Page last updated at 13:53 GMT, Tuesday, 27 October 2009

Making equality a reality in mental health

Dr Dave Anderson
VIEWPOINT
Dr Dave Anderson
Chair of Old Age Psychiatry, Royal College of Psychiatrists

Man clutching his head
Only 6% of older people with depression receive a referral to mental health services

The Health Secretary, Andy Burnham, says age discrimination in the NHS must end and there is particular concern about the treatment given to those over 65 suffering from mental health problems.

Dr Dave Anderson from the Royal College of Psychiatrists outlines the scale of the problem and says treating everyone equally is not the answer.

The ageing population has been described by researchers as a demographic tsunami.

In 2007, for the first time in the UK, the number of people aged 65 or over was greater than those aged under 16.

The figures are truly shocking. For every 1 million older people with depression, 850,000 receive no treatment whatsoever

And this number is projected to increase by another 15% in the next 10 years.

Without doubt, this is the greatest challenge facing health and social care services now and in coming decades.

Yet astonishingly, investment and development in mental health services has explicitly excluded older people.

'Arbitrary age limits'

A Royal College of Psychiatrists' report has revealed that tens of thousands of over 65s are missing out on vital support and risking serious deterioration in their mental health because of arbitrary age limits.

The figures are truly shocking. For every 1 million older people with depression, 850,000 receive no treatment whatsoever.

While 50% of younger adults with depression are referred to mental health services, only 6% of older people will receive a referral.

Numerous examples of older people who have been left without the support they desperately need

In a recent report by the Healthcare Commission, a service audit found that of 1300 referrals for psychological therapy only 49 were for people over the age of 65.

There is no argument that age discrimination exists. Access to mental health services have traditionally been configured by age.

Consequently, people under 65 years old can receive a wide range of support through adult mental health services.

But access to these same services is denied to people over the age of 65. This leads to misery, disability and increased cost to society.

'Suicidal thoughts'

The Royal College of Psychiatrists has collected numerous examples of older people who have been left without the support they desperately need.

Such as Mr M, a 78-year-old man who attended a local hospital emergency department at 10pm on a Friday night. He had become severely depressed after the death of his wife and had suicidal thoughts.

The proportion of deaths by suicide of older people has also not declined as it has for younger adults

But because the 24-hour crisis resolution and home treatment service provided by the mental health trust will only see people younger than 65 years of age, and there is no equivalent service for older people, no support was available to Mr M until the following working week.

Then there was the case of Mrs A, a 72-year-old lady suffering from traumatic bereavement after her son killed himself.

She was willing to have psychological treatment - but the local service for psychological therapy was limited to people under the age of 65.

Her condition remains distressing and she continues to be at risk.

Depression common

Most people think that dementia is the main mental health problem affecting older people but it only accounts for 20-25% of the conditions they suffer.

Depression is three times more common, and the risk of older people suffering from psychosis is much higher than it is for younger people.

All mental health services should be provided to people on the basis of need - not age

The proportion of deaths by suicide of older people has also not declined as it has for younger adults.

Over 80% of suicides among older people are associated with depression - a treatable condition.

There is no justifiable reason why an older person with the same need as a younger person is denied equitable mental health care - yet this is the current position.

If we are to tackle the problems of an ageing population, the barrier that is age discrimination has to be addressed.

'Respect differences'

The Royal College of Psychiatrists believes all mental health services should be provided to people on the basis of need - not age.

Older people must become a focus for health and social care commissioners

But we need to remember that equality is not simply achieved by treating all people in the same way.

It is just as important to respect their differences.

As we get older, the health problems we experience change and certain needs become more common.

It is therefore essential that we further develop specialist mental health services specifically to meet the different needs of older people while ensuring that people can access the full range of services regardless of age.

The Dementia Strategy, Ageing Strategy, Equality Bill and New Horizons mental health strategy are all welcome Government initiatives.

They encapsulate fairness and recognise the special needs of older people.

'Additional investment'

But in addition to these national drivers, there has to be a change in thinking and attitude within services at a local level.

Older people must become a focus for health and social care commissioners.

And serious questions about resource distribution must be asked.

Independently commissioned reports have shown that to provide older people with mental health and social care services comparable to those available to younger adults would require an additional £2-4 billion of investment per year.

This is not an insignificant amount.

But there is both a moral imperative to tackle age discrimination in mental health services, and a business imperative to better meet the needs of older people as more of us live into later life.

This has to be a national priority - we cannot go on wasting opportunities.




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