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Question: Mary, in 'Madness Made Me' you challenge readers to... "Imagine services that are run like democracies, with power coming from the bottom up. Mad people are the drivers of their own recovery and mental health workers support them from the passenger seat. Mad people also lead in the development and delivery of services -as politicians, bureaucrats, CEOs, psychiatrists, team leaders, peer workers and the rest. Madness is seen as a qualification, not something to be kept in the closet." How can older people achieve this?

Mary O’Hagan: One of the first things to consider when looking at older people’s mental health is that a lot of mental health problems start when a person is young. Everyone is different but people with labels like bipolar, schizophrenia and major depression often find their problems tend to peter out over the course of their lifetime. Issues for older people around their mental health tend to depression related to grief and loss of valued roles and dementia.
The big tension that goes on in the helping system is the families that want safety for their loved ones. You can see this with younger people with mental health problems and it is no different with older people. The system at both ends of life is over zealous ensuring security and under zealous in ensuring autonomy. The individuals that use the system tend to be much more interested in their autonomy than other people’s attempts to keep them safe. They should be fully engaged in the design of services so that they are more responsive their needs as they see them.
When older relatives start to burn pots or get into little accidents driving the response tends to be to take the cooking and driving away from them. Older people do not always want that. How can we support people to do what they want? The problem is the helping services are accountable for ensuring safety rather than autonomy so they system is not geared to meet their wishes.
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