Education And Debate Care of older people

Mental health problems

BMJ 2001; 322 doi: (Published 31 March 2001) Cite this as: BMJ 2001;322:789
  1. Alistair Burns, professor of old age psychiatry (,
  2. Tom Dening, consultant psychiatristb,
  3. Robert Baldwin, consultant old age psychiatristc
  1. a University Dept of Psychiatry, Withington Hospital, Manchester M20 8LR
  2. b Box 311, Fulbourn Hospital, Cambridge CB1 5EF
  3. c York House, Manchester Royal Infirmary, Manchester M13 9BX
  1. Correspondence to: A Burns

    This is the third in a series of four articles

    Specialist mental health services for older people have grown rapidly and successfully over the past two decades, aiming to offer services that are comprehensive, accessible, responsive, individualised, multidisciplinary, accountable, and systematic. As with all mental health problems, the burden falls on primary care (where minor morbidity often goes undetected) and specialist services tend to be reserved for those conditions and patients where diagnosis and management is problematic. The total cost of caring for people with dementia in the United Kingdom is estimated at £6bn ($9bn) a year1—a figure whose impact is diluted by the fact that it combines both health and social services. We outline the current evidence of benefit in four areas: services currently available; interventions that have been shown to be effective; rating scales that should be recommended to clinicians for detecting common mental health problems; and the needs of carers.

    Summary points

    Recent reports have highlighted the needs of older people with mental health problems

    Mental health problems are underrecognised and undertreated in primary care

    The use of guidelines and standardised screening instruments may improve this

    Caring for a person with dementia is stressful, and carers' needs are being increasingly recognised

    Carer interventions in people with dementia have been shown to be effective in randomised controlled trials

    Depression, the commonest mental health disorder in later life, is eminently treatable, but psychological therapies are underused

    Services for older people

    A recent report by the Audit Commission surveyed 850 carers and 1005 general practitioners by visiting 12 areas of the United Kingdom and conducting face to face interviews.2 The results showed that the range of services in health authorities was patchy and varied between the different authorities; in addition, coordinated care between …

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