Mr. John Dunne:

The Senator has raised an interesting question. The language in dementia is around responsive behaviours, whereas the language in supporting children with complex conditions and additional needs is around behaviours that challenge. We do a lot of training in this areas. There are two ways to approach it. One is to understand, which is obviously important to stretch the sympathy, if that is the right phrase. The second aspect is managing the condition. There is a third aspect, which is handling it, I hesitate to say "positively".

I mentioned the word resilience earlier on, and the importance of promoting resilience. We have a danger of talking ourselves into a bit of a quagmire by defining everything as hopelessly sinking down. It could easily become a self-fulfilling prophecy if people start thinking that way. The asset-based approach we try to adopt obviously does not work for everybody, but surprisingly works for more people than you might think. It helps them steady the ship, look at what they have going positively for them, look at what potential they can bring in with additional support and see if they can stabilise it. One of our earliest realisations when it came to supporting carers was that not everybody can continue caring. People get to the end of the road, where it is just not reasonable or practical anymore. Recognising that as a step means when you work back from that you can then differentiate other gradations.

There is definitely a great demand for counselling. I am not sure the system is generally as good as it could be. It is a fixed intervention. If you need another round at the end of it you go around again. However, a surprising number of people come off after the first round with clearly measured and sustainable improvements in their situation. The trick to getting counselling for people, is to get people in crisis back to a sustainable routine. In that context, while the counselling is obviously one to one, we are looking at beginning to develop resilience training. That will be a group thing. For people who are maybe at the point of tipping into a potential crisis, and are at the upper end of struggling, we hope group training might help them avoid that worst case. At the risk of sounding a bit to the right of Attila the Hun, there is interesting research at the moment that talks about how processing all of this stuff psychosocially is not always necessarily the best way to go. The norm now is that you cannot and should not bottle it up. You should get it out there and process it, and when it is all sorted it will go away. No, there are definitely arguments and evidence that suggest in some situations that is not the best way to go. It is not the best way to encourage it.

I will illustrate another issue with an example. When the health system looks at a carer, it looks at a carer from the toolbox it has. It tends to medicalise caring. It would say there is an issue there that requires counselling. There is no point counselling someone who does not have enough money, unless you do something about the money as well. One of the things we do, which I am proud of, is this wraparound approach. If that is the issue, we do not just deal with the counselling bit, we also try to deal with the practicalities. It is a complicated issue. I go back to the idea of trying to promote a positive approach. People talk about the stigma of dementia. What is the stigma? It is a condition you have developed. You do not say the stigma of breaking your leg. Fear is behind it all - fear of the person who has it, fear of the family and the deep fear of the community. I remember asking a group of carers quite early on what we could do for them. A male carer said that if he was in the pub with a group of his friends or people he has met, he would love if there was not an awkward silence when he told them he was a carer when they asked what he did. I have often wondered what the hell is behind the awkward silence. Do people feel in awe of this person, or do they wonder if they will be contaminated? There is a bit of the same about the stigma associated with dementia. We can try to take these things positively. With my mother, and as Deputy Kenny was saying, it was a thing that happened. She forgot things. It became a bit of a joke. It did not stop her doing crosswords and enjoying them. She recognised she might not get them all out. You can cope with this. It is a bit like years ago when you heard the word cancer you asked how many weeks you had. It is still a scary diagnosis, but at least if you hear it you ask how you will go forward. That is where we need to go with a lot of conditions, for both carers and the person being cared for.