"The rising tide".

Special psychiatric services for the elderly now exist, some very well developed, in about half of all health districts, and over one tenth of all consultants in general psychiatry specialise in work with the elderly.' This development has taken place largely over the past decade, reflecting both progress in psychiatry and growing concern about how to cope with The Rising Tide2 of mental disorder in old age. The tide threatens to overwhelm the health and social services (where it has not already done so). Awful buildings, prehistoric thinking, and a vague hope that it will all go away or be dealt with by someone else have still too often nourished complacency, punctured only occasionally by media worthy scandals when the greatest deficiencies in this non-strategy have broken surface. It is to the credit of the director of the Health Advisory Service that he has made psychogeriatric services the special interest of his organisation in recent years, culminating in the publication of a document which brings together good sense and hard won experience in establishing such services. The Rising Tide should help particularly in those districts where people have not been able or willing to plan an effective response. People may turn also to a new textbook3 which devotes two detailed chapters to psychogeriatric services, and these also provide references to the already large volume of published work. A recent excellent personal review of issues and achievements has come from the Centre for Policy on Aging, which has chosen to launch its new series of policy studies with Alison Norman's Mental Illness in Old Age.4 The growing spate of publications itself reflects the urgency of the matter. Coupled with the appearance of The Rising Tide has been an announcement by the Minister for Health that an extra £6 million is to be made available over three years-about £130 000 per region a year.5 Not that this is a lot of money in relation to the scale of mental disorders in old age-for between half a million and a million old people suffer from dementia and about twice as many again from other mental disorders-but it is helpful both practically and symbolically. Much more investment will be needed ifthere is everywhere to be a minimum standard of decent services, but even relatively little cash can catalyse action, enable people to try new things, or help established services to do even better or …