All Party Parliamentary Group on Mental Health

15th November 2005

Meeting to discuss Older People’s Mental Health

Dr Jane Garner, Faculty of Old Age Psychiatry, Royal College of Psychiatrists

Dr Garner began by noting that everyone wants a long life but that the reality is that people don’t want to be old or vulnerable and older people often miss out on care and treatment available to younger people. She said that the Mental Health NSF excluded people over 65 and that the Older People NSF made little mention of mental health and consequently people often fall between services and don’t receive the care or drugs they need. Institutional abuse is a problem, this can be at a criminal level or at a more subtle level such as patronising people or over-medicating. A cultural and attitudinal shift is needed to improve the care of people in homes. The czars responsible for mental health and older people have pledged to work more closely together and work towards more respect and equity. Dr Garner also noted that the proposal by NICE to stop the supply of certain dementia drugs through the NHS was a symptom of the way rationing discriminates against older people.

Sophie Corlett, Policy Director at Mind

 Mind recently published a report on older people’s access to care, ‘Access all Ages’. Ms Corlett noted that Department of Health figures show that the NHS has to deal with a large number of older people with mental health problems. Mind’s report showed that often people’s most basic needs are not met. Stigma and discrimination connected to mental illness and old age have a direct impact on the care of many vulnerable people. There is an assumption that mental health will decline with age and that this is acceptable. Men over 65 have a high risk of suicide but because of their age it is not perceived as such a problem as young men committing suicide. The use of electro-shock treatment is high amongst over 65s and Mind feels that this is because the patients aren’t properly consulted about the treatment in advance. Older people can often be socially excluded, this can be tackled through pro-active policies such as encouraging exercise. Ms Corbett finished by urging Parliamentarians to sign EDM 705 in support of their campaign.

Jennie Whitford, Dementia Care Service Manager, Alzheimer's Society Hounslow Branch with service users and carers Naran Kotecha, Barbara Frederick, Tina and Mick Edwards 

Ms Whitford said that her branch of the Alzheimer’s Society help raise awareness of dementia and help people in the area. She stressed that psychological wellbeing is very important. Mr Edwards spoke about the importance of dementia drugs and the fears that many patients and carers have about the possible withdrawal of funding for this treatments by NICE. Mrs Frederick noted that carers are not given enough support and often face unbearable stress particularly when looking after their partner, Mr Kotecha seconded this point.

Q&A

In response to a question from Lynne Jones about the provision of old age psychiatry, Dr Garner said that the specialty has existed for 30 years and has benefited the client group. However some people do fall between the gap if they have more than one illness or if they are moving from adult to older people’s services. Young people with dementia have traditionally fallen between services but the Royal College and Alzheimer’s Society have recently produced new guidelines for their care. There is also a discussion in the Faculty about moving from an age-based to a needs-based system.

Baroness Murphy asked whether more investment was needed in services for older people. She noted that the Mental Health NSF seemed to prioritise young people with severe mental illness and that there was little pressure to divert funds to older people and their carers particularly those living in the community rather than in care homes. She also noted that many people in care homes have mental health problems but this is often hidden to stop them being moved to specialist home for dementia care. The speakers agreed with all these points.

Steve Boddington from the British Psychological Society noted that the standards in care homes are often not high enough to cope with those with serious mental health problems. There is not enough funding to provide the numbers of clinical psychologists needed. He noted that Lord Layard had recently promoted the need for more psychological therapies for people of working age but that it was important to note that older people need this too.

The speakers from the Alzheimer’s Society noted that it is often in the best interests of the patient to be in a home with people who have the same illness as there will be the expertise to deal with them. They also noted that there needs to be more continuity of care and a longer-term commitment from support workers.

Louisa Stevens from the English Community Care Association noted that care homes need more secure funding from local authorities in order to give a more consistent level of care. She agreed that institutional abuse needed to be stamped out.

Margaret Coombs from the office of Evan Harris MP and the Mental Health Act Commission said that the funding process for receiving care in older age was like a maze and put great financial pressure on families.

Prof. Nick Bosanquet brought the debate back to the NICE decision on dementia drugs which he felt was extremely serious and could have far reaching implications for patients. Lynne Jones noted that it was hard to raise the public’s interest in dementia drugs and that politicians seemed to have more sympathy for drugs such as herceptin.

Other comments from the floor included that the physical health of older people was often neglected and that this was part of the discrimination that people face as they age. Another speaker mentioned the problems faced by people when their care shifts from an adult team to the old age team. Dr Garner noted that the Royal College has written guidance for its members about this transition to improve matters.

Vicki Coombe from the Alzheimer’s Society updated that group on the campaign to ensure funding for dementia drugs. She noted that NICE was due to meet on 20^th December to make its final decision. Over 100 MPs have signed their EDM and 100,000 members of the public have sent postcards in support of the campaign.

Lynne Jones thanked the speakers and noted that Lord Carlile would address the next meeting in January 2006.

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