Psychiatric Bulletin (2003) 27: 235. doi: 10.1192/pb.27.6.235
© 2003 The Royal College of Psychiatrists
Psychiatric Bulletin (2003) 27: 235
© 2003 The Royal College of Psychiatrists
Caring for people who enter old age with enduring or relapsing mental illness (‘graduates’)
CR110 2003 12 pp £5.00
This document has been produced jointly by the Faculty of General
Psychiatry, the Section of Rehabilitation Psychiatry and the Faculty of Old
Age Psychiatry.
Its purpose is to define and encourage good practice in the management of
mental disorder in people who suffered from enduring or episodic severe mental
disorder throughout adulthood and are now reaching old age. Such people are
sometimes described as ‘graduating’ from services designed for the
needs of adults of working age to those designed for older people. These
patients are potentially at risk of neglect or sub-optimal care by services
because of changes that have occurred in the organisation and responsibilities
of services over the past 30-40 years. Their particular needs have never been
addressed in policy documents. The principles of care for people with mental
disorder, as outlined in the ‘National Service Framework for Mental
Health’ remain applicable to them, although in many instances their care
will fall to specialist services for older people working within the
‘National Service Framework for Older People’.
Previous generations of graduates lived out their lives in mental
hospitals. Many are now housed in hostels, residential or nursing homes, or
may be supported with complicated packages of care in private households.
Estimates of the most severely affected range from 11 to 60 per 100 000
population. The majority suffer from chronic schizophrenia or relapsing mood
disorder. Many continue to demonstrate evidence of florid symptomatology as
well as defect states. Their physical health is often poor and they might have
no social infrastructure other than that provided by statutory services. Some
have been relocated out of their district of origin as part of a mental
hospital closure programme, and might have lost contact with their original
services. New graduates often encounter difficulties when general psychiatry
or rehabilitation services feel that they should give way to services for
older people.
Recommendations to services
- Each local health and social care economy should identify all graduates as
characterised.
- A full reassessment should be made of each individual's current health and
social care needs and a care plan should be agreed, designed to meet these
needs within available resources. Progress towards improved care and improved
health should be monitored by annual reviews.
- For people who are currently approaching the age of 65, their birthday
should trigger a comprehensive review of health and social care needs.
Following this review, a care plan should be agreed and be subject to annual
review.
- Medical responsibility will rest with a principal in general practice or a
consultant psychiatrist, and maintenance of continuous review should be the
responsibility of the case manager.
It is intended, with the support of the National Institute for Mental
Health for England, to monitor progress in the implementation of these
recommendations and to publish the findings annually.
