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There are many older people with mental health problems who do, and woud, benefit from care and treatment from servcies. The focus of this lerning object is to outline the range and types of services available to older people with mild, moderate and more serious mental helath problems and to offer an overvew of which agencies provide which services.
Before we look at services themselves it is helpful to offer some key statistics about the main mental helath problems older people experience by way of providing context.
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Quiz
Quiz 1 of 6
How many people do you think there are in the UK with dementia?
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Quiz
Answer: There are 700,000 people with dementia in the UK rising to 1.7 million in 2050.
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Quiz
Question 2 of 6
What is the estimated prevalence of dementia amongst those ages 85 and over living in a care home?
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Quiz
Answer: Prevalence of dementia in care home populations is estimated to be 50% of those aged 65-74 to 58% of those aged 75-84 and 56% aged 85 and over.
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Quiz
Question 3 of 6
What proportion of older people with moderate to severe dementia live in the community?
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Quiz
Answer: It is estimated that about two thirds (424,378) of people with moderate to severe dementia live in the community and a third (244,185) live in care homes. The costs supporting people with dementia are between £17 and £18 billion a year including the contribution of family carers(Alzheimer's Society, 2007).
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Quiz
Question 4 of 6
Which mental health problem is most prevalent in later life?
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Quiz
Answer: Depression is the most common mental health problem in later life. At any point in time, it affects between a fifth and a quarter of older people. The percentage is higher still for those living in care homes. Men aged over 75 are at greater risk of completed suicide than any other group.
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Quiz
Question 5 of 6
What proportion of people aged 65 and over have schizophrenia, bi-polar disorder or another severe and enduring mental health problem?
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Quiz
Answer: The correct answer is fewer than 100 per 100,000 people. Estimates vary considerably from 11 to 60 per 100,000 of the population aged 65 and over (Royal College of Psychiatrists, 2002).
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Quiz
Question 6 of 6
What proportion of dementia carers are older people themselves?
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Quiz
Answer: 1/20. Family carers provide the majority of support of older people with long-term mental health problems, particularly dementia (Alzheimer's Society, 2007). About a third of dementia carers are older people themselves; they are at enhanced risk of stress and depression.
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Policy Context
In the next few screens an outline of the policy context of service provision is provided. It is important as policy (including laws) underpins how and what services are developed.
(Policy: A policy is a plan of action to guide decisions and actions. The term may apply to government, private sector organisations and groups, and individuals. The policy process includes the identification of different alternatives, such as programmes or spending priorities, and choosing among them on the basis of the impact they will have. Policies can be understood as political, management, financial, and administrative mechanisms arranged to reach explicit goals.)
In the UK the care of older people with long-term mental ill health is increasingly provided in the community rather than in institutional care.
Recent policy developments focus on promoting and maintaining independence, provision of care at home, improving access to services and a need for greater consistency, dignity and improved quality of life for users and carers.
Other policy priorities include:
- Early detection
- Comprehensive assessment
- Access to specialist services, advice and treatment
- Integrated care
- A whole systems approach to developing and commissioning services.
(Department of Health, 2001, 2005)
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Policy Context
Here are a number of key policies and related guidance which you may wish to learn more about.
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The National Service Framework for Older People
Department of Health, 2001 -
‘Everybody’s Business’
A service development guide for developing comprehensive services for older people with mental health problems (Department of Health, 2005a) -
The 2006 White Paper, Our Health, Our Care, Our Say
Department of Health, 2006 -
The health and social care guidelines ‘Supporting People with Dementia and their Carers’
(National Institute for Excellence/Social Care Institute for Excellence, 2006). - For carers there are also a number of specific policies that aim to facilitate the continuation of caring and offer relief for those carers under excessive stress
- Mental Capacity Act 2005
National Service Framework for Older People
The National Service Framework for Older People (Department of Health, 2001) offers a framework of eight standards for the delivery of care and treatment. It states that older people who have mental health problems will have access to integrated [glossary] mental health services, provided by the NHS and social services departments, across the course of their illness.
