Age inclusive services or separate old age and working age services? A historical analysis from the formative years of old age psychiatryc.1940–1989

Abstract

The Equality Act 2010 made it unlawful to discriminate in the provision of services on the grounds of age. This legislation is open to interpretation, but it is affecting the way older people’s services are defined and provided. Historical evidence indicates that, since the 1940s, apart from psychiatrists working in dedicated old age services, most were unenthusiastic about working with mentally unwell older people and unsupportive of those who chose to do so. A historical analysis might shed light on current dilemmas about ‘all age’ or ‘old age’ services and inform decision-making on future mental health services.

Interface between general adult and old age psychiatry

“…Hilton's comprehensive review of the history of old age psychiatry (Hilton 2015) shows that, before the 1950s, dedicated old age services were almost non-existent. The stereotypical view of the inevitability of decline with older age undermined proactive approaches to treatment.…”

“…Services for older people have continued to lag behind those for younger people (Anderson 2013; Hilton 2015). Since the 1970s, policies for older people have appeared after those for younger people, reinforcing the idea that the needs of older people are less pressing.…”

“…Hilton found that there were few formal studies comparing the clinical effectiveness of dedicated old age and all-age psychiatric services (Hilton 2015). One study, conducted in 1985–1986, that compared ‘specialised’ and ‘non-specialised’ services treating older people with mental illness indicated outcomes ‘in favour of the specialised services’ (Wattis 1989), suggesting that dedicated services provided more forward-thinking and needs-led care.…”

Old age psychiatry in the modern age

“…The first specialised old age psychiatry services began in the late 1950s. 2 They were much needed! Prior to that, there had been scant regard for the mental health needs of older people.…”

The third New Zealand Psychiatry of Old Age services and workforce survey

“…Psychiatric services to meet the special needs of older people were introduced in the UK in the late 1950s. 3 By the 1990s, old age psychiatry services were available in most parts of Australia and NZ. The Faculty of Psychiatry of Old Age (POA) in the Royal Australian and New Zealand College of Psychiatrists was established in 1999.…”