Munjal’s social prescribing story : Making first contact with clients with dementia.
Munjal is a social prescribing link worker in a number of GPs in a large city in Northwest England. He has often finds that people with dementia struggle to engage in social prescribing, especially on first contact, which in most cases occurs over the telephone. Munjal shares some of his experiences and suggestions to address the challenges he faces at this stage of the support journey.
As a first step, Munjal observes that it is important to ensure that the client has capacity to consent:
“We need consent to be able to go forth as there could be issues with mental capacity. If I see that could be the case, what I do is close the case and I let the GP know and I push forward for a mental capacity assessment. This would enable us to also address other support areas, such as appointing a mental capacity advocate on their behalf”.
In Munjal’s experience, most clients with dementia show resistance to accept support or continue the conversation during that first call:
“When I make the phone calls it’s sometimes very dry at first and it’s not going nowhere. They’d say – Oh, thank you very much, but we’re alright. Thank you. Yeah. No, we’re alright. We don’t need anything”.
Munjal states that because of this resistance, there is a risk here to close the referral too early:
“We may be actually closing the referrals for patients that could really benefit. For example, I call somebody, tell them I’m calling from the social prescribing to kind of discuss the service and they tell me I don’t need anything. So, I close the referral, but then later I may receive a call from their sister. And they say – yeah, let’s do this. I’ve got power of attorney – But those people that don’t have the sister, they may not have that second chance if you close the referral there and then”.
There are some strategies that can help to explore whether client’s resistance is genuine or a gut reaction. The first one is trying to arrange a home visit, if possible.
It is Munjal’s experience that showing up in person / multiple times can lower resistance from clients with dementia, when phoning in proves ineffective:
“I had a client once who was not even picking up the phone. So, I went and knocked on the door and nothing. It was very close by, so I went a second, third time and eventually we got the person sat on that day. She was fine, totally fine, normal person talking”.
Another important tool to combat resistance is using clear and accessible language when giving information and explain social prescribing:
“Describing your role rather than saying the name of the role can be helpful because for a lot of people when you say social prescribing the first thought is social worker. So, they think we’re from adult social care. They get a little bit worried”.
Trying to establish contact or a communication channel with a family member prior to first contact could also prove very helpful, but it is important to keep in mind (and sometimes remind family members) that ultimately social prescribing is person-centred, and clients need to want to cooperate:
“Unless someone has got power of attorney and the person is deemed not to have any capacity, I have to listen to what the client is telling me”.
Despite trying all different strategies, Munjal still finds that sometimes clients are resistant to engage in social prescribing.
It is important to acknowledge that clients might not be ready to accept support, whatever the strategy you adopt you get them on board.
Munjal suggests that it might be helpful to:
“Just close the referral. But I let them know that they can always come back to us if they change their mind in the future. Sometimes people just want to know there’s that someone if they need it”.
In addition to reassurances that support is always available should clients need it, Munjal says it is also good to:
“Send them out a leaflet that’s got all groups in the area and some links and it’s got a page that’s a bit of a checklist of things you might want to think about. And then we can schedule a six-month callback as well if they want it”.
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