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'Ageless' psychiatric care could harm elderly

Royal College of Psychiatrists warns against the trend for the NHS to develop generic 'all-age' services

Mark Gould

Monday, 10 June 2013

Leading psychiatrists are warning that the creation of generic all-age services by health providers is “leading to erosion and fragmentation of services” and could threaten the quality of care provided to elderly patients.

Writing in The Lancet Dr James Warner, chair of the Royal College of Psychiatrists (RCPsych) Faculty of Old Age Psychiatry, describes the creation of ageless psychiatry services as “a worrying trend driven mainly by financial savings and a misunderstanding of the Equality Act.”

The results of a recent survey carried out by the RCPsych reveals that in many areas mental health services specifically developed to care for older people had been absorbed into general adult services. Survey responses were received from 457 consultant old age psychiatrists, representing 95% of mental health trusts in the UK. 195 respondents (47%) reported development of at least some ‘ageless’ services in their organisation. 52 (11%) reported that whole sections of their service (e.g. inpatients or community services) had become totally ageless, and 34 (7%) reported that plans were in place to convert to wholly ageless services.

Although in some cases these changes were seen as positive, only 16% of respondents regarded the move to ageless services as ‘very good’ or ‘good’, while 52% regarded it negatively.

Dr Warner says: “There are 10 million people over 65 in the UK and this group need specialist services. Old age mental health services traditionally see patients in their own home. Specialist teams which understand the nuances that the social, physical and psychological consequences of ageing bring to the management of mental illness are essential. We would argue that old age psychiatry is needed to provide a service which understands the complexity of managing people with dementia, severe co-morbid physical illness, or psychological impact of ageing and end-of-life.”

Dr Warner continues: “The trend for ageless services will disadvantage further a growing, but already disadvantaged, section of society. We believe that Old Age Psychiatry services should be preserved and enhanced, and not left to whither on the vine.”

In January the RCPsych – together with representatives from the NHS Confederation, Royal College of Nursing, British Geriatric Society, British Psychological Society and Alzheimer’s Society – wrote to all chief executives and medical directors of mental health trusts to request their help in securing a pause to the re-provision of ageless services. The RCPsych’s Old Age faculty is consulting on new needs-based service criteria which will ensure old age services are strengthened in the future.

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