Mind exposes severe neglect of older people

Posted Monday 10 October 2005

New research highlights services cut-off, lack of treatment choice, age discrimination by GPs, lack of suicide prevention policy, high levels of ECT, and diagnosis failure despite growing statistics.

"Ageism in my GP's surgery is all too evident. I am dismissed as ... too old to take seriously."

"Too many people are unaware of any choices ... many are told they are 'unsuitable' for talking therapies."
Mind survey respondents

Today, World Mental Health Day, leading mental health charity Mind publishes a deeply disturbing report, Access all ages (1), into older people's experiences of mental health services. Key concerns are:

• cut-off of services available for 65s plus
• lack of treatment choice 
• age discrimination by GPs, including lack of drugs information 
• lack of any specific suicide prevention policy despite very high suicide rate: one third of suicides committed by over 55s 
• high prescription of electro-convulsive therapy: doubles for this age group.

The National Service Framework for Mental Health only deals with adults up to 65, so it has been left to the NSF for Older People to deal with mental health. This NSF did not come with ring-fenced funds for any part of it, and mental health requirements have not been met, lost among the many other areas covered. There is a complete lack of mental health promotion activity for this group. Mind studied a sample of PCT mental health strategies, none of which mention older people. Resource issues must be tackled now.

Access to services

Currently, when 65, the availability of many mental health services changes as you are classed as an 'older person' rather than a 'working age adult', due to the division between the NSFs. This is reflected in funding criteria, including Local Authorities, resulting in service providers having to operate age barriers on their services. For example, the Government's Mental Illness Specific Grants (MISG) can only fund development of social care services for 'working age' people, forcing people to leave supportive services such as day centres, on reaching 65. Our research found that the general range and style of services being offered becomes much more restricted and the emphasis on mental health is lost (2).

High suicide rates

The Government's NSF for Older People doesn't even mention suicide. Older people over the age of 75 are only six per cent as likely to be asked about suicide by their GP, one fifth as likely to be asked if they feel depressed, and one third as likely to be referred to a mental health specialist.

Treatment choice

Survey respondents reported that a choice of treatments, particularly talking therapies, are often not available as waiting lists are long, and older people are seen as a lower priority for treatment such as psychotherapy, cognitive behavioural therapy, exercise or acupuncture.
"I was not told about any treatments at all ...except pills." was a common complaint.

Drug treatments

Recent research backs up Mind's ongoing campaign on the vital need for more information about drugs and their side effects - with particular impact on older people, given their greater lack of treatment choice. In our research, 38 per cent said that they were not given sufficient information about treatments and 40 per cent felt that they weren't adequately consulted about treatment options. In addition, a Royal Pharmaceutical Society survey showed that as many as 50 per cent of older people may not be taking their medicines as intended. They are also more likely to be prescribed an older tricyclic drug than a more modern SSRI, and recent analysis has shown that when a tricyclic is prescribed only 43 per cent of over 65s received an appropriate dose.

Electro-convulsive therapy (ECT)

A DoH survey (2002) showed that the use of ECT for over 65s was double any other age group, with no acceptable explanation. The controversial treatment's serious side effects include memory loss, and there are added risks for older people as they are more likely to suffer from heart complaints and other cardiovascular conditions that can cause complications during ECT.

Diagnosis failures despite growing statistics

It is of grave concern that despite the increase of mental health problems in old age, and increase of the older population, older people's mental health problems are often not recognised by doctors and hospital staff and they are seldom seen by psychiatrists*3. One in six people develop clinical depression after they reach 65, 40 per cent of those in care homes. Dementia affects one in 20 people aged over 65 years, rising to one in five people over 80. In the next 10 years, the population of over 65s will increase by 15 per cent, and the population of over 85s by 27 per cent.

Campaign launch

Today's report launches a new Mind campaign. Access all ages demands that the Government, Primary Care Trusts, Local Health Boards and GPs act together to ensure that older people have the same level and quality of support and treatment available to others. Mind's President Lord Melvyn Bragg and Chief Executive Richard Brook will address a Parliamentary reception, an art and creative writing competition is launched today, and many of our 210 local Mind associations are running activities to promote the campaign around World Mental Health Day.

Richard Brook, Chief Executive of Mind, said: "Access all ages highlights the shameful neglect of this vulnerable and often isolated group of people. The sudden removal of services and treatment at the age of 65 clearly causes great distress to many people - this unfair discrimination must be removed. 

Some GPs provide excellent support to older people, but too many health professionals do not yet receive the training to identify and deal with the growing mental health problems older people face.  And it is crucial that for them, just like anyone else, treatment choice should be a right, not a gamble."

Notes

1. Mind survey Access all ages collates the views and experiences of 489 people with mental health problems over 50, conducted Summer 2005.
2. Funding criteria has resulted in one LMA older service user only able to access facilities through role as a volunteer, and at another people over and under 65 have to be segregated.
3. WHO European Ministerial Conference on Mental Health (2005).

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