older psychiatryThe Royal College of Psychiatrists (RCPsych) has called for a halt in the development of ‘ageless’ mental health services because they could threaten the quality of care provided to older people.

Writing in medical journal The Lancet, the RCPsych Faculty of Old Age Psychiatry warns that the creation of generic all-age services by health providers is “leading to erosion and fragmentation of services” that could adversely affect specialist provision to older people.

Worrying misunderstanding of the Equality Act

Dr James Warner, chair of the Faculty of Old Age Psychiatry, described the development of ageless psychiatry services as “a worrying trend driven mainly by financial savings and a misunderstanding of the Equality Act.”

The results of a recent survey of 457 consultant old age psychiatrists – representing 95% of Mental Health Trusts in the UK – carried out by the RCPsych found that in many areas mental health services specifically developed to care for older people had been absorbed into general adult services.

In the survey, 195 respondents (47%) reported development of at least some ‘ageless’ services in their organisation. In addition, 11% said that whole sections of their service, such as inpatients or community services, had become totally ageless and 7% reported that plans were in place to convert to wholly ageless services.

Although in some cases these changes were seen as positive, only 16% of respondents regarded the move to ageless services as ‘very good’ or ‘good’, while 52% regarded it negatively.

“Old age psychiatry is needed”

Writing in The Lancet Dr Warner said: “There are 10 million people over 65 in the UK and this group need specialist services. Old age mental health services traditionally see patients in their own home. Specialist teams which understand the nuances that the social, physical and psychological consequences of ageing bring to the management of mental illness are essential. We would argue that old age psychiatry is needed to provide a service which understands the complexity of managing people with dementia, severe co-morbid physical illness, or psychological impact of ageing and end-of-life.

“The trend for ageless services will disadvantage further a growing, but already disadvantaged, section of society. We believe that old age psychiatry services should be preserved and enhanced, and not left to whither on the vine.”

In January the RCPsych, together with representatives from the NHS Confederation, Royal College of Nursing, British Geriatric Society, British Psychological Society and Alzheimer’s Society, wrote to all chief executives and medical directors of mental health trusts to request their help in securing a pause to the re-provision of ageless services.

The RCPsych’s Old Age faculty is consulting on new needs-based service criteria which will ensure old age services are strengthened in the future.  


Jenkinson J and Warner J (2013) Whither old age psychiatry? Ageless psychiatry services in the UK – a worrying trend. The Lancet 381 9882, p1985 www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61202-7/fulltext