We rightly challenge all types of discrimination that assign more importance to physical health than mental health

I feel excited, privileged and perhaps a little overwhelmed to have been appointed the first National Speciality Advisor in Older People’s Mental Health (OPMH) at NHS England and NHS Improvement.

This position could not have been created at a more important time – or a more challenging one with the COVID-19 pandemic demanding the full attention of the NHS. Whilst much of the immediate focus has been on the acute care response, we also need to ensure that mental health isn’t forgotten, especially the mental health of our older people.

The population is ageing. By 2046, one in four of us will be aged over 65. Today, we already have many older patients with more complex physical as well as mental health needs, and a more diverse society with more diverse needs. COVID-19 has intensified this even further and we know there is a lot of work to do to improve the way we care for older people’s mental health. The NHS Long Term Plan (LTP) offers us an unparalleled opportunity to make a difference for older people, an ambitious vision for mental health and its ageing well agenda, and much needed hope for the future. It can be tempting to focus on the worst aspects of dealing with a global health emergency, but I choose to pursue a different view. To me, the pandemic in many ways shows just how brilliant the NHS, social care and local communities can be in bringing about positive change when the need for this is recognised. The response has shown clearly that, when there is a will to change; innovation, collaboration and new ways of working can happen at speed.  We need the same sense of urgency and “can-do” spirit in tackling the many challenges for OPMH, which has long been the Cinderella of NHS and social care provision.

If we go back 70 years, there was almost no special provision for older people’s mental health. In 1960, there were only two old age psychiatrists in the UK. However, with the formation of the Faculty of Old Age Psychiatry in the Royal College and shifting attitudes that challenged assumptions about the inevitability of decline, a transformation occurred.

The pioneers listened to what older people said they needed and focused on these needs. They were innovative and creative, and worked collaboratively with their health and social care allies along with local voluntary sector organisation and community partners. They took an integrated, multidisciplinary approach based on supporting people to remain in their community.

As we look to seizing the opportunities that the LTP brings, we now have the chance to meet these needs – in a way that is more appropriate for our times. We now rightly challenge all types of discrimination, including ageism and attitudes that assign more importance to physical than to mental health.  We are also challenging a system that has become too based on the structures and needs of the organisation rather than the needs of the individual. We have a chance to break up the silos.

Throughout the LTP there are opportunities to improve the ways that we prevent, recognise and treat mental illness among older people. For example via our expansion of access to Improving Access to Psychological Therapies (IAPT) services, our roll out of 24/7 open access crisis services and our expansion and transformation of integrated community services for adults and older adults with serious mental illness. My role will include identifying and promoting these opportunities but it is my colleagues – doctors, nurses, allied health professionals, social care workers, voluntary sector colleagues, and administrators – working alongside the most important people, those older people living with mental illness and their family carers,  who will make this work.  I am optimistic that the next few years will bring the greatest shift for a generation in how we meet the mental health needs of older adults. COVID-19 has put further pressure on our health and social care services but we need to face these challenges head on. It is the responsibility of us all to bring about change and improve the mental health of our nation.

Dr Amanda Thompsell

Dr Thompsell was a GP Principal before retraining in psychiatry and becoming an Old Age Psychiatrist. She has been the Consultant for a multidisciplinary team supporting care homes with nursing and then an old age liaison service in an acute hospital before working in inpatient specialist care. She recently completed 4 years as chair of the Faculty of Old Age Psychiatry at the Royal College of Psychiatrists. 

She was vice chair of the NICE Guidelines development of medicines management in care homes and led on the improving care in dementia workstream for the London Dementia Strategic Clinical leadership group. She was also Clinical Lead for the dementia workstream of the Modernisation Initiative to improve end of life care for those with dementia. 

She is also a medical member of the First-Tier tribunal (Mental Health) for the Ministry of Justice.