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Mental Health: Age Discrimination

My Lords, I thank my noble friend Lady Murphy for initiating this important debate; I thank also the noble Baroness, Lady Neuberger, for being so instrumental in bringing it about. I shall concentrate on discrimination. Although I agree that much progress has been made, which we all applaud, I shall concentrate on the difference in the way in which older people and younger people are treated, specifically in mental health, although of course there are younger people in exactly the same situation. It is estimated that, for every 10,000 people over 65, 2,500—or 25 per cent—have a diagnosable mental illness, 500 of whom will have dementia. That figure is taken from the position statement of the Royal College of Psychiatrists, which the noble Baroness, Lady Murphy, quoted. The noble Baroness mentioned depression. We know that, on an average day in a 500-bed district general hospital, 330 beds will be occupied by older people, 220 of whom will have a mental disorder. We also know that depression is the most common health problem in later life, affecting 15 per cent of older people. However, 85 per cent of older people with depression receive no help from the NHS, which is blatant discrimination. It cannot be excused, however much progress we make. Depression is the cause of 80 per cent of suicides. It doubles natural mortality and it is the major reason for admission to care homes. Those figures again come from the Royal College of Psychiatrists’ position statement of last October. We know that, if you are under 65 and have a mental health crisis, you will almost certainly receive immediate assessment and treatment at home from a 24-hour specialist team. I have personal experience of this from the past few months. I saw a crisis team go to everybody who was younger before arriving at nine o’clock at night—having been called at 7.30 in the morning—to see an elderly person who was in a very bad state. An immediate move is made to the younger person, not to the older person. If you are under 65 and have been admitted to a general hospital, you will probably receive an assessment of your mental health, but if you are over 65, you most likely will not. However, if you have a mental health problem, you are more likely to stay in hospital for twice as long or be discharged to a care home instead of to your own home—again, the Royal College of Psychiatrists has made that clear. I turn to an issue very close to my heart—dementia. Yesterday, the Alzheimer’s Research Trust produced a report that demonstrated that one person in five over 80 is affected by dementia and that every patient costs the UK economy more than £27,000 a year. That makes £23 billion a year overall. However, in the UK, for every £10 spent on research into health and social care, the princely sum of 5p is spent on dementia. Although dementia accounts for over 50 per cent of the combined health and social care costs of cancer, heart disease, stroke and dementia, it receives 6 per cent of research funding. A survey of several thousand people with dementia found that almost 50 per cent of carers said that being in hospital had a very negative effect on the person with the condition. The average length of stay, which is about a week, more than doubles for people with dementia. I am delighted that the Government recently held a research summit on dementia, which I was privileged to chair. A ministerial advisory group has now also been set up. We just hope that, regardless of who wins the general election, there will be a political consensus about the importance of dementia. We hope that all the parties will make sure that, whatever happens, this work continues. I hope that the spokespeople from all parties will make that clear. There is blatant ageism in accessing mental health services. The Healthcare Commission’s report Equality in Later Life, which examined six mental health trusts, found that older people were excluded from mental health services received by young people, that there were very low levels of referrals from GPs to specialist units for mental health sufferers who are older and that there was a lack of age-appropriateness throughout. Two out of the six trusts have made a lot of progress towards eliminating ageism but they have taken very different paths in terms of structure. A common feature was the role of clinical and managerial leaders in bringing about change. A lot can be done. The same report demonstrated that many mental health providers have organised their services into working-age and older adult services, which is reinforced by policy divisions between the mental health and older people national service frameworks. Reaching the age of 65 does not mean that you change very much, but suddenly your services are completely different. In my view, that is very difficult to understand, let alone accept. The unintended effect is definitely a disparity between older and working-age adults. Surely the goal must be that services are based on need, not age, as was made clear by the report to the Secretary of State by Sir Ian Carruthers and Jan Ormondroyd in October this year. We must aim to achieve age equality partly by taking up the recommendation in the Royal College of Psychiatrists’ position statement: ""All professional regulatory organisations will need to review and, if necessary, revise their standards"," and codes of conduct. The statement recommends: ""Comprehensive specialist mental health services for older people must be reconfigured and developed, with an urgent need to provide: access to crisis home treatment … early diagnosis and intervention … care home liaison … general hospital liaison"," and, as my noble friend Lady Murphy emphasised, ""access to psychological therapies"." Surely the biggest discrimination of all in dementia is that a terminal illness experienced mostly by older people is generally treated as being eligible only for social care funding, rather than NHS care. Why is that? Nothing in the proposed national care plan or the Personal Care at Home Bill will radically alter that, so far as I can see, but we must be fair. An Equality Bill is going through the House, intended to achieve fairness in our society. We need the same fairness, whatever our age.