Severe and enduring mental illness

Severe and enduring mental illness refers mainly to the long-term experience of schizophrenia and psychosis but also to other chronic functional disorders. The prevalence of psychoses in older people is hard to measure but estimates are around 0.5% of the population. Historically many people with long term illness resided in psychiatric hospitals but now most are in the community, receiving variable amounts of support from mental health, primary care, and social services. The physical health of this population is often poor and they receive less treatment and support than other older people with comparable physical health needs. Problems with psychiatric comorbidity (e.g. depression and substance misuse), cognitive impairment and social exclusion are also common. Treatment includes the judicious use of medication, nonpharmacological approaches, and social support—especially appropriate accommodation. Positive outcomes can be achieved by a recovery approach that attends to all aspects of the person’s health.