Making equality a reality in mental health

VIEWPOINT Dr Dave Anderson Chair of Old Age Psychiatry, Royal College of Psychiatrists

Only 6% of older people with depression receive a referral to mental health services

The Health Secretary, Andy Burnham, says age discrimination in the NHS must end and there is particular concern about the treatment given to those over 65 suffering from mental health problems.

Dr Dave Anderson from the Royal College of Psychiatrists outlines the scale of the problem and says treating everyone equally is not the answer.

The ageing population has been described by researchers as a demographic tsunami.

In 2007, for the first time in the UK, the number of people aged 65 or over was greater than those aged under 16.

The figures are truly shocking. For every 1 million older people with depression, 850,000 receive no treatment whatsoever Read your comments

And this number is projected to increase by another 15% in the next 10 years.

Without doubt, this is the greatest challenge facing health and social care services now and in coming decades.

Yet astonishingly, investment and development in mental health services has explicitly excluded older people.

'Arbitrary age limits'

A Royal College of Psychiatrists' report has revealed that tens of thousands of over 65s are missing out on vital support and risking serious deterioration in their mental health because of arbitrary age limits.

The figures are truly shocking. For every 1 million older people with depression, 850,000 receive no treatment whatsoever.

While 50% of younger adults with depression are referred to mental health services, only 6% of older people will receive a referral.

Numerous examples of older people who have been left without the support they desperately need

In a recent report by the Healthcare Commission, a service audit found that of 1300 referrals for psychological therapy only 49 were for people over the age of 65.

There is no argument that age discrimination exists. Access to mental health services have traditionally been configured by age.

Consequently, people under 65 years old can receive a wide range of support through adult mental health services.

But access to these same services is denied to people over the age of 65. This leads to misery, disability and increased cost to society.

'Suicidal thoughts'

The Royal College of Psychiatrists has collected numerous examples of older people who have been left without the support they desperately need.

Such as Mr M, a 78-year-old man who attended a local hospital emergency department at 10pm on a Friday night. He had become severely depressed after the death of his wife and had suicidal thoughts.

The proportion of deaths by suicide of older people has also not declined as it has for younger adults

But because the 24-hour crisis resolution and home treatment service provided by the mental health trust will only see people younger than 65 years of age, and there is no equivalent service for older people, no support was available to Mr M until the following working week.

Then there was the case of Mrs A, a 72-year-old lady suffering from traumatic bereavement after her son killed himself.

She was willing to have psychological treatment - but the local service for psychological therapy was limited to people under the age of 65.

Her condition remains distressing and she continues to be at risk.

Depression common

Most people think that dementia is the main mental health problem affecting older people but it only accounts for 20-25% of the conditions they suffer.

Depression is three times more common, and the risk of older people suffering from psychosis is much higher than it is for younger people.

All mental health services should be provided to people on the basis of need - not age

The proportion of deaths by suicide of older people has also not declined as it has for younger adults.

Over 80% of suicides among older people are associated with depression - a treatable condition.

There is no justifiable reason why an older person with the same need as a younger person is denied equitable mental health care - yet this is the current position.

If we are to tackle the problems of an ageing population, the barrier that is age discrimination has to be addressed.

'Respect differences'

The Royal College of Psychiatrists believes all mental health services should be provided to people on the basis of need - not age.

Older people must become a focus for health and social care commissioners

But we need to remember that equality is not simply achieved by treating all people in the same way.

It is just as important to respect their differences.

As we get older, the health problems we experience change and certain needs become more common.

It is therefore essential that we further develop specialist mental health services specifically to meet the different needs of older people while ensuring that people can access the full range of services regardless of age.

The Dementia Strategy, Ageing Strategy, Equality Bill and New Horizons mental health strategy are all welcome Government initiatives.

They encapsulate fairness and recognise the special needs of older people.

'Additional investment'

But in addition to these national drivers, there has to be a change in thinking and attitude within services at a local level.

Older people must become a focus for health and social care commissioners.

And serious questions about resource distribution must be asked.

Independently commissioned reports have shown that to provide older people with mental health and social care services comparable to those available to younger adults would require an additional £2-4 billion of investment per year.

This is not an insignificant amount.

But there is both a moral imperative to tackle age discrimination in mental health services, and a business imperative to better meet the needs of older people as more of us live into later life.

This has to be a national priority - we cannot go on wasting opportunities.

Gordon Brown said Mr Blair would make an "excellent president"

Blow to Blair's hope of EU post

Mr Blair has not publicly commented on whether he wants the job

Tony Blair's hopes of becoming president of the European Council are fading after his supporters failed to secure the backing of EU leaders.

