Mental Health Services for Older People: Time for Change
| Date | 01 June 2001 |
| DOI | https://doi.org/10.1108/13619322200100012 |
| Published date | 01 June 2001 |
| Pages | 3-5 |
| Author | Elaine Murphy |
| Subject Matter | Health & social care |
Mental Health Services for Older People:
Time for Change
Elaine Murphy
Chair, East London and the City Health Authority,
London, and Visiting Professor, St Bartholomew’s
and Royal London School of Medicine and Dentistry,
Queen Mary College
A personal perspective
Services lagging behind
Older people have had a raw deal from central
government mental health planners of late. The
national ‘Brummification’ programme of teams for
early intervention, assertive outreach and crisis
resolution for those with severe and enduring mental
illness demands complete ‘re-engineering’ of general
adult psychiatry services. Not surprisingly, this imposes
a workload on health authorities and mental health
trusts that is both time-consuming and expensive.
Both children’s and older people’s services have been
left dragging behind as a consequence. Sadly, hardly
anyone in the services is complaining. As Roger
Bullock wrote last year, mental health services for
older people are in danger of becoming complacent,
almost smug, having made such massive strides in the
early enthusiastic days but now failing to grasp the
huge potential for change that beckons the services
(Bullock, 2000).
The impact of primary care trusts
We wait, but don’t hold your breath for anything
very stunning or visionary, from the National Service
Framework for Older People. Rumour suggests the
‘framework’ may be so flexibly floppy that it may be
very difficult to use constructively to demand invest-
ment from service commissioners. Last year’s Audit
Commission Report, Forget Me Not, distinguished by
possibly the most excruciatingly twee title ever to
grace an official report, was not exactly revolutionary
either. More of the same but better was the
prescription (Audit Commission, 2000).
On the other hand there are many potentially
positive changes that could shift services dramatically,
given time. Alan Prigmore, writing in the December
2000 issue of the Mental Health Review, pointed out
that PCTs could be the ideal organisational framework
to bring together the planning and delivery of services
where partnerships are crucial to delivering effective
care (Prigmore, 2000). The curiously unbridgeable
trenches which still bedevil the proper integration of
many services need to be filled in – once and for all.
Furthermore, 90% of mental health problems in
older people should surely be dealt with in primary
care – with the right shared protocols and agreed
guidance between psychiatric teams and GPs there
are very few occasions when a specialist medical
opinion is required. Of course there are difficult and
complex taxing cases where special expertise is
needed but perhaps not as many as some consultants
think. For too long the ‘gatekeeper’ function that
specialist services exercised controlling access to care-
management and long-term residential care brought
trade flooding in to specialist community teams. As
control of commissioning passes to GPs and primary
care staff working closely and directly with patients,
their families and social services, very different styles
of service are likely to emerge.
The independent sector, both voluntary organisa-
tions and the increasingly important ‘for-profit’ sector,
have largely been left out of the equation until now.
It is still relatively rare for the statutory services to
acknowledge the importance of the contribution they
make or to recognise the potential for entrepreneurial
originality in developing new styles of service,
something which small grass roots organisations
often have but which large bureaucracies find almost
impossible to generate. Increasingly the specialist
services are going to become true ‘consultants’,
educators and travelling salesmen peddling expertise
to colleagues in primary care, the independent sector
The Mental Health Review Volume 6 Issue 2 June 2001 ©Pavilion Publishing (Brighton) 2001 3
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