Introduction

At present, there is an intense policy, practice, education and research spotlight directed towards mental health and older people. As Professor Jane Gilliard states in the Foreword to this book, in the United Kingdom (UK) this is reflected in successive policy reports which have recently culminated in the publication of New Horizons: A shared vision for mental health (Department of Health 2009). This important document sets out a vision for a public mental health strategy [defined as ‘the prevention of mental ill health and promotion of mental health’: Department of Health 2009: 18] for the whole population whilst simultaneously addressing prevention, early intervention and treatment and a recovery approach from mental illness. Such strategies are to be placed within a life course approach (younger years-mid-adult years-older years), whilst also setting out a commitment for non-discriminatory services whereby older people are to have access to the same mental health services as are available to younger people, such as Crisis Resolution and Home Treatment services, assertive outreach services, Improving Access to Psychological Therapies and psychological services (Department of Health 2009: 84: Annex A). New Horizons defines older people as those over the age of 65 years (Department of Health 2009: 84), continuing a social and societal view on what it is to be ‘old’ that is embedded within our collective consciousness and aligned to social and public policy configurations of retirement. Whilst a life course approach and commitment to service equality is to be welcomed,

the New Horizons report (Department of Health 2009) contains some implicit assumptions about the design and delivery of mental health services that are still to be resolved. For example, is working with older people with mental illness the same as working with younger people with mental illness, the only difference being the passage of time?; do recovery-based models make sense when applied to older people?; how do people with dementia fit within a recovery approach?; is age attainment/division the best way to shape, deliver and fund a mental health service, or should this be constructed solely on the basis of need?; and what specialist evidence, training and skills exist in the preparation of practitioners to work in the field of later life mental health care? These are searching questions and are not confined to the shores of the UK. Indeed, a

European consensus paper on mental health and older people (Jané-Llopis and Gabilondon 2008: 6) found that older people (those over 65 years) have the highest suicide rates in Europe and that depression, chronic and painful illnesses and social isolation present in 71-95 percent of all completed suicides. The report also linked physical health and functional limitations to mental health problems in later life with socioeconomic inequalities in health consistent amongst older people in the European Union. Interestingly, the report also found that the most pressing area to be addressed across

member states was the reduction of stigma followed by, in descending order of priority, promoting active ageing and social participation; implementing prevention strategies: depression, anxiety, suicide, dementias, elder abuse; improving physical health; integrating services to support older people; undertaking carer interventions; improving the overall knowledge base; and capacity building and training (Jané-Llopis and Gabilondon 2008). Contemporaneously, in the UK, this call for a more equal and inclusive agenda for

older people’s mental health was echoed in a high-profile and forthright consensus statement issued by the Mental Health and Older People Forum (2008), from which the following quote is taken: ‘All [original emphasis] of mental health in later life must be accorded the highest priority in terms of sustained vision, leadership and policy ownership, not falling through gaps between mental health and older people’s policies. (p. 3)’ Mindful of this vision, as Editors of this book we have drawn on our practice,

research and education experience of over 20 years each to respond to these priorities within a meaningful practice context: John during his role as a mental health nurse specialising in dementia care since the late 1980s, and Sue as a clinical psychologist working in older people’s mental health from around the same time. Indeed, Sue remains embedded in practice in her role as Head of Psychology for Older People (Salford) at the Greater Manchester West Mental Health NHS Foundation Trust, whilst John holds a joint (older person’s mental health nursing) appointment between the same Mental Health NHS Foundation Trust and The University of Manchester. It is this complementary professional background and contemporary practice experi-

ence that has guided the philosophy behind the production of this book. As Editors, we are not trying to make grand claims and assumptions within the text about revolutionising mental health services for older people; rather, we have seen this book as an opportunity to hold a mirror to the mental health and later life field in the UK to see what works, why, and who is involved in multi-disciplinary care provision. Just as importantly, we seek to pose a question: where do we want to go?