Mental Health Services for Older People: A UK Perspective

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This paper outlines the approach of the UK Government to providing modern and high quality mental health services for older people. The Government wishes to encourage innovation and initiative on the one hand, while trying to improve service quality and reduce variations and health inequalities across the country on the other. This paper discusses existing policy for older people, in general, and mental health services, in particular, and outlines what may be expected from the National Service Framework for Older People, which is due to be published soon. Because of devolution within the UK, the initiatives described apply only to England, although developments in Wales, Scotland, and Northern Ireland are similar.

Key words: Dementia, Mental health, Older people, Policy, Services

THE GOVERNMENT'S STRATEGY FOR OLDER PEOPLE

The current administration in the UK is a Labour Government, which has been in office since 1997. Their election victory followed 17 years of Conservative governance. Tony Blair and his Ministers have been keen to set an active policy agenda, with particular emphasis on modernising Government and embracing technological advances. In this context, the Government has developed several general policy initiatives for older people aimed at helping them to play their full part in society.

Better Government for Older People was a 2-year programme aimed at developing new ways of working across traditional organisational boundaries and creating innovative solutions to problems. This report, All Our Futures, made a series of recommendations for action related to the need to:

* combat age discrimination

* improve engagement with older people

* improve decision making

* better meet older people's needs

* promote a strategic and integrated approach to an ageing population.

Another important development for older people is the Inter-Ministerial Group (IMG) on Older People, a cross-government group designed to coordinate government policy for older people. The IMG is chaired by Alistair Darling, Secretary of State for Social Security. The group published Life Begins at 50, a programme of action to tackle the issues raised in the Government's recent Listening to People exercise. This programme highlights:

* lifelong learning and leisure

* work and volunteering

* a good life at home--social care, housing, and security

* health, income, and transport

* consultation and involvement.

Other recent publications are intended to improve the employment position of people older than 50 years and to provide practical guidance to the law relating to older peoples' rights to healthcare, pensions and benefits, housing, safety, and leisure.

HEALTH AND SOCIAL CARE FOR OLDER PEOPLE

Many problems can arise from trying to provide appropriate and well coordinated care for older people and such difficulties are encountered worldwide. Planning between health and social care services may not be sufficiently integrated. Some services function badly, while others such as preventative and rehabilitative services are insufficient. Availability of services may be inadequate. Older people may have difficulty in accessing services, and may not feel fully involved in decisions made on their behalf. Family carers, many of whom are elderly themselves, may also have difficulty in accessing support.

Several important policy initiatives address these issues, many of them first outlined by the Government in their white papers on the National Health Service (NHS) and Social Services. First and foremost, both mental health and older people's health are among the priorities highlighted in the Government's National Plan for the NHS, published last year. The plan emphasises the Government's determination to eliminate ageism in health care, so that services are available on the basis of assessed need and not allocated according to arbitrary criteria such as age. …