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The Royal College of Psychiatrists set up an interface group to look at the interface between old age psychiatry and learning disability and, as part of its work, the…
The Royal College of Psychiatrists set up an interface group to look at the interface between old age psychiatry and learning disability and, as part of its work, the group commissioned a survey of learning disability and old age psychiatrists to investigate their experience of working across the boundary between the two specialities. This paper is based on the report produced. It summarises the findings of the survey and sets out eight recommendations to further the work. There was no clarity on how services should be provided to older people with a learning disability who develop a mental health problem in later life but the need for collaboration between the two specialities is compelling.
The Faculty of Old Age Psychiatry, Royal College of Psychiatrists, has been involving users and carers in its work since 2002. The model that has been developed involves…
The Faculty of Old Age Psychiatry, Royal College of Psychiatrists, has been involving users and carers in its work since 2002. The model that has been developed involves regular meetings of a consumer group, which was set up in partnership with the Alzheimer's Society and Age Concern, and which meets with the officers of the faculty. This development is in line with a number of recent policy initiatives and has had considerable influence on the work of the faculty.
The Mental Capacity Act 2005 (MCA) was fully implemented in October 2007 in England and Wales. This article reports on two similar, but separate, pilot questionnaire…
The Mental Capacity Act 2005 (MCA) was fully implemented in October 2007 in England and Wales. This article reports on two similar, but separate, pilot questionnaire studies that examined the experience of consultants in old age psychiatry and consultants in other psychiatric specialities in the early implementation of the MCA pertaining to issues relevant to black and minority ethnic (BME) groups. Fifty‐two (27%) of the 196 consultants in old age psychiatry and 113 (12%) of the 955 consultants in other psychiatric specialities returned useable questionnaires. Eighty per cent or more of the consultants in old age psychiatry and consultants in other psychiatric specialities gave consideration to religion and culture and ethnicity in the assessment of decision‐making capacity (DMC). Almost 50% of the consultants in old age psychiatry reported that half or more of the patients lacking fluency in English or where English was not their first language received an assessment of DMC with the aid of an interpreter and 40% of the consultants in other psychiatric specialities reported that no such patients received an assessment of DMC with the aid of an interpreter.The low rate of using interpreters is of concern. The nature of the consideration and implementation of factors relevant to culture, ethnicity and religion in the application of the MCA and the precise reasons for the low rate of using interpreters in patients lacking fluency in English or English not being their first language require clarification in further studies.
The purpose of this paper is to detail developments in UK alcohol policy for older people over the past 20 years, based on evidence for a growing public health problem…
The purpose of this paper is to detail developments in UK alcohol policy for older people over the past 20 years, based on evidence for a growing public health problem with alcohol misuse in older people.
A literature search was carried out using health and social care databases, including grey literature.
There has been considerable progress in areas such as screening and brief intervention, low-risk drinking and service provision for integrated care in older people with dual diagnosis.
There remains a dearth of research and policy for older people with alcohol misuse and dual diagnosis prior to 2011. Although there remains limited empirical evidence for public health interventions to improve health outcomes from alcohol-related harm, improvements in population health from implementation of recent policy changes and intervention programmes remains to be seen.
This review has implications for best practice in the provision of integrated care to reduce harm and improve health and social outcomes in older people with alcohol misuse and dual diagnosis.
This review draws together a large area of research and policy on alcohol misuse in older people that has the potential to improve public mental health for older people who are at risk of alcohol-related harm.
Suicide is a tragic cause of death and causes considerable distress for families, carers and healthcare professionals. Thankfully, suicide rates in older people in the UK have steadily declined for both men and women since the mid‐1980s. An understanding of the clinical and demographic characteristics of both completed suicide and non‐fatal self‐harm in older people is important in informing the development of preventative strategies to sustain this decline. Non‐fatal self‐harm in older people is relatively uncommon compared with younger age groups, but research indicates that self‐harm among older people is frequently a failed attempt at suicide. Thus, the important factors associated with self‐harm in this age group are similar to those linked with completed suicide, particularly high rates of clinical depression, poor physical health and social isolation. Unfortunately, there is also a high rate of subsequent completed suicide. For this reason, self‐harm in later life needs to be taken very seriously and a careful assessment of risk and need by a specialist in older people's mental health should be conducted. The identification and appropriate management of older people with depression in the community and general hospitals is a key area for the prevention of self‐harm and suicide in this age group and requires further attention, particularly with targeted support programmes for those at high risk.
The aim was to determine the number of referrals of people aged 55 and over to three forensic and psychiatric intensive care unit (PICU) services in Scotland, and to…
The aim was to determine the number of referrals of people aged 55 and over to three forensic and psychiatric intensive care unit (PICU) services in Scotland, and to describe their demographic, criminological and psychiatric characteristics. Of a total of 1838 referrals, 63 (3.4%) were aged 55 and over. Of these, 35 were referred for court reports or prison assessment and half had been charged with violent or sexual offences. Most were diagnosed as suffering from a psychiatric disorder at the time of assessment, 11 (31.4%) were admitted for further assessment. There were a further 28 admissions to PICU beds. Older adults form a small but important minority of referrals to forensic and PICU services. A single case register would aid further study in this area. Further exploration of the clinical needs of these patients would be useful.
In most cases job satisfaction serves as a protective factor against burnout and the negative consequences of stress at work. Psychiatrists are reported to experience high…
In most cases job satisfaction serves as a protective factor against burnout and the negative consequences of stress at work. Psychiatrists are reported to experience high prevalence of burnout yet their ability to enjoy work and derive satisfaction from it appears not to be impaired. This paper examines this anomaly and the factors that may affect job satisfaction. The consequences of job satisfaction on variables such as staff retention is examined and a comparative account of various rating scales for job satisfaction is presented.
The purpose of this paper is to raise issues around the involvement of clinicians relevant to current policies for integrated care by reviewing a previous policy to…
The purpose of this paper is to raise issues around the involvement of clinicians relevant to current policies for integrated care by reviewing a previous policy to integrate assessments.
This paper is a review of data from a survey of specialist clinicians' involvement in the single assessment process for older people.
The paper finds that clinician involvement was limited, with assessments not changing to a discernable degree and little involvement of older people. Changes to assessment were predominantly related to paperwork. However, the use of standardised tools by clinicians did increase. The use of shared record systems with social services was significantly associated with involvement.
Clinicians have previously not been engaged in policies around integrated assessments. Factors that can help engagement include development of a shared vision, drawing on the traditions of particular groups of clinicians in informing integrated assessment policies, and appropriate IT systems to promote information sharing. Factors hindering engagement include national policy implementation, viewed as inimical to clinical practice and low involvement by service users/patients.
Reviewing such previously implemented polices around integration, particularly at the assessment stage, offers lessons to learn in terms of the factors that may help or hinder the achievement of integrated practice, particularly regarding current policies around clinical leadership.
The Rowan report was published in 2003, following an investigation into allegations of abuse on a ward providing longterm care for older people with mental health…
The Rowan report was published in 2003, following an investigation into allegations of abuse on a ward providing longterm care for older people with mental health problems. The factors identified as important were similar to those identified in other inquiries that took place before and after the Rowan inquiry. Why do organisations fail to learn the lessons of the past?This paper examines what happened following publication of the Rowan report and the ensuing publicity. Some positive outcomes are identified but, putting these in context, it seems unlikely that they will prevent further incidents. How do organisations prevent incidents/suspicions of abuse? The author suggests a multi‐level approach and argues that residential and nursing care is at least equally at risk. The fundamental problem lies in society's failure to prioritise and adequately resource the care of older people with dementia and other mental health problems.