Characteristics of a later life population in a general adult community mental health service setting

Objectives: Globally, increasing life expectancy has escalated demands on psychiatric services caring for a later life population. It is recognised that those with enduring mental illness may have specific needs with advancing age. In this study, we describe the characteristics of a population aged over 60 years attending a general adult community psychiatric service and compare demographic and clinical features across age and diagnostic categories. The study aims to gather preliminary information which may guide future local mental health service planning. Methods: We conducted a cross-sectional observational study using retrospective chart review of all patients aged over 60 years attending four community mental health teams in North Dublin. Cohorts of attenders were stratified by age comparing 60–64 year age group with the population aged 65 years and over. Attenders were also stratified by diagnosis and regression analysis was used to determine predictors of psychotic disorder diagnosis. Results: The study included 127 patients. There was a higher prevalence of psychotic disorders among those aged 65 years and over (n = 73), while those aged 60–64 years (n = 54) were more likely to have depression and non-affective, non-psychotic disorders. Among the population aged 65 years and over 78% (n = 57) were long-term psychiatric service attenders. Conclusions: The majority of the sample aged 65 years and over were long-term service attenders with a diagnosis of severe mental illness. Further research is warranted to determine optimal service delivery for later life psychiatric service attenders.

The interface of general psychiatric and forensic psychiatric services

This chapter examines community psychiatric service provision for mentally disordered offenders, focussing on the United Kingdom and United States. In doing so, it acknowledges that mentally disordered offenders are at risk of rejection and of falling between services. They are doubly stigmatized by having a mental illness and being offenders. It explores the context, commissioning, components of a service, and models of care (including the evidence base for them). Also considered are the pros and cons of specialist services, as well as how they might differentiate their task from that of the CMHT. The chapter concludes by considering how services can work together to meet the needs of this complex and challenging group of patients.

Lessons to be learned from the oldest community psychiatric service in the world: Geel in Belgium

SummaryThis article reviews the family foster care model practised in the small Belgian town of Geel. A historical introduction is followed by a description of a family foster care project in its current form. Issues are raised as to whether the current culture of care pathways, managed care, payment by results and an emphasis on ‘cure’ are conducive to recovery as promoted by the recovery model. Finally, the lessons from Geel are summarised and it is argued that there is much that can be learned from this way of working to support the recovery movement.