Evans and Reynolds highlight the limited access to psychological therapies for older people in Wales. Similar problems exist in England despite a commitment to psychological therapies in the National Service Framework for Older People (Department of Health, 2001) and the National Institute for Clinical Excellence guidelines for anxiety and depression (NICE, 2004).

A survey across Suffolk, Norfolk and Cambridgeshire for the National Institute for Mental Health in England (East Region) in 2004 showed that in several areas the availability of psychologists was very limited (survey available from NIMHE East Region or by e-mail from dm214@aol.com). College guidelines suggest there should be 0.5 psychologists per 10 000 population aged over 65 years, but few areas achieve this level and some have none. Interviews with community team leaders revealed that several had unfilled psychology posts owing to recruitment difficulties. Psychologists frequently support memory clinics, but the availability of drugs enhancing cognition has also increased the need for psychologists in the community.

Psychology resources are key for the supervision of other staff providing psychological therapies, behavioural therapy and psychometry where a diagnosis of dementia is in doubt.

Unfortunately our survey revealed insufficient A grade psychologists to supervise assistants, and therefore the old age specialty was not attracting new entrants. Community psychiatric nurses (CPNs) are often trained in psychological therapies, but with a threefold variation in CPN numbers (from 2000 to 7000 population aged over 65 years per CPN), time for delivering these therapies was often limited. If we are to provide psychological therapies to older people with mental illness, the shortage of psychology resources needs to be addressed.