Gordon Brown said Mr Blair would make an "excellent president" but there were "many candidates who may come forward".

Meanwhile ratification of the Lisbon Treaty, which creates the post, moved closer after EU leaders struck a deal with the Czech president.

Mr Brown said they had cleared the way for the treaty to be ratified.

No 10 has signalled that a defeat for Mr Blair's candidacy is now "a clear possibility".

'Excellent president'

The former British PM has not declared himself a candidate but British ministers, including Mr Brown who is at a meeting of EU leaders in Brussels, have been talking him up for days.

Speaking at the end of the summit, Mr Brown said: "I think I am right to say that Britain has someone in Tony Blair who would make an excellent president of the Council of the European Union.

"I think there are many people who are members of the council who accept that and believe that to be true."

Gordon Brown: "I believe his credentials are well proven"

But he added: "I recognise also that there are many candidates who may come forward, some have already indicated their intention to do so, but I do believe that Tony Blair will remain an excellent candidate."

At the summit EU leaders agreed to grant the Czech Republic, the only EU state not to have signed up to the treaty, an opt-out from the EU's Charter of Fundamental Rights.

Mr Brown said he believed that the meeting had "cleared the way" for the Czech Republic to ratify the Lisbon Treaty - should the country's constitutional court rule in its favour next week.

Once that happened European member states would discuss the position of the presidency and the commissioners, he said.

'Slim' chance

If it is ratified it will also increase pressure on the Conservatives - who oppose the treaty and say there should have been a referendum on it - to spell out what they will do if they win power and it has come into force.

Conservative leader David Cameron told the BBC: "If that comes to pass we'll set out straight away what our approach to that important issue will be."

The BBC's Jonny Dymond in Brussels said Mr Blair's chances of becoming the first president of the European Council - a post created by the treaty - seemed "slimmer today than before".

POSSIBLE PRESIDENTS? Tony Blair - former British prime minister Jean-Claude Juncker - Luxembourg's prime minister Jan Peter Balkenende - Dutch prime minister Vaira Vike-Freiberga - former president of Latvia Wolfgang Schuessel - former chancellor of Austria Felipe Gonzalez - former Spanish prime minister John Bruton - former Irish prime minister Names in the frame Gavin Hewitt on Blair's prospects Send us your comments

A lack of support from European socialist leaders has served to undermine Mr Blair's chances.

However the leaders failed to back any prospective candidate and have now set up a three-man team to decide on their position.

Austrian Chancellor Werner Fayman, who will be one of the three on the panel, expressed doubts about Mr Blair's prospects.

Mr Fayman said: "My personal opinion is that the candidate ... should have an especially good relationship with (President Barack) Obama and not stand for a good working relationship with Bush."

Spain's Prime Minister Jose Luis Zapatero also failed to endorse Mr Blair. Mr Zapatero said: "We have all heard names. But the work to achieve a larger consensus, that is going to take some time."

Mr Zapatero also raised the prospect that the socialists might instead decide to seek the post of high representative for foreign affairs.

This would leave the presidency open to a centre-right candidate, thereby ruling Mr Blair out

Curry spice 'kills cancer cells'

The yellow spice gives curries their bright colour

An extract found in the bright yellow curry spice turmeric can kill off cancer cells, scientists have shown.

The chemical - curcumin - has long been thought to have healing powers and is already being tested as a treatment for arthritis and even dementia.
Now tests by a team at the Cork Cancer Research Centre show it can destroy gullet cancer cells in the lab.
Cancer experts said the findings in the British Journal of Cancer could help doctors find new treatments.
Dr Sharon McKenna and her team found that curcumin started to kill cancer cells within 24 hours.
'Natural' remedy
The cells also began to digest themselves, after the curcumin triggered lethal cell death signals.
Dr McKenna said: "Scientists have known for a long time that natural compounds have the potential to treat faulty cells that have become cancerous and we suspected that curcumin might have therapeutic value."
Dr Lesley Walker, director of cancer information at Cancer Research UK, said: "This is interesting research which opens up the possibility that natural chemicals found in turmeric could be developed into new treatments for oesophageal cancer.
"Rates of oesophageal cancer rates have gone up by more than a half since the 70s and this is thought to be linked to rising rates of obesity, alcohol intake and reflux disease so finding ways to prevent this disease is important too."
Each year around 7,800 people are diagnosed with oesophageal cancer in the UK. It is the sixth most common cause of cancer death and accounts for around five percent of all UK cancer deaths.

junk food'

Leisure centre 'junk food' alert

Many of the snacks were high in sugar, fat and salt

Vending machines stocked with unhealthy snacks in leisure centres run the risk of fuelling childhood obesity, warn experts.

Crisps and chocolate are on sale where children exercise despite being banned from schools and children's TV, the British Heart Foundation found.
And children's meals on offer at the 35 venues spot-checked were dominated by chips, nuggets, sausages and burgers.
The charity wants stricter regulation over the food choices available.
The report, which was prepared by the Food Commission, looked at leisure centres, bowling alleys, ice skating rinks and park cafes.

It's fantastic that these kids are getting fit and having fun at the same time but this is being undermined by venues peddling junk food at them Chief Executive of the BHF Peter Hollins

The average calorie content of vending machine snacks was 203 calories, which would take a seven-year-old 88 minutes of swimming to use up.
Fresh fruit was displayed at less than half of the venues visited, and nutritional information was displayed at just two of the venues visited.
The BHF said this severely limits the child's and parent's ability to assess the nutritional values of the products they are buying.
Junk ban
BHF chief executive Peter Hollins said: "It's fantastic that these kids are getting fit and having fun at the same time but this is being undermined by venues peddling junk food at them.
"Councils and leisure providers need to rigorously reconsider the food options they are providing and make it easier for parents and children to make healthier choices."
The charity is now calling for public and private sector providers to lead the way in ensuring healthy food options are available and easily identifiable.
It says it should be made a requirement that vending machines in publicly owned facilities are stocked with healthier products.
A Department of Health spokeswoman said: "We are fully committed to encouraging the adoption of healthy vending machines across the country and expect local authorities to make sure there are healthy food options available in their leisure centres."
Confectionery, crisps and sugary fizzy drinks have been banned from all school vending machines in England since September 2007.
Judy Hargadon, chief executive of the School Food Trust, said: "Convenience doesn't have to mean unhealthy.
"Many schools are using vending to offer pupils extra choice and independence whilst still keeping their options well-balanced and consistent."

'Freezer plan' bid to save coral

Coral reefs are a key source of food, income and coastal protection

The prospects of saving the world's coral reefs now appear so bleak that plans are being made to freeze samples to preserve them for the future.

A meeting in Denmark took evidence from researchers that most coral reefs will not survive even if tough regulations on greenhouse gases are put in place.
Scientists proposed storing samples of coral species in liquid nitrogen.
That will allow them to be reintroduced to the seas in the future if global temperatures can be stabilised.
Legislators from 16 major economies have been meeting in the Danish capital, Copenhagen, to try to agree the way forward on climate change.
The meeting has been organised by the Global Legislators Organisation for a Balanced Environment (Globe).
Losing the fight

Key coral reefs 'could disappear'

One of the issues they have been considering is what to do with coral reefs, which make up less than a quarter of 1% of the ocean's floor.
Yet the reefs are a key source of food, income and coastal protection for around 500 million people worldwide.
At this meeting, politicians and scientists acknowledged that global emissions of carbon dioxide are rising so fast that we are losing the fight to save coral and the world must develop an alternative plan.
Freezing samples for the future may be a necessary option.
''Well it's the last ditch effort to save biodiversity from the reefs which are extremely diverse systems," said Simon Harding from the Zoological Society of London (ZSL).
"It would take other work to try and reconstruct the reef so that you can start the process of building up a reef again," he said.
"That is something that needs to be looked at in detail, but we can definitely store the species and save them in that way."
According to recent research, one of the world's most important concentrations of coral - the so-called Coral Triangle in South East Asia - could be destroyed by climate change before the end of this century with significant impacts on food security and livelihoods.

jesus its mustard

The term Christ (or similar) appears in English and most European languages, owing to the Greek usage of Khristós (transcribed in Latin as Christus

As on many other occasions, Jesus answered the question with a parable:

"It is like a grain of mustard seed, which, when it is sown in the earth, is less than all the seeds that be in the earth: But when it is sown, it groweth up, and becometh greater than all herbs, and shooteth out great branches; so that the fowls of the air may lodge under the shadow of it." [Mark 4.31,32]

No doubt the prolific yellow flowers of the mustard plant would be in evidence all around them as the people listened to Jesus' words, since, as one authority remarks, wild mustard is conspicuous in the vegetation around the Sea of Galilee. [Plants of the Bible - Michael Zohary]
The mustard referred to by Jesus is probably which for a long time has been extensively cultivated, and in Bible times was the source of mustard seed oil and was also used as a medicament. It is an annual herb with large leaves clustered mainly at the base of the plant. Its central stem branches prolifically in its upper part and produces an enormous number of yellow flowers and small, many seeded linear fruits. It normally grows to just over a metre in height but specimens have been known to grow as high as five metres.
One writer, travelling in the region of Galilee during the last century, exclaimed: 'Is this wild mustard that is growing so luxuriantly and blossoming so fragrantly along our path? It is; and I have always found it here in spring and a little later than this, the whole surface of the vale will be gilded over with its yellow flowers. I have seen this plant in the rich plain of Akkar as tall as the horse and his rider.' [The Land and the Book - W M Thomson

Giving birth to womb transplants

A transplant would allow women without a womb to bear a child

British doctors say they are a step closer to carrying out the first ever successful womb transplant. Is this really feasible, and indeed desirable?

It is not the first time that doctors have declared a functioning womb transplant is within our grasp, but a surgeon from London's Hammersmith Hospital now claims to have overcome one of the most insurmountable problems: securing the complex blood supply.

Dr Richard Smith, who has presented his latest research on rabbits at a reproduction summit in Atlanta, is now looking for funds to take his work further having failed to secure grants from Britain's big awarding bodies.

For women with Rokitansky syndrome, in which they are born without a womb, or those whose womb has been destroyed by cancer treatment or fibroids, transplant would offer them the chance to bear their own child - an alternative to surrogacy or adoption.

Ethicists, medics and feminists have long argued as to whether infertility is a disease or a cultural phenomenon born of a society where women feel they have no value if they cannot reproduce.

But illness or otherwise, it is not a fatal disease, and the suggestion that women could undergo major transplant surgery to fulfil their desire for a child may prompt unease.

Perfecting techniques

Practical hurdles have beset womb transplants. It has been tried in a human just once, in 2000, when doctors in Saudi Arabia transplanted a womb from a living donor to a young woman.

Initially hailed as a medical breakthrough, the success was short-lived. Less than four months later the organ had to be removed when the transplanted tissue began to die as a result of a blood supply failure. A pregnancy was never attempted.

Researchers have been trying to perfect the technique on a number of animals - from mice to monkeys.

There's a lot of dismissal in the profession in terms of of this being a step too far in fertility management Richard Smith Hammersmith Hospital

More than two years ago, a team of New York doctors said they were nearly ready to carry out the procedure having confirmed that it was possible to remove the womb of a dead donor in the same way as hearts, kidneys and livers are taken for transplant.

Now Dr Smith and colleagues, who have set up a charity called Uterine Transplant UK, say they have perfected surgery on rabbits to ensure an adequate blood supply.

Using a "vascular patch technique" major blood vessels including the aorta were connected. Two of the five rabbits lived to 10 months and dissection after death showed the womb had stayed healthy.

Blood supply is key when it comes to a womb that could take the strain of pregnancy and support a developing foetus. Dr Smith has yet to impregnate the rabbits and see how their transplanted wombs would fare.

Specialists are not convinced. "I think there is a big difference between demonstrating effectiveness in a rabbit and being able to do this in a larger animal or a human," said Dr Tony Rutherford, chairman of the British Fertility Society.

"This is something that is ongoing research. I don't think it's something that is going to be available in clinical practice in years to come."

Finding fulfilment

There will in any event be ethical debate to be had before it is.

The first full face transplant has yet to be carried out, but the string of partial transplants have generated discussion about the rights and wrongs of such procedures for non-life threatening conditions.

When IVF was first developed many people felt very unhappy about making babies in test tubes, and now it is something which the majority accept Susan Seenan Infertility Network UK

It is society's refusal to accept the face distorted by accident or disease which is the problem, it has been argued, not the face itself.

Womb transplants - with the many risks they carry - may trigger a similar response. As well as the surgery itself, the woman in question would have to take immunosuppressant drugs to stop her body rejecting the organ.

Diabetes and osteoporosis are among the consequences of this form of medication which can also lead to renal failure, cardiac arrest, and increasingly, it is believed, cancer.

For this reason the womb would be removed after the desired pregnancies were achieved and the babies delivered by caesarean, as the womb would be unlikely to tolerate labour. The babies would have to be conceived through IVF as surgeons believe these women may run a greater risk of ectopic pregnancies.

But all doctors involved in the field report intense interest from women unable to bear their own children.

"There's a lot of dismissal in the profession in terms of of this being a step too far in fertility management," said Dr Smith.

"But for a woman who is desperate for a baby, this is incredibly important."

Susan Seenan of the UK's Infertility Network said: "Clearly there does come a point when enough is enough, and treatment can go too far. We do need to consider the potential ramifications very carefully.

"This kind of development can make people very uneasy, but when IVF was first developed many felt unhappy about making babies in test tubes - now it is something which the majority accept. We do need to embrace advances in all areas of medicine or we wouldn't be where we are today.

