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The many ages of psychiatry

 

The NHS needs to reverse its misguided practice of incorporating old age mental health services into generic “all age” services.

According to recent research in the British Journal of Psychiatry (http://bjp.rcpsych.org/content/207/5/440), older adults have better outcomes if cared for in mental health services specifically set up to meet their needs. The journal asked me to write the accompanying editorial (http://bjp.rcpsych.org/content/207/5/375), and in it I outlined the reasons why I believe the NHS has been wrong to move away from services catering specifically for the needs of older people.

Over the last few years, some NHS trusts have incorporated old age mental health services into generic “all age” services. In these services an 18 year old and 80 year old person would be treated by the same team. There are three main reasons for this trend to ageless services: cost saving, misunderstanding of the Equalities Act and ageism. There are also three main reasons why older people should have their own dedicated services:

a) The types, presentation and course of illnesses are different.  For example: few younger people have dementia or delirium; depression in the elderly may present with agitation rather than sadness; and older people with psychosis may cope very well without treatment.

b) Older people are more likely to be frail or confused and will have difficulty getting to a clinic. So if a service is to meet their needs it should, wherever possible, be delivered to them at home. Seeing someone in their home also provides a wealth of clinical and social information that would never be discovered in a hospital clinic.

c) Older people have far greater complexity. A host of social, physical and psychological factors related to ageing mix together and complicate diagnosis and treatment. Teams with skills and experience in understanding and managing these complexities are essential to make sure each patient gets the right treatment first time, every time.

Old age psychiatry began in the UK and, after a period of uncertainty in the first few years of this decade, is on the ascendency again. The Chief Medical Officer’s report in 2014, The Commissioning Guide for the NHS and NHS England all support specific old age mental health services. Long may that continue because, if I need mental health care in my dotage, I can tell you now I’d like to be treated by a team who fully understand what I need.

 


staffDr James Warner 
Medical Director, Red & Yellow Care
Chair, Faculty of Old Age Psychiatry, RCPsych
National Professional Advisor, CQC

 

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