A new needs-based criteria for old age psychiatry services has been developed for commissioners by the Royal College of Psychiatrist’s Old Age Psychiatry Faculty.
The criteria, developed in consultation with a range of stakeholders, will serve as a framework for services following the redefinition of access criteria required by the Equalities Act 2010.
The College accepts that it is not reasonable to use the criterion ‘older than 65 years’ for access to a service, and the Equality Act in essence makes this unlawful.
Fragmentation of older people's services
But in the absence of a robust definition of ‘old age psychiatry’ – ideally through nationally accepted criteria – the College believes there has been increasing fragmentation of services for older people with mental health problems, with a corresponding rise in the number of generic all-age services.
Dr James Warner, chair of the Royal College of Psychiatrist’s Old Age Psychiatry Faculty, said: “These criteria will ensure that mental health services for older people are person-centred and needs-based.
“We hope this work is considered useful, that the Department of Health will give its support to these new criteria, and that they might be referred to in relevant Department of Health guidance and other communications about old age mental health services.”
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A recent survey conducted by the Old Age Psychiatry Faculty found that 11% of NHS trusts had already disbanded specialist old age psychiatry teams, with a similar number planning to do so imminently.
While the College welcomes the Department of Health’s national mental health strategy, which states that services should be age-appropriate and non-discriminatory, it has serious concerns that the increasing prevalence of so-called ‘ageless’ services will be ill-equipped to meet the complex physical, social and psychological needs of older patients.
Interventions for older people
The Faculty’s needs-based criteria sets out for which people the interventions provided by older people’s mental health services are most relevant. These are:
• People of any age with a primary dementia
• People with mental disorder and physical illness or frailty which contribute(s) to, or complicate(s) the management of their mental illness. This may include people under 65
• People with psychological or social difficulties related to the ageing process, or end of life issues, or who feel their needs may be best met by a service for older people. This would normally include people over the age of 70
• Respect patient choice about which service they are treated in
• Not transferring someone between services during a crisis.
The College will circulate the criteria to commissioners of older people’s mental health services and it is also contained in the Joint Commissioning Panel for Mental Health guide for commissioning old age services, published in June 2013.