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Psychological therapies, older people and human rights

  • Claire Hilton (a1)
Summary

Additional funding has recently been made available by the government for the treatment of anxiety and depression. However, this is targeted towards people of working age, to reduce expenditure on incapacity benefit. That older people with the same mental illnesses do not receive equitable access to psychological therapies contradicts other recent government recommendations. Economic data appears to hugely influence provision of services for this group of users, but is this appropriate and humane? the Human Rights Act 1998 (Chapter 42) has been largely ignored in the provision of mental health services for older people, and the centrality of this legislation needs further consideration.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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1 Department of Health. Johnson announces &pond;170 million boost to mental health therapies. Government News Network, 10 October 2007 (http://www.gnn.gov.uk/content/detail.asp?ReleaseID=321341&NewsAreaID=2&NavigatedFromSearch=True).
2 Centre for Economic Performance, Mental Health Policy Group. The Depression Report: A New Deal for Depression and Anxiety Disorders. London School of Economics, 2006 (http://cep.lse.ac.uk/textonly/research/mentalhealth/DEPRESSION_REPORT_LAYARD.pdf).
3 Department of Health. National Service Framework for Older People. Department of Health, 2001.
4 National Institute for Health and Clinical Excellence. Depression: Management of Depression in Primary and Secondary Care. The British Psychological Society & the Royal College of Psychiatrists, 2004.
5 Mayer-Gross, W. Electric convulsion treatment inpatients over 60. J Ment Sci 1945; 91: 101–3.
6 UK Inquiry into Mental Health and Well-Being in Later Life. Improving Services and Support for Older People with Mental Health Problems: Second Report. Age Concern England, 2007.
7 Layard, R, Clark, D, Knapp, M, Mayraz, G. Cost benefit analysis of psychological therapy. Natl Inst Econ Rev 2007; 202: 90–8.
8 Appleby, L. Mental Health Ten Years On: Progress on Mental Health Care Reform. Department of Health, 2007.
9 Philp, I, Appleby, L. Securing Better Mental Health for Older Adults. Department of Health, 2005.
10 Phillips, C, Thompson, G. What is a QALY? Hayward Medical Communications, 2001 (http://www.jr2.ox.ac.uk/bandolier/painres/download/whatis/QALY.pdf).
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13 Royal College of Psychiatrists. Response from the Faculty of Old Age Psychiatry to the NICE Appraisal Consultation Document: Donepezil, Rivastigmine, Galantamine and Memantine for the Treatment of Alzheimer's Disease. Royal College of Psychiatrists, 2005 (http://www.rcpsych.ac.uk/pdf/responseNICE_March05.pdf).
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Psychological therapies, older people and human rights

  • Claire Hilton (a1)
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eLetters

What's right for older people

David Jolley, Consultant Psychiatrist/Hon Reader
25 May 2009

Claire Hilton's article is a clear and challenging description of thecurrent state of play. I understand her declaration of interest: 'I work in a Trust where I perceive older adults services to be less well-funded relative to services for younger adults' has been deemed controversial by some. How can this be? She is simply stating her perception of things - and that perception is congruent with the truth of the matter in every Mental Health Trust in the country, and in every situation in which older people receive sponsored care (1).

Things were much worse before we created specialist services, when older patients were housed in 50 bedded wards and received no therapeutic input (2). It was deemed they did not need therapy because they would not benefit from it. Yet older people and those of us who have worked with them have never shouted loudly for equality, preferring to make modest best-use of the resources made available to us.

I was astonished, when working for a while in a Learning Disability setting, to find that individuals with dependency and behavioural profilesquite commonly seen in Old Age services were regularly being supported with care-packages costing several times the top rate payable for older people with dementia.

Perhaps now is the time to ask for more.

Sadly the Healthcare Commissions review ducks the issue, preferring to cite commendable examples of good practice and pursuing the line that age-related services should be abandoned (1). That should bury the problemand make it less visible - just as it was when we came in (2).

References:

1)Healthcare Commission. Equality in later life: A national study ofolder people’s mental health services. Commission for healthcare audit andinspection (2009) 2)Robb B. Sans Everything: a case to answer. Thomas Nelson and sons Ltd, London 1967
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Conflict of interest: None Declared

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