Now You See Them, Now You Don't: Mental Health Problems in Old Age in the General Hospital Setting.

This thesis details research undertaken in two general hospitals in the South of England. The study examines perceptions of mental health problems in old age from the standpoint of those within the setting. I consider various social influences and ask whether different models of mental health service provision impact on how mental health problems are perceived and addressed. Fifty-two qualitative interviews were conducted with older people, relatives and staff members. All of the older people were hospital patients, with some having diagnosed mental health problems. Similarly some of the relatives had seen a mental health professional. None of the research participants had contact with mental health services prior to their current hospital experience. None of the staff members had specific mental health qualifications. Examination of the data highlights vying and powerful phenomena, associated with organisational and professional traditions. These intertwine and serve to influence how mental health problems in old age in this setting are both constructed and sustained. The key findings uncover a paradox of visibility and invisibility. Mental health problems, particularly dementia, are noted in the presence of overt problematic behaviour that is perceived to interfere with the smooth running of the setting or the organisation. Many mental health problems, as defined by psychiatry, are not perceived. They remain invisible and unaddressed. Particularly the phenomenon of depression is not seen as a mental illness, but rather as an artefact of normal ageing, especially in the presence of ill health. People with mental illness are not seen as the proper business of a general hospital ward. There is an expectation that external mental health experts should respond to the needs of this patient group. While there is evidence that the presence of a consultation / liaison mental health service can improve staff knowledge and skills, conclusions suggest that current models of service perpetuate the stigmatised position of older people with mental health problems in general hospitals