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Long-standing mental ill-heath - introduction

The focus of this section of the learning object is on what happens to people who have experienced episodic or enduring mental ill-health throughout adulthood once they reach the age of 65.

People in this group are sometimes referred to as ‘graduates’ because they graduate from specialist services designed for adults with mental health needs who are under the age of 65 to those designed for older people. A large number of ‘graduates’ were former in-patients of large institutions who are now dispersed in a wide range of community settings.

It is difficult to state with confidence how many older people are graduates of adult mental health services. This lack of information in itself indicates that they may not have received the level of attention they require. If we don’t know how many people are in this group, how can we understand their needs? Estimates of the prevalence of ‘graduates’ range widely, from 11 to 60 per 100,000 population, with the national average thought to be in the region of 30.

It is likely that the size of this group will grow as their numbers will tend to reflect the increase in numbers of older people in general.

(Source: Jolley et al 2002; 2004)

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Mental health needs

Despite the lack of knowledge about older people with long-standing mental health needs, we do know enough to establish that the largest group within the population of these graduates are people who have a long-standing diagnosis of schizophrenia1.

Schizophrenia is likely to be the main diagnosis for at least half, and possibly three-quarters of this group. It is thought that the next biggest group within this population is made up of people with a diagnosis of a mood disorder such as depression or bi-polar affective disorder2.

As well as the issues and problems associated with severe and/or enduring mental ill-health potentially faced by all service users, those who are older are more likely to face additional issues that may make them especially vulnerable.

1 Schizophrenia is normally diagnosed when someone has intense feelings, thoughts or ideas, such as hearing voices, which are not shared or understood by anyone within their own social or cultural group(s). People diagnosed with schizophrenia are often described as being unable to distinguish their own feelings and thoughts from reality. The impact of symptoms such as paranoia can be very disabling and can affect everyday functioning such as eating and sleeping.

2 Often known as manic-depression, bi-polar affective disorder usually involves extreme swings in mood, from deep depression to high elation or ‘mania’. When manic, people can behave in ways that are extremely problematic for themselves and those close to them, including behaviour such as spending excessive amounts of money and making claims about fame and fortune. In the depressive phase, there can be a deep sense of failure and hopelessness, and despair for the future.

For more detailed information about these conditions, see: http://www.mind.org.uk

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Issues

Pick out from the statements below those issues that you think are more likely to affect people who have a long-standing mental health need. When you have finished, move to the next slide to read our views:

  • Stigma
  • Disturbing symptoms such as hearing voices and delusional beliefs
  • Unwanted effects from long-term treatment
  • Physical health problems
  • Increasingly complex mental health needs
  • Risks associated with the transition from one service to another
  • Getting lost in the system
  • Discrimination
  • Social isolation

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Issues

Stigma

Stigma is known to affect many mental health service users - old and young alike.

Disturbing symptoms such as hearing voices and delusional beliefs

Experiences such as hearing voices are common across all age groups of people who have serious mental health needs such as schizophrenia.

Unwanted effects from long-term treatment

Whilst unpleasant side-effects from drugs are experienced by many service users, those who have been on older treatments and/or have been treated for many years often have specific health problems associated with them.

Physical health problems

The effects of neglect due to long-standing mental ill-health can accumulate over time, affecting older service users in particular ways. The risk that physical health problems can be overlooked by professionals and others because the mental health issues dominate their attention applies to all age groups.

Increasingly complex mental health needs

Older people with long-standing mental health needs are not immune from developing other conditions such as dementia in old age. This type of ‘comorbidity’ means that their needs can be very complex, requiring careful assessment and care planning. (Comorbidity - A concomitant but unrelated pathological or disease process.)

Risks associated with the transition from one service to another

This issue is more likely to affect older people with long-standing mental health needs as they are transferred from specialist mental health services to services for older people

Getting lost in the system

While this is a danger for all service users, it is a particular danger for older service users as they transferred from one service to another.

Discrimination

All mental health service users are potentially at risk from discrimination, not least because of the stigma associated with developing a mental health problem.

Social isolation

Whilst social isolation is a major issue for many mental health service users, older people may have even weaker social networks due to the number of years in which relationships may have proved difficult to form or re-establish.

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Issues

By far the biggest set of issues facing those older adults with long-standing mental ill-health needs is the transition from adult mental health services to a different set of services altogether, those for older people. A particular threat that they face is the loss of key relationships with service providers with whom they have established links over many years.

The risks that ‘graduate’ mental health service users face are exacerbated by the pressures that adult mental health services are already under to provide care for those under 65 years. These pressures makes it less likely that service providers and individual professionals will feel able to continue to provide services for ‘graduates’ where they have the option to move them on.

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Improving support

Steps to improve the transition from one service to the other

  • What is required to improve the situation?

    Willingness to allow people to remain within adult mental health services beyond the age of 65 if their needs demand this.

  • Full assessment as people approach the key age of 65

    Transfer of appropriate resources to follow people if they transfer away from adult service provision.

  • Greater flexibility in services to accommodate individual needs

    Stronger links between the two types of services, those for adults and those for older adults, to facilitate joint assessment.

    All of these changes will be required if older people with long-term mental health needs are to get the support they need.

Source: Jolley et al 2004