SEC-22b-12
DATE:14 March 2012
RESPONSE OF:The Royal College of Psychiatrists in Scotland
RESPONSE TO: Intermediate Draft Framework Consultation
We are pleased to respond to this consultation. This response was prepared by the Royal College of Psychiatrists in Scotland. For further information please contact: Rebecca Middlemiss on 0131 220 2910 e-mail
The Royal College of Psychiatrists is the leading medical authority on mental health in the United Kingdom and is the professional and educational organisation for doctors specialising in psychiatry.
The Royal College of Psychiatrists in Scotland welcomes the opportunity to respond to the Intermediate Draft Framework and would like to make the following comments:
The College believed this is a very balanced document which highlights the need for this concept to be seen nationally as applying to mental health. The document also highlights some good practice in mental health.It is helpful that cognisance is taken of the central role which psychiatry of old age services needs to pay in the reshaping care for older people agenda.
The explicit linkage of more specialist services for people with dementia to reducing delayed discharge within the umbrella of Reshaping Care for Older People is to be welcomed. Strategic thinking on older people tends to proceed separately from that on mental health with only lip service paid to demographic realities and trends in the latter.
The placing of leadership for intermediate care within local health and social care partnerships is logical as the integration agenda evolves but does re-ignite concerns about the poor track record of many CHPs in respect of the mental health of older people. Some progress is beginning to be seen in relation to dementia since publication of the national strategy but services for those with functional disorders continue to lag behind their counterparts for working age adults, particularly access to psychological therapies. Clear reference to the possible implications of Age Discrimination legislation is lacking.
Geriatricians are mentioned specifically, but not Old Age Psychiatrists, and it is thus unclear whether the latter are seen as part of the agenda under discussion or whether it is envisaged that Community Mental Health Nurses will function with generic, rather than specialist, medical support. Reference to the role of Old Age Psychiatry liaison services within general hospitals appears restricted to the excellent, but atypically well resourced, situation in Aberdeen. The focus of the national dementia strategy on this is again to be welcomed but has not translated to other mental health issues for older people. Even delirium has received disappointing little attention to date despite obvious overlaps of affected patient populations.
Participation of psychiatric services within the ambit of a single access point would seem useful for reducing artificial divisions between disciplines. Having personalisation explicitly encompass mental health would also appear a positive step. Operational as well as strategic coordination is a similar approach to that being advocated in relation to dementia and the latter’s often unacknowledged role in delayed discharge emphasises the sense of such communality. Physical and mental comorbidity is not mentioned explicitly but would be similarly amenable and the psychological dimension to Comprehensive Geriatric Assessment has made an important contribution to progressively more holistic care.
The inclusion of depression and anxiety alongside dementia in terms of impact within general hospitals represents something of a landmark and will hopefully not be an isolated occurrence. The importance of psychological needs across admission, duration and institutionalisation has long been underestimated, if not frankly ignored, and the dual approach of liaising with psychological services, where these exist to a meaningful extent, plus extending the skills of existing staff has much to commend it. Likewise, some of the examples and scenarios are potentially inspirational and could be strengthened even further by confirmation that they had survived, and hopefully been extended, beyond project status as well as by details of the disinvestment or reinvestment agreements involved.
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