Older Mind Matters

Of mice and men - the best laid schemes ....


Happy 2013 to everyone I know, to those who work with Older Mind Matters Ltd, and those who read the blog.

As 2013 starts I look backwards and forwards based on some themes from 2012:

· Specialism versus generalism: I have mixed feelings about this. Older people’s mental health specialises in dealing with the problems that get more common with increasing age or become particularly troublesome with the complications of later life. Dementia is the classic condition, but also depressive illness, which is often associated in older people with the social, economic, physical and psychological complications of getting old. Yet it doesn’t seem fashionable to be a specialist at the moment. At the same time I believe that old age psychiatrists are generalists in the sense that often they will tackle whatever problems they are faced with (drugs, alcohol, interesting personalities etc). There is a move, though, to have sub-specialities within older people’s mental health and I’m not sure that this is particularly helpful (with apologies to esteemed colleagues who fall into this category).
· ‘Ageless services’: Connected with specialism, I am heartened to learn of the recent initiative of the Royal College of Psychiatrists in calling for a halt to so-called ‘ageless’ services - see the College newsletter. Congratulations to all those involved.
This leads on to the issue of -
· The changing shape of old age psychiatry. Older Mind Matters is part of that changing shape, in working outside the NHS. I sometimes wonder how I can do that as a firm supporter of the NHS and someone opposed to privatisation of services. It illustrates how one needs to be able to live with contradictions. If old age psychiatry is to cope with future demographic changes, then it will inevitably have to evolve. Perhaps one sign of that is that I now work in a primary care memory clinic, see my post in August 2012 for more information. 
If you want to now why I took early retirement see my piece on pages 4-5 of the Spring 2011 Old Age Psychiatrist Newletter entitled Sailing into the wind (but please note – I’ve tried it many times and it can’t be done!)
· Psychological treatments: I’m developing my practice as a systemic therapist so this is an important theme for me. Yet my fellow blogger in December linked this with the specialism/ generalism issue (see link). I think access is a bigger issue, both access to psychological therapies and to therapists who are open to trying to understand (and work with) the issues and challenges of later life. For me it links with the challenges in all areas of health and social care to be both person-centred and relationship centred.

4 comments (Add your own)

1. David Jolley wrote:
Well you set me to remember the Steinbeck book and then flick on to The Grapes of Wrath – sad stories of exploitation and spoiling by thoughtless people with power and no care
The College’s letter is marvellous and strong for including the range of signatures from President Sue Bailey (Manchester), Nori (Alzheimer’s Society) as well as three Chairs of the Old Age Faculty together with a general Psychiatry view.
Let us hope it has an effect. I have wondered about sending a copy to the Guardian today but became distracted with teeth, dentists (or lack of them), dogs and a church survey which could have been better thought through.

Let’s see how the time goes – The Guardian might still be in for a message

The future of services based in Primary Care is a secure winner and your expansion of the vision and practice to include family Therapy and other psychotherapies will move things on. These are important changes which will cultivate the ground in which people are living and being cared for. So, continuing with Steinbeck, we will reverse the trend toward denaturing the soil and leaving a dustbowl while everyone goes in search of ‘state of the art’, ‘cutting edge’ new technologies which are appropriate and affordable for only a few. This will be a greener, sustainable future – plenty that will make men, women, mice and spiders much happier

Mon, January 28, 2013 @ 8:33 PM

2. David Jolley wrote:
Oh - Happy New Year to everyone - Well to most

Mon, January 28, 2013 @ 8:34 PM

3. Victoria sharman wrote:
The idea of specialism and generalisim draws my attention to the tension between medical and psychosocial models. On one hand I agree with the call for the protection of expertise and specialism in old age services. However, I wonder whether specialism might be a barrier to integration, collaboration and partnership across psychological services.

I welcome the role of psychiatry in primary care and I see this as supportive of all groups in particular for BME groups in encouarging access to dementia care. I connnect to the stigma associated with dementia - One male carer said "I went to my GP for help for my wife's dementia and they sent me to a mental hospital ..."(Sharman 2010, unpublished).

Recent publication by Ruth Elvish et al 2012, BACP recommend some key issues around developing studies that measure the impact if psychotherapy and counselling on carers of people with dementia and the effectiveness of various types of intervention. In the studies they used mixed methods based on individual/ groups counselling approaches like CBT, Gestalt, transactional analysis but not family therapy approaches.

I wonder if specialism tends to emphasise scientific approach more and generalism about clinical/research practice and interventions.

Fri, February 1, 2013 @ 11:11 PM

4. Susan Mary wrote:
Thanks Vistoria. The review Victoria refers to can be downloaded from the BACP website. Go to:

http://bacp.co.uk/admin/structure/files/pdf/9346_dementia.pdf

(If the link doesn't work just copy it and paste it into your browser.)

Sat, February 2, 2013 @ 11:04 AM

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