It was welcome news when health secretary Andy Burnham announced last week that the NHS, under the new Equality Bill, will have to comply with age discrimination rules by 2012. There is no question that age discrimination exists in the NHS, and the bill - along with New Horizons - is an important step by the government in tackling discrimination.
But the problem cannot be addressed through national action alone. We are in desperate need of local change. Unless services are commissioned, configured and developed locally to better meet the need of older people, discrimination will continue.
The ageing population has been described by researchers as a demographic tsunami, and is the biggest challenge facing health and social care services today. Yet investment and development in mental health services has explicitly excluded older people.
The figures speak for themselves. For every 1 million older people with depression, 850,000 receive no treatment whatsoever. While 50% of younger adults with depression are referred to mental health services, only 6% of older people will receive a referral. And in a recent report by the Healthcare Commission, a service audit found that of 1,300 referrals for psychological therapy only 49 were for people over the age of 65.
There is no justifiable reason why an older person with the same need as a younger person is denied equitable mental health care, yet that is the current position. Earlier this month, the Royal College of Psychiatrists’ Faculty of Old Age Psychiatry launched a new position statement: Age Discrimination in mental health services: making equality a reality.
The statement and accompanying evidence document show how tens of thousands of older people are missing out on vital support and risking serious deterioration in their mental health purely because of arbitrary age limits.
Access to mental health services has traditionally been configured by age. Although having administrative benefits by creating clear accountability of services, this approach may be considered discriminatory, such as when a person attending any specialist mental health service is required to transfer to an older people’s service purely because they have reached the age of 65. In doing so, they can lose benefits of the relationships they’ve formed with those services and be disadvantaged. People over 65 may also be denied access to services available to younger people, such as 24-hour crisis resolution and home treatment services.
The college’s Faculty of Old Age Psychiatry believes all mental health services should be available to people on the basis of need, not age, and is calling on local services to abolish the arbitrary age limit. We know that local change can make a difference and we have gathered some excellent examples. For example, in 2006, following reconfiguration of services in Doncaster, a specialist older people’s mental healthcare home liaison team was established to deliver person-centred care and training to local registered care homes. In the first year, the team received 460 referrals and admissions to hospital reduced by 75%.
And in West Suffolk, the crisis resolution home treatment team for working-age adults was extended in 2006 to include people aged over 65. The number of older people admitted to hospital fell by 31% without any loss of patient or carer satisfaction.
But we also need to remember that people’s needs change as they progress through the life cycle. In moving towards equality for older people, we must guarantee their needs are addressed by mental health services specially designed to meet them. If this doesn’t happen, age discrimination will continue in another guise.
Our position statement clearly states the actions required at a local and national level. These actions include an urgent need to provide access to crisis home treatment, early diagnosis and intervention, care home liaison, general hospital liaison and access to psychological therapies.
The statement’s launch at the House of Commons was attended by 18 Parliamentarians, including shadow minister for mental health Anne Milton MP. It’s notoriously difficult to persuade busy Parliamentarians to find space in their diaries to attend such events, so we were enormously encouraged that so many came along. Just maybe, it’s a sign that ministers are starting to listen - and are prepared to give older people’s mental health services the attention they so desperately need.
Tags: Discrimination, older people, psychiatry
