principles into practice network

Auld age disnae come itsel’

Topics covered in this article: Schizophrenia

By Mary Weir, Chief Executive of NSF Scotland

A few things have reached my notice recently that have highlighted the variety of challenges brought on by an ageing population (and I'm not talking about my bad back!).  Dementia campaigners have been working hard to highlight the estimated costs and complex issues that need to be tackled if we are to provide adequate dementia care in Scotland.

What has received less attention is what happens to people who have perhaps experienced a lifetime of poor mental health and longstanding engagement with mental health services. People who have specialist mental health needs and who, once they reach a certain age, find themselves referred to services which although they are well set up to address the needs of the frail or people with dementia, are less able to respond to the needs of an older person with another form of mental illness.

Of course, the greatest risk factor for dementia is living to an old age. While current statistics on health inequalities may show that people with a history of mental ill health tend to die ten years younger than the general population, people with a mental illness do still live into old age.

A lifetime of medication, smoking and poor diet (all much more prevalent amongst psychiatric service users than the general population) might just speed the kind of health problems that come to many of us a few years later. So, the issues of providing good care and support for older people merit our attention. These issues are well demonstrated in the case of one of our members who has schizophrenia and is already well past the age of 65 and lives in the community.

'Lizzie' has no informal carers, but has good support from community mental health services. From time to time her illness means that she needs to spend short periods in a psychiatric hospital. One of her greatest fears is that the time will come when she can no longer look after herself in the community because of failing physical health and frailty. She is terrified of finding herself in an nursing home alongside people with dementia and being cared for by people with no understanding of her mental health needs - how her mental illness can affect her perceptions and behaviour.

When she speaks of this, as she often does, I don't feel I can give her robust assurances that this won't happen. I'm not sure the services are there to meet her needs - are they?

 My experience in relation to an older man who has been in a psychiatric hospital for many years indicates that there might be at least one such service in Scotland. As the man has become older, poor physical health has required a move to a nursing home.

The first attempt to move him to a nursing home was an unmitigated disaster. Nursing home staff had no knowledge or expertise in mental illness -other than dementia- and could neither understand nor cater to his very different needs. Unsurprisingly the man returned to the psychiatric ward very quickly, contributing a considerable amount of distress to both the patient and his carer.

Since that episode however, this man's carer reports that she is experiencing 'a new lease of life' . Her father is now living in a nursing home style of environment that is run by the NHS and is staffed by psychiatric nurses. They are working with him in a way that is respectful and person centred, consistent with the principles of good mental health care and treatment.

What this highlights for me is the on-going need to care for what may be a relatively small number of people whose mental health challenges throughout their life aren't going to disappear when they get older. It is imperative that while we look at the broader picture of addressing dementia,the mental health needs of  this small number of people don't get  lost too, in an environment where the needs of an ageing population are making more general demands on the available resources. Mental health nurses working with older people must be enabled to maintain and develop their wider knowledge and skills so they can respond appropriately to the needs of all older people with mental illness and mental health problems. Otherwise we'll be failing in our duty to provide appropriate care and treatment.

It's an argument that is well worth making in an economic climate that many fear will see mental health services at the forefront of NHS budget cuts.

Related resources

For more on some of the issues Mary raised there's a research paper by McNulty et al 2003 called Care needs of elderly people with schizophrenia: assessment of an epidemiologically defined cohort in Scotland .