Confronting and Complex: How Dementia Influences First Responder Actions

Few could forget the traumatic and confronting story in 2023 when 95-year-old aged care resident Clare Nowland was tasered by New South Wales police. Clare, who had dementia, was hospitalised after she fell and fractured her skull. She died one week later.

The incident began because Clare was holding a knife that staff were unable to retrieve. The police were called and although one female officer allegedly said she could take the knife, a male officer, Kristian White, allegedly said “Nah, bugger it” before firing his taser.

The case put a spotlight on how police respond to situations involving people living with dementia. 

Julane Bowen is a dementia and mental health law advocate. She also has a lived experience of dementia through her husband, Jeff. Jeff retired in 2015, aged 65, after spending almost 45 years as an international commercial airline pilot. 

However, his health deteriorated rapidly and two years later he was diagnosed with behavioural variant frontotemporal dementia, or BvFTD. She explained that before he received that diagnosis, in a rare heated argument she dropped down to the ground at one point and when Jeff tried to pick her up, he dropped her, causing her head to hit the side of the bed.

Julane knew it was likely whiplash, but asked for him to get the next-door neighbours to help. Together they decided to call an ambulance. 

“The paramedics were amazing. Within minutes of being on the scene, the senior ambulance officer could see that something was very wrong with my husband. But Jeff wouldn’t let him take me away,” Julane shared at the International Dementia Conference. 

“The ambulance officer was trying in earnest to reason with him, but you can’t reason with BvFTD. They called the police and it all went pear-shaped from there.”

Julane said the police arrived and instantly treated the situation like a callout for domestic violence: “They came in aggressively. They didn’t slow down to get a handover from the ambulance. That started a very long progression of hell.”

While there was no fatal consequence like Clare Nowland’s case, Jeff went on to spend over eight months in hospital while the police pursued a domestic violence charge against him. The dementia diagnosis ultimately saved him, but even then, Julane said a domestic violence liaison officer accused her of bribing a doctor for the diagnosis.

The view from the other side

Scott Duval is the Assistant Commissioner (Metropolitan Operations Service) for the South Australia Police. He is a self-professed career policeman who takes a hard-line approach to protecting his officers.

His mother also lives in a residential care home and has been diagnosed with vascular dementia. Mr Duval brings the lived experience into a role of power, and there is intent to use that to create positive change when attending situations. 

Mr Duval explained that confronting stories like Clare Nowland’s has been a hard lesson for all police, even those in different jurisdictions. 

“We recognise that people with dementia are vulnerable. But the fact that the police have been called means it has gone beyond a medical emergency and requires those skills that the police come with. Our police come equipped with a whole range of tactical options,” he shared.

“We saw that with the example where the 90-year-old woman who was tasered. Those options are carried by police to enable the police to safely resolve something. We heavily train our police to look at the threat and have a response that’s commensurate to the threat. Sometimes it doesn’t go as well as should be expected.

“We train people how to de-escalate by communication. If that doesn’t work you have another option to go to; a taser, capsicum spray, the worst-case scenario being a firearm.”

South Australia Police has also partnered with the State’s Mental Health Commission for a dual approach to mental health incidents, which can include people living with dementia, to provide an alternative approach to de-escalation. Mr Duval said this has resulted in more people avoiding hospital admission so they can remain in the community without posing a risk. 

Dementia Training Australia also offers first responder training, while there has been increased collaboration between Dementia Support Australia and officers looking for support when dementia is a factor.

“Increasing the education and awareness of our police is really important. The type of response we’re looking at is nuanced. A police response to a mental health incident may not be the police response to a dementia incident. Getting those police for millions of the types of data that they’re getting access to. Our world is built on collaboration,” Mr Duval added.

Complexity is a difficult obstacle

South Australia is not immune to challenging cases involving dementia. Last year, 91-year-old Frank Dimasi murdered his wife, Maria. The case is highly confronting as he allegedly stabbed her 76 times. Frank has dementia, however, and this has severely complicated the case.

“He’s still in custody and the court system is struggling with how to detain him in a safe environment,” Mr Duval said. “Currently he’s sitting in a hospital with correctional services guards on him and they’re looking at whether he can be bailed to an aged care facility under license and under condition.

He’s still got incredibly violent behaviour associated with him. The system generally struggles with the concept.”

There is hope, however, that by partnering with mental health clinicians and dementia experts that increased empathy can result in better ways to de-escalate situations. 

“Just because they’re holding a knife or a weapon and they’re threatening something, it doesn’t mean it’s going to happen. It’s a world of opportunity for the evolution of how we respond. In doing that we get a much better outcome, firstly for our protection, but importantly for the person, their family and carers.”

Julane reinforced the need for specialised mental health and dementia training for all first responders. But she also called for better treatment of people living with dementia. 

“The number of times my husband was treated badly if he does something peculiar. Everybody thinks there’s something wrong with him,” she said.

“We’re all people doing the best we can and he can still live a good life. We’ve had seven years since the dementia diagnosis. I want people to see that he is still here. He’s different, but he’s still him.”