Inpatient Services for Older People with Mental Illness
| Pages | 18-21 |
| Date | 01 June 2001 |
| Published date | 01 June 2001 |
| DOI | https://doi.org/10.1108/13619322200100015 |
| Author | Stephen Bradshaw,Nitin Purandare |
| Subject Matter | Health & social care |
Inpatient Services for Older People
with Mental Illness
Stephen J Bradshaw
Consultant in Old Age Psychiatry
Clinical Director Mental Health
Stockport NHS Trust
Nitin Purandare
Clinical Lecturer in Old Age Psychiatry
University of Manchester
Focus on…
Introduction
Inpatient facilities form a vital part of a comprehensive
mental health service for elderly people. The
characteristics of an excellent service are integration
and a non-turbulent movement of patients from one
area of service to another according to need. The focus
of such a service will not only be the treatment of
mental illness but also the promotion of mental health.
It will aim to treat mental illness in the least restrictive
environment, ideally the patient’s home, and also to
improve or at least maintain the quality of life when
the odds are stacked against it due to increasing age.
For such a service to be effective, a multi-disciplinary
‘health and social care’ team working closely with the
voluntary sector, the provision of day centres, day
hospitals, sheltered, residential and nursing homes
and inpatient beds for assessment, treatment, respite
and continuing care are essential. In this sense it is
somewhat false to look at inpatient services in isolation.
However, leaving this caveat aside, this article
describes different aspects of inpatient service provision
and their role in providing care for elderly mentally
ill people.
Historical perspective
Early psychogeriatric services in the UK date back to
late 1960s. In the early 1970s the government circulars
on ‘psycho-geriatric assessment units’ paved the way
for the formal opening of such units. This was
followed by the rapid growth of private long-stay care
in the 1980s (Jolley & Arie, 1992). The number of
small and large private care homes including
residential, nursing and dual registered homes has
expanded further to well over 20,000 (Laing &
Buisson, 2000). The number of psychogeriatricians
has also increased from about half a dozen in the late
1960s to over 500 in the 1990s, concomitant with the
formation of community services and the increase
in the number of smaller specialist assessment units
based in the general hospitals.
We now have a patchwork of services with varying
configurations depending on local circumstances,
including whether the area covered is urban or rural
(Tym, 1991; Lennon & Jolley, 1991). Some areas still
lack dedicated services for elderly mentally ill people
and in these areas the medical responsibility remains
with ‘generic’ psychiatrists.
The publication of the National Service
Framework for older people with mental health
problems will provide the central guidance for
service development. We expect it to emphasise the
importance of detailed personal, humane assessment;
treatment which is provided locally and speedily; and
the co-ordination of integrated teams which respect
patients’ and carers’ rights, if one extrapolates from
the existing National Service Framework for adults
up to 65 (Department of Health, 1999).
Organisation and role of inpatient services
In this section we have identified four broad categories
of older mentally ill inpatients – that is, those patients
requiring inpatient assessment and treatment for
functional illnesses, those requiring inpatient
18 The Mental Health Review Volume 6 Issue 2 June 2001 ©Pavilion Publishing (Brighton) 2001
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