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Mental Health: Age Discrimination

My Lords, it is with particular feeling that I express my gratitude to the noble Baroness, Lady Murphy, for tabling this Question, to which she spoke, as ever, so compellingly. I add my thanks to the noble Baroness, Lady Neuberger, for the conspiracy that she entered into with the noble Baroness, Lady Murphy. I was shocked when I looked at this subject closely. We owe it to the Royal College of Psychiatrists and to the former Healthcare Commission for publishing the evidence of what is little short of a national disgrace. In using that phrase I am not necessarily pointing the finger at the Government, for reasons that I shall explain in a minute, but, nevertheless, I am sure that the Minister will agree that the systemic failings highlighted in the debate cannot now be ignored. They require action both at the centre and at every level of the health service. Her reply today will be listened to and noted with more than usual attention. I am the first to say that mental health services in general are a lot better than they were a few years ago thanks to the investment that has been made in them. However, it is sadly all too clear—the noble Baroness, Lady Greengross, gave some statistics—that those services are not available to nearly the same extent for older people. I am not going to repeat the statistics; we all have as our bible the compendium of evidence assembled by the Royal College of Psychiatrists, which will be our point of reference for the foreseeable future. The evidence assembled by Age Concern should also pull us up short. While I shall not repeat some of its figures, a few have not been mentioned today. They are figures that fall on the other side of the equation—what all this is costing us as a country. According to Age Concern, if we do not satisfactorily meet the mental health needs of older people over the next few years, the UK economy will suffer to the tune of £245 billion per year in lost consumers, £230 billion in lost workers, £15 billion from the absence of lost carers, and so on. Therefore, there is an imperative of a purely economic kind, never mind the one that we first think of—the cost in human terms. If as an elderly person you are seriously mentally ill and you find yourself in hospital, your prognosis is particularly poor. You are likely to stay in hospital longer. You are more likely to lose independent function. You are more likely to die. To my mind, admitting an elderly person to hospital because of their mental state is to admit that the system outside has failed them. What is going wrong? The royal college points to several things. One is the arbitrary cut-off at age 65 between adult mental health services and health services for older people. That cut-off, to which other speakers have referred, is less the result of deliberate action on anyone’s part than an unlooked-for consequence of the way in which services have been configured to conform to, on the one hand, the National Service Framework for Mental Health and, on the other, the National Service Framework for Older People. The age cut-off is of course lacking in any clinical significance, but it is also wrong in principle, because, as we so often say in this House, people of all ages have a right to expect that they will be treated under the NHS on the basis of need, not by reference to how old they are. The other main factor underlying this picture relates to professional training—the lack of training combined with misplaced cultural attitudes towards the elderly. The problem that the noble Baroness highlighted cannot be solved overnight or by passing an Act of Parliament. It is quite clear that the needs of older people are too often not properly understood at primary care and community level and, because of that, they are not being correctly addressed. Older people’s mental health needs are different from those of the young, which is why we have to think about how to meet those needs in a way that also looks at the older person’s total circumstances, including their physical illnesses. I was glad that the noble Lord, Lord Crisp, mentioned co-morbidities. It is not enough just to identify depression in an older person and then treat it. We need to look at the causes. Very often older people feel isolated and lonely. There can be all sorts of reasons for that. Someone who is incontinent may be afraid to go out. Someone whose toenails need cutting may find it painful to walk. Someone whose eyesight is poor may not be able to manage in the street. Yes, we need specialist mental health services for the elderly, but this is also about holistic care of the elderly in the community, and the services required to deliver that are often neither complex nor particularly expensive. We rightly hear a lot in the news about the increasing incidence of dementia, but the World Health Organisation is warning that, in 10 years’ time, depression will be the second highest health burden that we have to deal with. The number of people who live alone is steadily increasing and the availability of informal care is shrinking. Although we talk about wanting to keep elderly people in their own homes for as long as possible, we have to remember that a care home can provide an older person with company and stimulation. Delivering primary care services direct to care homes, as the noble Baroness, Lady Meacher, was right to tell us, is also very cost-effective in terms of patient outcomes and the use of professional time. However, with rising numbers we must invest in people. The way ahead lies in having clinical teams with the right skill sets, which are capable of providing age-appropriate services, including mental health services in the community. Age-appropriateness is important. There are examples of good practice and there are some good government initiatives, including New Horizons and the national dementia strategy, but if there is one message that we need to take from this debate it is surely that time is now of the essence.