will be in all sorts of bother.

Dementia is not a specific disease. It is a catch-all term that describes a group of symptoms associated with a decline in memory or other thinking skills. This decline is severe enough to reduce a person’s ability to perform everyday tasks. Alzheimer’s disease accounts for 60 to 80 per cent of cases. From no impairment to very severe cognitive decline, dementia has huge ramifications for the individual and significant emotional and financial implications for the sufferer’s family.

Imagine a fit 60-year-old who has been active all her days, who now cannot remember the names of her daughters. Imagine this same human being who cannot remember how to go to the bathroom from one day to the next, how to cook, what day it is, how to tell the time and so on.

The mental anguish that families suffer with the sufferer is hard to fully imagine. And these sufferers and families will need increasing support if the predictions for the rise in cases are accurate. Having a fall, breaking a leg and going into hospital is doable for many of us and those who are getting on years. There is a medical process that in the vast majority of cases leads to a positive outcome with the patient back on his feet and living a normal life within weeks.

Not so for the dementia patient and their families. The nightmare just gets worse. The day when your mother cannot recognise you at all and thinks you are someone she went to school with is heart-breaking. We all need our mums and dads even when we get older.

So, this degradation in the emotional connection between parent and siblings, not to mention partner, has an awful effect on many family members. Let’s not forget that they have jobs to hold down, their own families to look after and their own personal relationships to manage. When we add in a parent who is suffering from dementia then the stress levels can go through the roof.

NHS Scotland will need to be properly funded in the decades ahead to deal with dementia sufferers and their families. But, we need to start planing now. One Flew Over the Cuckoos Nest makes a statement about how we really ought to treat those with mental health issues – with dignity. But, that is going to cost money in the long run. So, let’s get it firmly on the agenda now.