Older people with long-standing mental illness: the graduates

People who survive into late life with chronic or relapsing illnesses, which had their onset in youth or middle age, have special needs. In the past, those most severely affected often lived out their lives in mental hospitals. The mental hospital closure programme led to discharges to alternative care, and the successes and failures of these have been monitored by some services. Subsequent generations are at risk of falling between the care of general psychiatry, rehabilitation psychiatry and old age psychiatry. These patients are uniquely disabled by a combination of personal, social, mental and physical health disadvantage. The Royal College of Psychiatrists has produced guidance to highlight the special needs of these ‘graduates', encouraging every locality to investigate its own performance in their care and bring it into line with best practice in the light of local strengths and resources.