The Royal College of Psychiatrists called for improved services for older people with mental illness in a new report published last week. Professor Susan Benbow is one of its authors.
What quality of service do older people with mental illness currently get? Is provision consistent across different areas of the country?
Several national reports have highlighted deficiencies in services for older people with mental illness. It certainly looks as though service development is patchy. Services for working-age adults developed on the back of the National Service Framework for Mental Health but this excluded older people’s mental health.
Older people’s mental health services didn’t get access to new monies, so they stood still, or even stagnated, while working-age mental health services developed.
Why are older people’s mental health services not given high priority by the Department of Health, despite the evidence to show what your report calls the “huge social, psychological and financial burden” of mental illness in later life?
The Department of Health published Everybody’s Business which set out details of older people’s mental health services, in late 2005 and has also established a programme board for older people’s mental health. These are welcome developments but the question is whether they will make a difference to services on the ground.
Everybody’s Business has no teeth and brings in no money. Provider organisations are on very tight budgets and faced by a plethora of competing priorities. Old age is something none of us likes to think about – yet most of us hope to live long and healthy lives.
In this situation, older people with mental health problems slip quietly down the agenda despite the fact that the huge burden of mental illness in later life, the use of hospital beds, the costs of residential and nursing home care and social care should move them up near the top. In fact I wonder if the size of the problem makes people feel they can’t do anything about it – so why try?
The National Service Framework for Older People requires that by 2011 every health district should have a fully resourced specialised service for old age psychiatry. Do you think this target will be met? What will it take to achieve it?
The NSF for older people set out some simple requirements that would make a big difference in relation to areas including community mental health teams. In many places these have still not been realised.
We have a lot of information about how effective services can be developed. Why don’t we learn from all this? At the moment I don’t think provider organisations are investing in the sort of flexible person centred services that are envisaged. 2011 is a few years away but I am not optimistic that we have the will or commitment to develop the necessary services.
All too often the emphasis is on working-age adult services. I think we need to value and respect the people using older people’s mental health services and their families, to build services which are more flexible, person centred and aim to meet the needs of patients and families, to minimise bureaucracy and to work together across health and social care.
Perhaps we need to recognise that older people are more important because they may have less time in the future to do the things they want to do, so keeping them as fit, healthy and independent as possible is even more important.
Perhaps we need to recognise that this is our future we are planning for.
Your report calls for increased integration of older people’s psychiatric services with social services. What are the current problems in co-operation between care agencies, and how can better integration be achieved?
Some places have close working relationships between health and social care, but boundaries tend to present obstacles for people using services and integration needs to translate into easy and rapid access to services on the ground, plus rapid tailoring of services when there are changes in a person’s mental health.
If there was a simple answer to this question then there probably wouldn’t be a problem.I am convinced that one of the basic problems is money. When budgets are tight one way that I can cut my costs is to try to get you to pay, and in the wrangling between organisations the patient and their family suffer. We could have joint budgets, although this would bring problems as well as advantages.
We also need to do away with the bureaucracy, which takes health and social care professionals away from doing their jobs and makes it more difficult for people to access services. We need to recognise that many people with mental health problems in late life aren’t in specialist services – nor should they be. We need strong specialist services to offer treatment and ongoing support for people with complex needs, and to work with the other organisations which provide for the majority who have less complex needs.
What should professionals do to reduce discrimination and abuse of older people with mental illness?
I think we have a responsibility to advocate on behalf of the people and families using our services and to support them in advocating on their own behalf. Whenever we see something unacceptable we must speak out and encourage others to do the same.
We must always remember that it might be other people today, but it will be us and our families tomorrow.