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Jill Manthorpe and Steve lliffe look at some of the challenges facing commissioners who are purchasing mental health services for older people
KEY WORDS
Mental health Older people Commissioning Social care NHS
Summary
At first glance, commissioning mental health may look like a heart-sink project, but it need not be. In fact, the opposite may be true. This report argues that consistent application of a long-term strategy, which allows the accumulation of small changes across agencies and disciplines, is likely to be the key to success. It sets out the issues that need to be addressed, the pitfalls to avoid, and examines a series of objectives for commissioners.
Middle-aged people fear dementia more than cancer, the issue of medication for people with dementia leads to protest marches outside Parliament, and the quality of care (or lack of it) for older people with mental health problems hits the headlines. Does this mean that older people's mental health services no longer have Cinderella status?
Mental health services for older people may well be a political and public concern nowadays, but NHS provision in England is a very complex and sometimes threadbare web of provision.
Older people with mental health problems test the capacity of professionals and agencies to work collaboratively, for a number of reasons. The first is the complexity of older people's identities, wants and needs. Mental health problems are common, and are probably rising in number, but remain under-diagnosed and under-treated.
The second is the special make-up of the workforces, which contain few specialists and in which the generalists are often non-professionals (care assistants, for example), and where boundaries between health and social care remain persistently fuzzy.
The third is the difficult nature of work with older people overall, in terms of both its resources and levels of remuneration for staff, and the anxieties that it generates about ageing, disability and death.
Finally, the multiple agencies involved in support for older people contribute to the challenges of working in this area. In no other sector of social care is the private sector so dominant and diverse, or partnership working so complicated by combined physical and mental health conditions, and frequent changes in both.
For commissioners, these complications offer opportunities to shape services that...