Mental health problems

Specialist mental health services for older people have grown rapidly and successfully over the past two decades, aiming to offer services that are comprehensive, accessible, responsive, individualised, multidisciplinary, accountable, and systematic. As with all mental health problems, the burden falls on primary care (where minor morbidity often goes undetected) and specialist services tend to be reserved for those conditions and patients where diagnosis and management is problematic. The total cost of caring for people with dementia in the United Kingdom is estimated at £6bn ($9bn) a year¹—a figure whose impact is diluted by the fact that it combines both health and social services. We outline the current evidence of benefit in four areas: services currently available; interventions that have been shown to be effective; rating scales that should be recommended to clinicians for detecting common mental health problems; and the needs of carers.

Summary points

• Recent reports have highlighted the needs of older people with mental health problems
• Mental health problems are underrecognised and undertreated in primary care
• The use of guidelines and standardised screening instruments may improve this
• Caring for a person with dementia is stressful, and carers' needs are being increasingly recognised
• Carer interventions in people with dementia have been shown to be effective in randomised controlled trials
• Depression, the commonest mental health disorder in later life, is eminently treatable, but psychological therapies are underused