Dan Neville (Limerick West, Fine Gael)

I welcome this timely debate on services for the elderly. We have already discussed the home help service, nursing home services, assistants in the community and assistance for carers, all of which are important in terms of the State's duty of care to the elderly.

I wish to deal specifically with one of the most neglected areas of service for older people, namely, mental health services. As life expectancy grows it is increasingly important to consider the mental health needs of people in later life and to provide a comprehensive range of services appropriate to their needs. While all users of mental health services are entitled to know their rights, what services are available and to access those services it is crucial for older people who have mental health problems. In addressing services for older people the Health Service Executive must subscribe to their inherent worth, respect and dignity and care for them on the basis of equity, fairness and accessibility. This is not only for those who are accessing mental health services but all services. We make decisions for elderly people. I see this all the time especially in discharging from general hospitals. We assume they do not have a view, a concern or a choice in regard to services. Of prime consideration is that the mental health services for older people should be person-centred and promote self-determination.

The role of carers in the older person's life should be considered in every aspect of the service provided for them. It is essential that carers be given support and education on the complex and challenging mental health problems experienced by those in care, especially the elderly in care. People of advancing years are faced with a number of stresses and challenges resulting from a loss of close attachments, their partner and friends, changes in their vocational and social role, retirement, being unable to have the social life they previously enjoyed and the depletion of their health and physical capacities.

The main conditions that come within the remit of the mental health services area are functional disorders of which depression is the most prominent in older people, organic brain disorder, particularly dementia and Alzheimer's, anxiety, substance abuse, mainly alcohol, and to a lesser extent psychosis which they experience for the first time. We assume that psychosis, like schizophrenia, occurs at a younger age but it also occurs for the first time in the elderly.

The gaps in the existing mental health services for older people include the following: an absence of mental health services in many catchment areas, incomplete multi-disciplinary representation in almost all mental health services for older people teams, a lack of specialised assessment and treatment in most acute admission settings, inadequate accommodation and continuing care facilities under mental health legislation, a lack of dedicated day hospital facilities in almost all services, a lack of emphasis on recovery and positive coping skills in existing service provision. In other words, many of the elderly, if they receive psychiatric treatment and are emotionally assisted, recover.

Primary care should be a critical component in preserving and promoting good physical and mental health in older adults. They should have regular contact with these services. That offers the possibility of identifying problems arising from social isolation, unsatisfactory living conditions and physical health problems. Given that most mental health problems in older persons will first present in the setting I have just outlined, it is important that the awareness level of primary care personnel is honed by education, through formal and informal means, to detect and intervene appropriately.

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