• Taking a wider view 21 February 2017 | View comments

  • The Mental Health Five Year Forward Review was published February 2016. It addresses issues of mental health care for all age groups and makes a point of requiring access to services throughout the 24 hours of every day, 7 days per week throughout the year. Views from 20,000 people were taken into account in formulating the report and its recommendations. 

    We are told that analysis of these views encouraged that priority be given to: 

    • Promotion of good mental health
    • Prevention of problems arising from mental ill health
    • Improved access to high quality services
    • Greater choice of evidence based care

    The Mental Health Five Year Forward Review is informed by the Children and Young people’s Mental Health Task Force Report. ‘Future in Mind’ 2015. ‘Hidden in plain sight’ which was published by Age UK 2016, might be deemed the Old Age equivalent of ‘Future in Mind’ but was not, I believe specifically taken into account. 

    The main priorities are summarised as crisis care, physical health and outcomes, finances and the establishment of an Advisory Board to report to the Five Year Forward Review Board of the NHS. 

    In more detail

    1. Support people in mental health crises and prevent suicide
    2. Improve responses to mental and physical health needs
    3. Developmental and age appropriate services for children and young people
    4. Standards for access and care pathways
    5. Payment models. There is a table of 12 considerations
    6. Acute and secure care should be least restrictive and provided near to home. The over representation of BME and other disadvantaged groups in acute care should be reduced
    7. Inequalities in access and outcomes should be tackled
    8. Employment of people with mental health problems must be supported
    9. All activities should be transparent.
    10. The physical and mental health of the NHS workforce must be improved. 

    How can the needs of Older People at risk of, or actually experiencing mental distress be best served?

    Unhappily, the profile of older people portrayed commonly by the press and other media is that of an undesirable group: no one wants to be recognised as old, older people are lumped together as ‘a burden’ on society, ’blocking beds’ in NHS hospitals which might be better used for others. The recent revelation that pensioner households are financially better off than working families has unleashed an ill-informed vicious assault upon their good name and worth.

    www.resolutionfoundation.org/app/uploads/2017/02/IC-intra-gen.pdf

    www.theguardian.com/commentisfree/2017/feb/13/rich-pensioners-tax

    ‘Apocalypse No’ the economists R.G Evans et al demonstrated more than a decade ago that the image of old age as a ‘burden’ on society does not stand up to scrutiny.

    https://www.researchgate.net/publication/5059675_APOCALYPSE_NO_population_aging_and_the_future_of_health_care_systems

    The reality is that age itself does not predict dependency or cost to the rest of society. Extrapolations are used based on morbidity and dependency in past generations to predict falsely high costs for the present and future. Morbidity and dependency have been displaced from much of later life and are confined to the last few weeks and months before death. Use of general hospitals in particular by serial cohorts has reduced dramatically. Where costs have risen, it is arguable that this is driven more by fashion and inappropriate use of the most expensive ‘modern’ treatments, where attempts to cure are fruitless and a palliative approach is more humane and suitable.

    Words such as ‘increasing disproportionately’ conjure the spectre of a ‘grey peril’ enfolding and choking the nations. Not true and best avoided.

    A dispassionate review of the demography and epidemiology of late life and contributions of people as they enter and live through late life will always be a positive and engaging story.

    I have always been uneasy with the split in policies and strategy between the care of people functional mental disorders and those who have dementia or delirium. It is not very long ago that all serious mental disorder in late life was summed as ‘senile psychosis’. The differentiation between the disorders was a major advance from the 1950s onwards and allowed an optimistic, anticipatory culture to rise from the previous nihilism. These clinical discoveries and demonstrations laid the ground for the creation of special services which addressed the needs of older people with mental health problems, across the diagnostic spectrum including the spread between physical and mental health. These services were and are, age related and age appropriate, in the same way that special services for children and adolescents are accepted to be.

    It may be felt that this is an unacceptable message for people and for government departments, but I think this is the time and opportunity to make the point and to correct errors of recent years. There is everything to be said for bringing together expertise and services for older people, as for children and youngsters, across the full spectrum of mental disorders which are seen amongst them.

    Let us consider the main mental health problems of late life. Dementia and delirium can be dealt with briefly and with reference to the extensive and successful work done since the launch of the Dementia Strategy 2009. Depression, which is more common than dementia and often coexists with it, needs careful description together with notes about the suffering it causes, the costs which are associated with it, its adverse effects on comorbidities, but also its potential for recovery, with treatments.

    But let’s not forget the other major disorders including those with onset earlier in life which recur or persist. The misuse of substances is also common. Suicide is a success story in that suicide in later life is less common now that it was in this country, but the potential for older people to feel that they and the rest of the world will be better off for their death remains a serious reality. Awareness to the hazards and preparedness to act to make people safe and begin their therapy, are essentials of good practice.

    Throughout, the relationship between physical health and mental health and the significance of the social setting, culture, ethnicity, spirituality and faith should be rehearsed. 

    The priorities identified by 20,000 voices

    • Promotion of good mental health
    • Prevention of problems arising from mental ill health
    • Improved access to high quality services Greater choice of evidence based care

    Fit very well with how we would wish to promote good mental health, across the spectrum, for people as they get older.

    Of the ten more detailed points, some seem relevant:

    1. Support people in mental health crises and prevent suicide. Better to avoid crisis by services which promote heath and engagement before matters become too severe.
    2. Improve responses to mental and physical health needs. No argument. 
    3. Developmental and age appropriate services for children and young people. What is right for young people is equally right for older people. 
    4. Standards for access and care pathways. Standards for access for sure but I am uneasy with the vision of mechanistic pathways. Individuals are individual and the road to this place and forwards is unique. 
    5. Payment models. There is a table of 12 considerations
    6. Acute and secure care should be least restrictive and provided near to home. The over representation of BME and other disadvantaged groups in acute care should be reduced
    7. Inequalities in access and outcomes should be tackled
    8. Employment of people with mental health problems must be supported
    9. All activities should be transparent
    10. The physical and mental health of the NHS workforce must be improved. 

    Overall, adoption of the key areas used by the Dementia Strategy but now applied across the field of mental disorder of late life might be reasonable:

    • Improve knowledge and promotion of good mental health
    • Improve identification/diagnosis
    • Ensure effective treatment and follow up through appropriate services within healthcare, social care and other dimensions of society
    « Back to archive
  • Leave your comment

  • Name:
     
    Email:
    Comment   
    captcha
    Enter the code shown above: