A psychiatrist's view

Dr Tony Rao is a Consultant Old Age Psychiatrist working at North Southwark Community Mental Health Team for Older Adults and is also a visiting researcher at the Institute of Psychiatry, King’s College London.

Having spent the best part of every working day for the past 15 years seeing older people in their own homes in one of most deprived areas of South East London, I never cease to reflect on the fact that I came to work here for a reason. It may surprise readers to learn that in spite of coming from a medical family, I spent my early years living in the most deprived area of Cambridge. Both my parents were immigrant doctors who chose non-consultant posts and the friends that I had were far from the stereotypical rich middle class children of suburbia. It was a humbling experience.   

No surprise then that I chose to work where I do. Although there is a high level of deprivation and one of the highest rates of alcohol misuse in the country for older people, the level of complexity in everyday clinical work means a challenging but immensely satisfying experience in really making a difference to improve the mental health of older people.

We cannot close our eyes to the swingeing cuts that the NHS has witnessed, decade on decade. In fact, many evenings and weekends as a child were spent accompanying my parents to their places of work. Both worked in community based hospitals, one in psychiatry and the other in care of the elderly medicine, but both were closed in the early 1990s in order to save money. This led to a rapid expansion of community based mental health teams all around the country over the next decade, my team being one of hundreds around the country.

Working with a vulnerable, hidden and forgotten group of older people whose problems often first come to light only when they present in crisis makes mental health professionals strong advocates for patient care. Many older people with mental illness expect little, have little political lobbying power and can languish in relative isolation with problems such as depression, dementia and alcohol dependence until their problems are discovered only because they have not paid their rent or have fallen over at home. Assessing, treating and coordinating their care can prove a Herculean task.

Some do not think that there is a problem, others do not think that anyone or anything can help them and more still believe that anyone seeing them at home must mean that they are going to be ‘put in a home’ or even ‘locked up’. Little do they or the public know that many mental health problems in older people can and do improve. The final episode of Bedlam is testimony to this. Working in partnership with patients in their own homes and respecting choice, dignity and independence is a far cry from the straightjackets and chemical cosh of yesteryear.

Doctors working in older people’s mental health have deliberately chosen to tackle the least popular area within one of the least popular specialties in medicine. Only about 5 per cent of medical students choose this specialty. I hope that Bedlam will play a special part in the history of media, by changing attitudes to both people with mental illness and those who care for them. Not only do we think that we can make a difference, we know we can. All we need now are the resources and the opportunities to make life changing decisions for the older people who so desperately need the skills that have taken us years to master.


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