"But we must do more to support the many who are ultimately unable to conceive - and this technique, were it ever available, would only benefit the very few. There is life beyond having children, and while the disappointment may never leave you, with the right support people can find other paths to fulfilment."

Apology to Aboriginees

Apology to Aboriginees richimag

The following is the historic formal apology given to the Aboriginal people of Australia by Prime Minister Kevin Rudd on behalf of its parliament and government.

Today we honour the

Indigenous peoples of this land, the oldest continuing cultures in human history.We reflect on their past mistreatment.We reflect in particular on the mistreatment of those who were stolen generations - this blemished chapter in our nation's history.The time has now come for the nation to turn a new page in Australia's history by righting the wrongs of the past and so moving forward with confidence to the future.We apologise for the laws and policies of successive Parliaments and governments that have inflicted profound grief, suffering and loss on these our fellow Australians.We apologise especially for the removal of Aboriginal and Torres Strait Islander children from their families, their communities and their country.For the pain, suffering and hurt of these stolen generations, their descendants and for their families left behind, we say sorry.To the mothers and the fathers, the brothers and the sisters, for the breaking up of families and communities, we say sorry.And for the indignity and degradation thus inflicted on a proud people and a proud culture, we say sorry.We the Parliament of Australia respectfully request that this apology be received in the spirit in which it is offered as part of the healing of the nation.For the future we take heart; resolving that this new page in the history of our great continent can now be written.We today take this first step by acknowledging the past and laying claim to a future that embraces all Australians.A future where this Parliament resolves that the injustices of the past must never, never happen again.A future where we harness the determination of all Australians, Indigenous and non-Indigenous, to close the gap that lies between us in life expectancy, educational achievement and economic opportunity.A future where we embrace the possibility of new solutions to enduring problems where old approaches have failed.A future based on mutual respect, mutual resolve and mutual responsibility.A future where all Australians, whatever their origins, are truly equal partners, with equal opportunities and with an equal stake in shaping the next chapter in the history of this great country, Australia.

Primate fossil 'not an ancestor'

Primate fossil 'not an ancestor' www.richimag.co.uk/chickenoregg/

The exceptionally well-preserved fossil primate known as "Ida" is not a missing link as some have claimed, according to an analysis in the journal Nature.The research is the first independent assessment of the claims made in a scientific paper and a television documentary earlier this year.Dr Erik Seiffert says that Ida belonged to a group more closely linked to lemurs than to monkeys, apes or us.His team's conclusions come from an analysis of another fossil primate.The newly described animal - known as Afradapis longicristatus - lived some 37 million years ago in northern Egypt, during the Eocene epoch. And the researchers say it was closely related to Ida.

This study would effectively remove Ida from our ancestry.

Erik Seiffert, Stony Brook UniversityIda lived some 47 million years ago and was given the scientific name Darwinius masillae.Dr Seiffert and his colleagues say that both Afradapis and Darwinius were in a sister group to the so-called "higher primates", which includes humans.This extinct sister group, they say, was more closely related to lemurs and lorises.

Cul-de-sac

''The suggestion that Ida [was]... specifically related to the higher primates, namely monkeys apes and humans, was actually a minority view from the start. So it came as a surprise to many of us who are studying primate palaeontology," said Dr Seiffert, from Stony Brook University in New York, US.''Ida, which is a member of this genus called Darwinius, is in a fossil group called the Adapiforms which have traditionally been seen as more closely related to the lemurs and lorises - which live today in Madagascar, Africa and Asia - than to [monkeys, apes and humans]."

This group, including this new specimen described in Nature, has a lot of traits that are found in apes and monkeys

Jorn Hurum, Natural History Museum, Oslo

He added: "We have analysed a large data set based on observations we have made on almost 120 living and extinct primates and what we find... [is that] Darwinius and this new genus that we've described are not part of our ancestry."They are more closely related to lemurs and lorises than they are to tarsirs or monkeys, apes and humans. This study would effectively remove Ida from our ancestry."Dr Jorn Hurum, from the Natural History Museum in Oslo, Norway, was one of the authors of the paper about Ida published in the journal Plos One this year.Responding to the study in Nature, he said: "It's a very interesting paper, and - at last - this is the start of the scientific discussion around the specimen we described in May nicknamed Ida."He added: "What the authors say is that this is an extinct side branch of the group leading to lemurs that is not in any way related to apes and monkeys.

"What we said in our scientific paper in May is that this group - including this new specimen described in Nature - has a lot of traits that are found in apes and monkeys."

However, Dr Seiffert and his colleagues regard such features as examples of "convergent evolution". This involves features arising independently in separate lineages, possibly as a response to similar evolutionary pressures