Abstract

It has been suggested that ageism, stigma, and other forms of discrimination lead to older adults with serious mental illness (SMI) being invisible in policy, practice, and research. This paper explores and critically examines stakeholders’ attitudes and perceptions concerning older adults with serious mental illness who also experience physical health needs and is based on research conducted in the United Kingdom. A qualitative case study approach was utilised, and a purposive sample of twenty-four staff involved in the commissioning, managing, planning, and provision of services for older adults with SMI were recruited. Data collected from ten semi-structured interviews and two focus groups were analysed using a framework analysis. Four themes emerged: 1) defining the patient group and their journey in care, 2) seeing the whole person, 3) devolving care (falling through the gap), and 4) making it happen and moving forward. Although participants held positive attitudes towards older adults with SMI with an emphasis on the provision of holistic care, gaps in service provision and organisational structures were apparent. Service users appeared to be moved through services dependent on presentation rather than need without a coordinated approach. Practitioners felt it was becoming increasingly challenging to manage physical healthcare needs in addition to managing more pressing mental health issues, and many older adults with SMI and physical health needs were falling through the gap in that they were not accessing the relevant services to manage their complex needs. However, the hospital trust was seen to be making steady progress with the implementation of early warning systems, recognition of the importance of education for all healthcare professionals, and early signs of linkage between physical and mental health services. It is suggested that more collaborative working between relevant services is required, and it is proposed that the establishment of a community psychiatric liaison service to coordinate care could prevent crisis situations arising for patients with comorbidities.