National Service Framework for Older People
More information on policies can be found at http://www.dh.gov.uk/en/index.htm
Foundations for developing comprehensive older adults mental health services are outlined in ‘Everybody’s Business’ a service development guide launched in 2005:
- Involving service users and carers
- Assessment and care planning
- Developing culturally appropriate services
- A whole systems approach to developing and commissioning integrated services
- Strong leadership
(Department of Health, 2005a)
More information on policies can be found at http://www.dh.gov.uk/en/index.htm
The changes implemented in the National Service Framework have been endorsed by the 2006 White Paper, 'Our Health, Our Care, Our Say' (Department of Health, 2006).
It sets out a vision to provide people with good quality social care and NHS services in the communities where they live. NHS services are half way through a 10-year plan to become more responsive to patient needs and prevent ill health by the promotion of healthy lifestyles. Social care services are also changing to give service users more independence, choice and control.
More information on policies can be found at http://www.dh.gov.uk/en/index.htm
The health and social care guidelines ‘Supporting People with Dementia and their Carers’ (National Institute for Clinical Excellence/Social Care Institute for Excellence, 2006) are for health and social care staff who work with people with dementia and their carers, those who work with older people and people with learning disabilities. It makes specific recommendations on the management and treatment of all types of dementia and the support of carers.
This guide can be found at: http://www.scie.org.uk.
More information on policies can be found at http://www.dh.gov.uk/en/index.htm
Key policies for carers are:
The Carers and Disabled Children Act 2000 gives local authorities discretion to meet carers' needs with any service that will genuinely help them to continue to care and maintain their well-being. It also empowers local authorities to make direct payments to carers (Department of Health, 2001b).
The Carers (Equal Opportunities) Act 2004 extends carers' rights to receive an 'assessment of need', access social care services and direct payments, and obtain support from health services if the carer's ability 'to provide care might be enhanced by such services' (Department of Health, 2005).
The Work and Families Act extends the right of working carers to request flexible hours (Department of Health, 2007).
There is also a 'New deal for Carers'.
More information on policies can be found at http://www.dh.gov.uk/en/index.htm
Mental Capacity Act 2005
An estimated two million people in the UK are unable to make decisions for themselves because of disability, mental ilness, brain injury or dementia. The Mental Capacity Act 2005 (covering England and Wales) provides a statutory framework for people who may not be able to make their own decisions due to limited capacity. It deals with who can take decisions, in which situations, and how they should go about this.
The Act was introduced in response to widespread concerns about the limited account taken of the views of adults with limited capacity in decisions about their care and treatment, including admission to a care home. It strengthens the rights of users and also clarifies the rights and duties of family carers and professionals.
More information on policies can be found at http://www.dh.gov.uk/en/index.htm
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Policy Context
Now we are going to turn service aims. Imagine you have an older relative with dementia or another long-term mental health problem.
What would you expect from services? What would be important aims for those servcies?
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Policy Context
How many of the key aims below, which are shared across service provision in the UK, did you have?
- Maintain community based living
- Support and maintain function including mobility and independence
- Ensure treatment and care takes into account each person’s individual needs and preferences and those of their family carer
- Treat users and carers with respect and work in partnership with them
- Accommodate variation and difference
- Be integrated and co-ordinated with one another.and co-ordinated with one another.
From an older person's perspective, an effective service is one which enables them to maintain quality of life, is person-centred and treats them with dignity.
It is very important to ensure that users’ views are heard and, as far as possible, accommodated. This includes people with dementia, however advanced the illness and however limited their capacity for verbal communication may be (Kitwood, 1997).
Person-centred care: (PCC) is an approach to working with people with dementia which places the person at the core of the delivery of care. It views each person as a unique individual and aims to maintain 'personhood', those elements of the person that make them who they are. It builds on knowledge - past and present - about the person and uses all avenues of communication and support to facilitate choice, maintain ability and skill and the expression of emotion. (Kitwood, 1997)