Intended for healthcare professionals


Mental health services’ framework must tackle age discrimination, commission says

BMJ 2009; 338 doi: (Published 01 April 2009) Cite this as: BMJ 2009;338:b1346
  1. Jacqui Wise
  1. 1London

    The care and treatment offered to users of mental health service of all ages in England have substantial failings, according to two reports by the Healthcare Commission.

    The first report, Equality in Later Life, found that older people are discriminated against in access to out of hours and crisis services, psychological treatment, and alcohol services.

    The independent health regulator for England studied services for older people at six specialist mental health trusts, about 10% of the total number. It found some evidence of high quality care where there was good integration of health and social services. But older people were often denied access to care because of stretched services or a lack of age appropriate care.

    Provision of psychological treatments for older people was poor in most of the trusts surveyed. One trust reported that in an audit of 1300 referrals to psychological treatments from GPs, only 49 were for people older than 65, which the commission says shows a lack of awareness among GPs of the older age group’s need.

    The existing national service framework for mental health expires in 2009. The commission calls on the Department of Health to ensure that the new framework for the delivery of mental health services tackles age discrimination. The commission also calls on the Royal College of Psychiatrists and other organisations to develop models of care based on assessment of need rather than the age of patients.

    Dave Anderson, chairman of the Royal College of Psychiatrists’ faculty of old age psychiatry, welcomed the report: “The college has recently set up a working group to look at how mental health services could be designed to create greater equity and better meet the needs of older people. Greater investment in older people’s mental health services and better access to services currently denied to older people will be essential ingredients for delivering equality.”

    Steve Shrubb, director of the mental health network, which represents most mental health trusts, said, “The best services are characterised by proper coordination between all parts of the health and social care system. Bringing these services up to the level of the best will therefore require all relevant bodies working together.”

    The Healthcare Commission’s second report, Adult Specialist Community Mental Health Services, found some improvements since the commission last reviewed this area. For example, more people with mental health problems are now involved in their care and treatment and receive annual reviews of their physical health. But the commission said that there remained significant room for improvement.

    For example, the report states that almost half of people who need specialist community mental health care do not have a number to contact out of hours if they are in crisis. Another key finding was that only 45% of people with schizophrenia are being offered cognitive behavioural therapy, despite guidelines from the National Institute for Health and Clinical Excellence that recommend this for all such patients. This figure has not risen since the last survey in 2006 and in many trusts the level is much lower. The commission questions whether the mental healthcare system has the capacity to deliver psychological treatment to the many people with psychosis.

    Paul Farmer, chief executive of the mental health charity Mind, said, “Considering that everyone is meant to have round the clock access to crisis care, it is truly shocking that nearly half of mental health service users don’t even have a contact number to call when they are in need.”

    Andrew McCulloch, chief executive of the Mental Health Foundation, added, “Given that improving access to psychological therapy is a flagship programme for the government, we are concerned that the Healthcare Commission’s report questions services’ capacity to deliver psychological therapies to the large number of people with psychosis.”


    Cite this as: BMJ 2009;338:b1346


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