A prickly bloom

Mental Health Nursing,  May 2000  by Rushforth, David

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Editorial

The first audit commission report out of the blocks this year focused on mental health services for older people. But beneath the glossy presentation, it contains some uncomfortable reading.

Framed within the all-too-familiar target-setting, beloved of central government, this quaintly titled report `Forget-me-not' is more akin to a thorny rose.

There are few surprises. Particular attention is given to the wide variation in resources for elderly care and the effectiveness, or otherwise, of collaboration across health and social agencies in England and Wales. The recommendations are laudable and uncontroversial. What community mental health nurse would disagree with improving information and advice services for users and carers? Who would argue against greater involvement of primary care teams in mental health care assessment or the principle of greater involvement of families in decisions about care?

The need for mental health professionals to provide input into the training and support of general practitioners and primary care teams is self evident, but precisely which mental health professionals is less clear cut. Community mental health nurses working with the elderly are stretched and the report readily acknowledges that the shortage of registered nurses in mental health means no respite.

Although research and training programmes offer a step in the right direction and many community specialists value involvement in primary care education, a balance between clinical and training responsibilities has to be struck. Too little attention is paid in this report to the growing influence of the voluntary sector and particularly the national charities such as Age Concern and the Alzheimer's Society in dissemination of information and advice.

The Audit Commission dutifully promotes the independence of older people and explicitly favours flexible, home-based services to provide support where it is needed, in the home. There is some recognition of good practice, illustrated by examples from the field. The commission will have plenty of opportunity to examine such services at close quarters. They now embark on a series of local audits of both health and social services, with local government thrown in for good measure. Community mental health nurses working for older people should show no fear.

Is this misplaced confidence? The Department of Health does not think so. There is tacit acknowledgement that the collaborative links between hospital and community care for people with dementia offers a reference point for generic elderly care services, which have rather lost their way The National Service Framework for older people will provide the opportunity to draw such parallels.

However, there is no need to wait for yet another report for such recognition. There is much within the Audit Commission's paper that implies that the work of CMHNs complements the style, strategies and goals of government policy What staff need is explicit acknowledgement of their valuable work with users and carers. A note to this effect passed on to the Treasury would not go amiss.

David Rushforth

Copyright Community Psychiatric Nurses Association May 2000
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