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Mental health experts should offer training to GPs, report says

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7229.208/a (Published 22 January 2000) Cite this as: BMJ 2000;320:208
  1. Oona Mashta
  1. London

    Mental health services for elderly people in England and Wales are patchy and inconsistent, with wide variations in resources, according to a new report by the public health expenditure watchdog, the Audit Commission.

    People aged over 65 with dementia or depression often fail to receive the help they need, owing to a lack of joint working between agencies, says the study. It claims that old people and their carers often miss out on mental health services because their initial call for help is usually to the GP, who often lacks the knowledge to assist effectively.

    The study also found that many GPs felt ill prepared to deal with mental health problems in older people. Out of a survey of 1005 GPs, half had not received any specific training in managing dementia and did not use any specific tests or protocols to diagnose it. Only about half believed that it was important to look out actively for early signs of dementia and to make an early diagnosis.

    Many others said they saw no point in looking for an incurable condition, even though carers could be helped by early advice. Three quarters, however, believed that their training was adequate to manage depression.

    The report therefore recommends that specialist mental health professionals contact GPs, especially those making few referrals, and offer support and training.

    Most of the resources for specialist mental health services go on hospital and residential care, yet people prefer to be supported in their own homes, according to the report, which therefore calls on health agencies to shift more resources towards community based services.

    In addition, people were much more likely to be admitted to hospital in areas where community services were inadequate and health and social services were not working effectively together.

    The Audit Commission makes a raft of recommendations in a bid to spread good practices in mental health services. It calls for mental health professionals to provide more training and support to GPs and other primary care staff, who should be able to provide better information, support, and competent advice to users and carers.

    Forget Me Not—Mental Health Services for Older People is available from Audit Commission Publications (tel 0800 502030), price £20.

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