The government's recent extension of its 'dignity in care' initiative for older people to people experiencing mental health problems (read article from DH website) is going to take substantial action if it is to make any significant impact on mental health services. Despite a whole raft of new initiatives and focus on providing support to people in their own homes as far as possible, inpatient psychiatric wards have become even more chaotic and overstretched. Women’s safety in particular is of serious concern with a woman inpatient recently murdered on a mixed sex ward in Rochdale.
The initiative is going to focus on tackling stigma, older people’s mental health, and acute inpatient care according to SCIE, whose updated Dignity in Care Guide is a valuable resource including links to recent useful mental health research and practice guidance relevant to dignity.
Action to involve more local people, and local people more, in advocating dignity and respect in mental health services (as in older people’s services with the original Dignity in Care campaign) has to be welcomed, but is more likely to be effective if it is tightly linked to grassroots networks including those led by service users and survivors who know about the realities of mental health services in their areas. These include women’s groups who have been campaigning for safety and dignity for years and whom SPN hopes to support next year if we are successful in obtaining funding to develop a national women’s mental health network.
Nationally the initative will need to work closely with the £16m ‘Moving People’ voluntary sector-led anti-stigma and discrimination programme as well as SCIE and CSIP who are key partners in translating Dignity in Care into practice. Beyond mental health services, SCIE’s Guide highlights SHIFT’s Five Action on Stigma Principles for employment. SPN would argue that anyone working and in a position to campaign for introduction of these in their workplace would be an immediate dignity champion with no need for the Department of Health’s blessing!
The Action on Stigma Principles
1. Employers can demonstrate that employees are helped to look after their mental health by making them aware of the steps they can take to preserve and maintain their own and others mental well-being
2. Employers promote a culture of respect and dignity for everyone, ensuring that the staff are trained to recognise and be sensitive to mental distress or disability in others, whether they are workplace colleagues or customers
3. Employers encourage awareness of mental health issues, so that employees are aware of the signs of distress and understand the importance of seeking help early
4. Employers can demonstrate that no one is refused employment on the grounds of mental health or disability
5. Employers make reasonable adjustments to the work environment for people with mental health problems so that they can continue working
6. Employers can demonstrate that they take positive steps to ensure that people with mental health problems are not disadvantaged, in relation to the availability of their goods and services
Well we have to dream!
Vicky Nicholls
3rd September 2007
Once upon a time the Department of Health pledged to eliminate ageism in the NHS. The reality remains that ageism operates as a form of rationing -sometimes overt (no reminders of mammogram checks after 70) sometimes covert by clinical judgements about the necessity of treatment for individuals,
And the prevalence of mental ill health in older age while noted in numerous reports remains as a Cinderella sector – under resourced and largely unnoticed – until the next report comes along.
Last month saw the publication of the final report of the UK Inquiry into Mental Health and WellBeing in Later Life – a major independent inquiry supported by Age Concern.
The Inquiry report reveals that mental health problems affect many more people in later life than previously believed – and that the nature of the problems is wider than often recognized. It reveals that up to 2.6 million older people – 1 in 4 people over 65 and 2 in 5 people over 85 – are suffering depression or serious symptoms of depression and one in five people over 80 suffer dementia.
It also highlights that older people with mental health services are often ignored and receive little support services, and there exists a poor level of services for people growing older with longstanding mental health problems such as schizophrenia. Women over 75 are more likely to take their own lives compared to any other age groups, and men over 75 have the second highest suicide rates of all men in the UK.
The report found that older peoples’ mental health issues remain poorly understood, highly stigmatised and are not given the priority necessary in policy, practice and research – despite official reports since at least 2000 highlighting discrimination and calling for action. Two thirds of older people with depression never even discuss it with their GPs, and of the third that do discuss it, only half are diagnosed and treated. This means of those with depression only 15 per cent or one in seven are diagnosed and receiving any kind of treatment.
Even when they are diagnosed, older people are less likely to be offered treatment and the Inquiry has heard of GPs who have called depression a symptom of growing older. In 2006, a review of progress against the Government’s National Service Framework for Older people said that since 2001 explicit age discrimination had not declined in mental health.
To date, the Department of Health framework for mental health services has focused only on people up to 65 – and people over that age receive different, lower cost and inferior services to younger people – even if they have same condition. Many find they are moved into ‘older people’s services’, regardless of the suitability of these services, just because of their birth date.
The Government’s new campaign for dignity in mental health services needs to look at what is happening to older people or will we have to wait for the next report to remind us how far services fall short in terms of quality, respect and dignity.
Terry Bamford
Read the newsletter from the User Involvement and Empowerment Project in Canterbury.
Promoting mental health and well-being in later life
The Inquiry into Mental Health and Well-Being in Later Life is a three-year, UK-wide project that aims to:
Raise awareness of this much neglected issue
Involve and empower older people
Create better understanding of the issue
Influence policy and planning
Improve services
The Inquiry has just published its first report, Promoting Mental Health and Well-Being in Later Life. The report can be downloaded for free here in PDF format.
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