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An undignified conclusion

Updated Monday, 14th April 2008

Joan's story is unfortunately typical of many older people in need of mental health care.

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Joan died last week in a Midlands hospital. She was 83. Joan was one of those old fashioned ladies who model their lives on the better natures of the late Queen Mother. However, unlike the Queen Mother towards the end of her life, the care and health authorities failed her. She had a most painful and undignified conclusion.

According to the final report from the UK Inquiry into Mental Health and WellBeing in Later Life, a mental health pandemic and an inadequate Government response mean that over 3.5 million older people who experience mental health problems do not have satisfactory services and support. Joan was one of more recent victims.

She had been suffering from vascular dementia. For the past 3 years, since the death of her husband of 61 years, the family had been able to look after her with the care of an agency. Joan benefitted from pleasant stays at the county respite centre where she became known as ‘the Scrabble Queen’ because of her intelligence and prowess at word games. But, as her behaviour deteriorated, she was forced to leave the safe environs of the respite centre, and under the threat of being sectioned, was admitted to a special geriatric mental health unit in the middle of February.

Playing Scrabble outdoors Creative commons image Icon Vainsang under CC-BY-NC-ND licence under Creative-Commons license
Like these women, Joan used to be a keen player of Scrabble

I visited her there daily for the last 50 days of her life. This was an appalling facility. It was a living testimony to the complacent and systematic disregard by a succession of governments towards those elderly vulnerable people in England who suffer from mental ill health. Stigmatised and starved of resource, the care for such people is in crisis. There is a huge chasm in care, and systematic failures, many of them avoidable, count against the elderly (I have not even mentioned the cruel vagaries of the postcode lottery of provision).

The elderly geriatric mental health facility where Joan spent 42 days of her life resembled a prison. The main door had two double locks. All the doors in the facility were constantly being locked and unlocked. All the games and stimuli to stimulate the patients were kept under lock and key. It resembled a prison. The 8 patients displayed a range of mental ill health symptoms. Some had been there for months. One spent every 20 seconds screaming blasphemies with the other patients sitting around in low chairs, too low most patients struggled to climb out of them. The patients were only there because no where else would have them, or, they had been abandoned by their families, or all the care and nursing homes were full. One kept trying to break out using her Zimmer frame as a battering ram.

Joan was profoundly deaf and suffered from arthritis. She walked with a stick. On many occasions she was left isolated and alone, her hearing aids locked away in the office, or the shared bedroom area, together with her stick. Gradually, she deteriorated. She developed skin tissue sores on her posterior and back. She became less co-operative, and refused some of the dreadful meals, and more critically, her medication.

For weeks, the family tried hard to find a nursing home. All were full. Eventually the family did find a wonderful nursing home which would take Joan and she passed the assessment in the Ward on, irony of ironies, the day before the fall which precipitated her premature death. She died 13 days after the fall in the orthopaedic ward of the local General Hospital.

Her neck was broken in two places in that fall, on the 25th March. Later that day she was sent in a taxi to the nearby General Hospital but returned to the geriatric ward and given aspirin. No X ray was taken. No scan. Over a week elapsed during which the family implored the staff to have Joan thoroughly examined. Two other doctors visited the ward and checked Joan but neither thought there was anything ‘sinister’ wrong.

On the 1st April she was finally taken in agony, and in another taxi, back to the General Hospital. Her pain was now unbearable. There, a doctor immediately diagnosed a critical cervical spinal injury. Joan was admitted but she slipped away, under morphine, on the 7th April.

One of the causes of death was the injury to her spine, sustained under the care of the NHS. Later on the 7th we visited the geriatric ward where Joan sustained the fall. On being told the news staff said nothing, and stood in shock. My partner told them they should take better care of the remaining patients than they did her mother. Some of the patients applauded as she left the ward, which was locked swiftly behind her as she flew the cuckoo’s nest.

The Age Concern report revealed that older people with mental health services are often ignored and receive little support services. It found a poor level of service for people growing older with longstanding mental health problems. Women over 75 are more likely to take their own lives compared to any other age groups, and men over 75 have the second highest suicide rates of all men in the UK.

Dr June Crown, Chairman of the Inquiry, said: ‘Mental health problems in later life are not an inevitable part of ageing. They are often preventable and treatable, and action to improve the lives of older people who experience mental health difficulties is long overdue. Current services for older people with mental health problems are inadequate in range, in quantity and in quality.

‘We have no excuse for inaction, and no time to waste. We need a radical shift to improve services and support for older people with mental health problems. At a time when the Government is aiming to make the most of older people’s contributions, the neglect of older people’s mental health needs represents a waste of human potential that we simply cannot afford.’

With the rising numbers of older people, the situation is set to deteriorate. Without a major change in policy and practice, there will be nearly 1 million with dementia by 2021, and 5 million with depression and 1.7 million with dementia by 2051 – around twice the current numbers.

The report found that older peoples’ mental health issues remain poorly understood, highly stigmatised and are not given the priority necessary in policy, practice and research – despite official reports since at least 2000 highlighting discrimination and calling for action. Two thirds of older people with depression never even discuss it with their GPs, and of the third that do discuss it, only half are diagnosed and treated. This means of those with depression only 15 per cent or one in seven are diagnosed and receiving any kind of treatment.

Even when they are diagnosed, older people are less likely to be offered treatment and the Inquiry heard of GPs who have called depression a symptom of growing older. Joan had such a GP. You will know of others. In 2006, a review of progress against the Government’s National Service Framework for Older people said that since 2001 explicit age discrimination in mental health had not declined.

To date, the Department of Health framework for mental health services has focused only on people up to 65. People over 65 receive different, lower cost and inferior services to younger people – even if they have same condition. Many find they are moved into ‘older people’s services’, regardless of the suitability of these services, just because of their birth date.

The Inquiry’s findings are unequivocal: years of ignorance, discrimination and underfunding must be overturned. There are thousands of vulnerable people like Joan in the system, and tens of thousands of more Joans yet to enter it.

Joan’s family are to pursue a negligent claim against the healthcare trust. Leaving this world with dignity is a right any civilised society should bestow on all its inhabitants. We failed Joan. I hope she might be the last, but I doubt it.

The UK Inquiry into Mental Health and WellBeing in Later Life began in late 2003 out of concern about the neglect of older people’s mental health in policy, practice and research. It is an independent inquiry supported by Age Concern.

 

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