Memorandum by the Christian Council on
Ageing
INTRODUCTION
Since its inception in 1982 the ecumenical Christian
Council on Ageing (CCOA) has worked to ensure that older people
remain high on the agenda of the churches and to provide a corporate
voice in consultations such as that promoted by the European Green
Paper on EU Mental Health Strategy. This response has been drawn
up by Dr Daphne Wallace, chair of the CCOA Dementia Group and
herself an old age psychiatrist, after consultation with the acting
chair of CCOA and members of its executive committee.
1. We would urge that older people be given
a significant place in this consultation and in the strategy and
options for action that may emerge. The population of UK is ageing
and the same is true of many other European countries. Dementia
is estimated to affect some 750,000 persons in UK and one in four
of those over 80. Clinical depression in older people is also
widespread, though not always recognised or diagnosed as such,
either as a concomitant of dementia or otherwise.
2. Progress in the EU as a whole in relation
to mental health of the population will only be possible if there
is, as suggested in the green paper, a comprehensive strategy
on mental health. Such a strategy should give goals towards which
all member states can aspire and work together to improve situations
which impair the mental health of its citizens. Such a strategy
would also serve to address the inequalities between the situations
in different member states.
3. Such a strategy would need to encompass
promotion of mental health, prevention of mental ill health and,
importantly, the promotion of appropriate, flexible, person-centred
care for those with mental health problems especially severe mental
illness. The importance of the recognition of spiritual needs
and the evidence regarding its impact on positive mental health
should also be taken into account. Use of appropriate medications
should not be influenced purely by cost. Care would also have
to promote appropriate dignity and rights for those with such
illnesses and only then would stigma be reduced.
4. The causes of inequalities and deficiencies
are many and complex. Differences in proportion of health budgets
spent on mental health affect mental health status but there is
not a direct correlation. How money is spent and on whom is also
important. It must be that cultural and other factors influence
what is appropriate and acceptable in different member states.
A comprehensive strategy as proposed should facilitate mutual
cooperation and learning, together with promotion of research,
which can only be beneficial.
5. The proposals in section 5 rightly promote
involvement of stakeholders, including patients, in building solutions.
Many groups have been seen in the past as being unable, because
of their mental illnesses, to contribute usefully to any such
discussions. The changing attitude to people with dementia in
many EU states has increased their ability to make a contribution
to planning their care. Other groups of elderly with mental health
problems have also often been neglected in the face of the needs
of those who are of working age—neglecting the valuable
contribution of the older members of the population to the overall
community.
6. It often seems that the needs of those,
young or old, with enduring mental health problems are regarded
as too expensive, whether long term care is available to people
in their own homes or through 24-hour care. Long-term "warehousing"
of problems is not unknown as a way of ignoring needs and rights
of people who can be hidden away. Even the abolition of the worst
of the old institutions does not prevent unsatisfactory provision
for the need for "asylum" for those most adversely affected
and damaged by enduring mental illness. Not everyone can "recover"
completely but that does not mean that they cannot contribute
to their society given the appropriate support and care. This
is part of the third focus proposed for the EU strategy. Social
inclusion, rights and dignity are important for all.
7. In section 6.1.1 of the paper the proposals
for preventative action are very important. Promotion of mental
health in older people often takes a back seat in provision despite
the known stressors leading to mental ill-health. Support interventions,
as suggested, can improve mental well-being but are all too often
rather neglected in this age group. CCOA has particular concerns
at present with the current situation in UK with regard to prescription
of drugs for dementia. The current view of NICE seems to be that
although it accepts that at least three of those currently available
can be effective, they should not be prescribed, at least until
the symptoms are "bad enough". There are already areas
in UK where people with Alzheimer's disease have never had access
to these medications causing distress and more rapid deterioration
in symptoms. It is important that decisions of this sort are not
made purely in relation to cost.
8. The proposals in section 6.2 with regard
to social inclusion are very important but it needs to be recognised
that not only does the community have to accept those with mental
health problems without stigma, but some of those with enduring
mental health problems cannot cope with the demands of life in
our modern societies. No-one likes to be in an institution, including
those with dementia or severe mental illness, but some aspects
of the institutions were beneficial. A sheltered environment with
easy access to recreation and useful activity may be the most
satisfactory way of preserving the rights and dignity of some
individuals. This does not have to be in an "institution"
but does need to alleviate isolation fear and anxiety. Support
should not mean disempowerment.
9. The use of Compulsory Admission and Involuntary
treatment should be strictly regulated and kept to a minimum.
It should be recognised that within such a legal framework the
rights of the individual may be protected. The Bournewood case
in Britain is an example of these issues. In UK statutory rights
under mental health legislation may help to ensure finance for
appropriate provision which may be less easily available for those
who are not subject to statutory responsibilities. Residential
environments may be very guilty of neglecting the rights and dignity
of residents, whether young or old, especially those with impaired
mental capacity. These issues are powerful examples of subjects
appropriate for consideration in an EU strategy with much scope
for exchange of knowledge and expertise and cooperation in research.
10. It is important that the proposed Dialogue
between states, while concerned initially with mental health promotion
and depression and suicide, should eventually extend to the many
other areas of concern I have touched upon above.
| 
