Mental Health and Ageing

1
Mental Health and Ageing

• Differing ways of viewing mental
  distress/illhealth
• Specific considerations for those over 65
• Current responses to mental distress/illhealth
• The specific issue of dementia

2

Organic or Disease and Medicalised Approaches
It is unusual for those who receive a diagnosis
of mental illness to remain completely untreated.
The great bulk of patients receive biological
interventions, usually psychotropic drugs,
occasionally ECT and, very rarely psychosurgery.
Such treatments are also routinely prescribed
alongside talking treatments. Thus virtually
everyone with a mental health problem has access
to biological treatments or may have them
imposed (Rogers and Pilgrim, 2003190)
3
Organic or Disease and Medicalised Approaches Key
points

• Dominance of organic or disease or medicalised
  approaches in defining mental illness
• Both emphasise symptom diagnosis treatment
  continuum with medical models adopting a more
  biopsychosocial approach
• Treatments predominantly drug orientated with
  some opportunities for cognitive, talking and
  group therapies
• Advantages ready availability of pharmaceutical
  treatments. Individual and families are not
  responsible for behaviour
• Disadvantages individual subject to control and
  care with the possibility of compulsory detention

4
Social Orientations Postpsychiatry
The idea that mental illness (we prefer to talk
about states of madness, distress or alienation)
is not simply located in individual heads. It is
a social phenomenon through and through, and as
such requires a social response. If we take the
views of service users seriously and acknowledge
the loss of social position that comes with
using services, then we must prioritise our work
with communities (Bracken and Thomas, 2004
13) Poverty, racism, unemployment, loneliness,
relationship difficulties, spiritual conflicts,
sexual abuse and domestic violence are at the
heart of mental health crises. These phenomena
occur within and are shaped by, different
cultural orientations to the world and to
suffering and healing. Pills or therapy cannot
resolve suffering, and may only make matters
worse by obscuring the real reasons for distress
and alienation (Bracken and Thomas, 2004 13)
5
Social Orientations - Postpsychiatry
Most psychiatric diagnoses are nothing more than
a particular way of formulating and naming a
persons problems. Psychiatric diagnosis is often
little more than a simplification of a complex
reality, and by formulating an individuals
experiences in terms of pathology it can be
profoundly disempowering and stigmatizing
(Bracken and Thomas, 2001 19)
As doctors, we are taught to encounter phenomena
such as voices, self harm, sadness, suicidal
feelings and paranoia as psychopathology
symptoms of disease processes. Our diagnosis and
treat medial models an easy fix. Our diagnoses
explain quickly our drugs deaden immediately.
But increasingly, service users tell us that this
approach robs their experiences of meaning and
strips them from the lived context (social,
cultural, personal) in which they have arisen
(Bracken and Thomas, 2004 7)
6
Social Orientations Postpsychiatry Key Points

• Faith in ability of science and technology to
  resolve human and social problems is diminishing
• Psychiatry has to engage with perspectives of
  service users/consumers
• Postpsychiatry emphasises social and cultural
  contexts, places ethics before technology and
  works to minimize medical control of coercive
  interventions
• Postpsychiatry challenges notions that
  psychiatric theory is neutral, objective and
  disinterested
• Postpsychiatry provides doctors with an
  opportunity to redefine their roles and
  responsibilities

7
Specific Considerations for those over 65
Population trends
Social Causational Aspects income
levels displacement from labour market loss
of significant others entry to residential
care experiences of care
Social Constructionist perspectives how the
behaviour of an older person is constructed
how older people are
constructed in political and policy terms
8
Current responses to mental distress/illhealth
Positive Practice Principles Attention being
paid to quality of life issues Mental
distress/illhealth being responded to in a
sensitive and context specific
manner Adoption of person centred
approach Prevention and promotion of positive
mental health in later life
Negative Practice Principles Mental
distress/illhealth ignored or seen as
inevitable Older people slotted into whatever
service is available whether appropriate or
not All mental distress/illhealth being
associated with dementia All mental
distress/illhealth problems being parked in the
health service arena
9
The specific issue of Dementia
Definitions Traditional neurobiological
approach Person centred approach Social
constructionism Social model of
dementia/disability