Mohammed T. Abou-Saleh

Principles and Practice of Geriatric Psychiatry.Editors: Professor John R. M. Copeland, Dr Mohammed T. Abou-Saleh and Professor Dan G. BlazerCopyright & 2002 John Wiley & Sons LtdPrint ISBN 0-471-98197-4 Online ISBN 0-470-84641-03The Development in BritainTom ArieUniversity of Nottingham, UKPsychogeriatrics, the psychiatry of old age, was born as a serviceactivity some 25 years ago; in 1989 it became an official specialtyin the National Health Service (NHS). Until the 1960s interest inthe mental disorders of old age had been largely confined toresearch, but today special psychiatric services for old people arewidely established, and the care of mentally ill old people isrecognized as a major issue by professional workers, governmentsand the lay public, not only in developed countries but also in theThird World. Britain has led this movement.ORIGINSAt the end of the 1960s, about half-a-dozen psychiatrists wererunning psychogeriatric services. Now there are some 450 andmost health districts have such a service 1 . This movement has thebacking of government and of the relevant professional andvoluntary bodies. The origins of this service specialty are five-fold:1. Pressure of the increase in the numbers of the aged,particularly of the very aged.2. Growth in psychiatry’s capacity to treat conditions previouslyregarded as hopeless 2 .3. The movement of psychiatry from mental hospitals intopeople’s homes, and into the general hospital.4. The effectiveness of geriatrics in British medicine.5. The writings and teaching in the 1960s of a small group offigures such as Sir Martin Roth and David Kay in Newcastle,Felix Post in London, and the pathologist Nicholas Corsellisat Runwell, on epidemiology 3 , clinical features and prognosis 4–6and pathology of the mental disorders of old age 7 .In 1966 a paper from Newcastle 8 emphasized the intertwiningof physical, mental and social factors in the psychosyndromes ofold age, and called for general hospital facilities for collaborativeassessment of these complex disorders. Other writers wereconcerned with the possibly damaging effects of ‘‘misplacement’’of old people in units of the ‘‘wrong’’ specialty, and DuncanMacmillan, a great psychiatric innovator, with his colleagues setup an early assessment unit and took a special interest in theassessment and care of old people 9,10 .THE PSYCHOGERIATRIC MOVEMENTA symposium at the end of the 1960s 11 stands as a statement of whathad then been achieved, and of the directions in which people werelooking. Half-a-dozen younger psychiatrists were meeting as a‘‘coffee house group’’, sharing their experiences of setting up localservices. They established contacts with government and withnational bodies and they wrote, lobbied and spoke at innumerablemeetings. Above all, they influenced younger colleagues l2 .In 1973 they formed a Group within the Royal College ofPsychiatrists and in 1978, as numbers grew, the Group achievedthe status of a Specialist Section. The Section has providedguidance on development of services, norms for staff and facilitiesand advice on changing issues. Successive chairmen of the Sectionhave reflected the development of the specialty through three‘‘generations’’ of workers.By 1985–1986 some 250 psychiatrists were running localpsychiatric services specifically for the aged 13 , in a variety ofdifferent styles but with a common philosophy; there have beenmany reports describing such services (reviewed in ref. 14).Currently, it is likely that some 450 consultant psychiatrists areprimarily engaged in this work.From the late 1970s, international networks were established,both personally and through bodies such as the World HealthOrganization, the Geriatric Psychiatry Section of the WorldPsychiatric Association, and the International PsychogeriatricAssociation. For a decade a course on psychogeriatrics has beenrun in Nottingham for the British Council, with participants fromover 30 countries; versions of this have been ‘‘exported’’ toAustralia, Israel, Poland and Portugal. An apparatus of educationis established, and the Royal College of Psychiatrists setsstandards for training. There are full professors of psychogeriatricsat some seven UK universities and academic posts areestablished in most medical schools.A TYPICAL SERVICEPrinciples for providing such services, and accounts of resourcesneeded, have been the subject of publications by individualworkers, by the Royal College of Psychiatrists and by thegovernment (reviewed in ref. 14). The Rising Tide from theNHS Health Advisory Service l5 has also been influential.Developments have generally been around a group of coreworkers and facilities, the latter often determined by whathappened to be available in the locality. One, and preferablytwo, psychiatrists will have special responsibility for the aged,working with nursing (including community nursing), remedial,social services, psychology and housing department staff, and withfamily doctors and their teams, with geriatric medical services andwith voluntary and private facilities. The service generally dealswith all forms of mental illness in old age, of which the commonestis depression, and the most exacting is dementia; but old agepsychiatry spans virtually the whole of psychiatry—few problemsPrinciples and Practice of Geriatric Psychiatry, 2nd edn. Edited by J. R. M. Copeland, M. T. Abou-Saleh and D. G. Blazer&2002 John Wiley & Sons, Ltd