Changing provision for the elderly mentally ill: a geographical perspective

Abstract

The focus in this study is on the reasons for the changing form of psychiatric services for the elderly. Attention is also focussed on how planners can develop appropriate services for the elderly mentally ill, hereinafter referred to as the "EMI". In Chapter One, background details of the problem of providing services for the EMI are presented. The analysis is identified as
being a geographical contribution to the study of mental health and ageing at the intersection of three areas of interest: the pathology of mental illness in the elderly mental health service provision and programme evaluation. This is achieved by the development of a Purpose - Structure - Evaluation framework which has its origin in geographical public services research. As a foundation to the study in Chapter Two mental illness in the elderly is examined. From this background which highlights the service requirements an historical review of service provision in the U.K. is provided in Chapter Three which culminates in an empirical description of the present form of services and outlines models of the deinstitutionalisation process. The findings from the case-study of the Exeter District Health Authority (DHA) in Chapter Four and those from a national questionnaire survey of district health authorities in Chapter Five, highlight the inadequacy of these models and the
difficulty of developing psychiatric services for the elderly. Evaluation of the Exeter DHA locality planning approach by location-allocation modelling in Chapter Six and the results of a community attitude questionnaire survey in Chapter Seven reveal the potential of the locality planning method. Finally, in Chapter Eight an explanation of the policy transition is proposed together with a planning methodology for the implementation of local services for the EMI.