Nationally, and internationally, there is a shortage of psychogeriatricians. Practically every week consultant posts are advertised with special responsibility for developing old age services. Appointments committees are often frustrated by a lack of suitable, or indeed of any candidates, and some authorities have given up their attempts to fill their vacant posts. At the same time, the College and the Joint Committee of Higher Psychiatric Training have put considerable pressure on the organizers of training schemes to provide more training slots in old age psychiatry so that this training is available for anybody who wants it. Recently, the College has persuaded the DHSS to provide more higher training posts, especially in old age psychiatry. Thus the pathway to a consultant post in this specialty should be reasonably easy. But there are already indications that the available training opportunities are not all taken up or, when they are, it is only for 'experience' rather than 'a career'. There is, it seems, a disinclination to enter the specialty. Why should this be so?
A few months ago, I was listening to a patient whom I have looked after for some years, a nurse who, with my encouragement and approval, had retired early and had felt much the better for it. She had been quite severely depressed, and, as is so often the case, she found it much easier, and less frightening, to talk about the things that had been troubling her when she was feeling well than when they were overwhelming her to a distressing degree. Distance did not lead enchantment to the view but made it less immediately threatening.
*Based on a lecture given to the Nottingham Department of Health Care of the Elderly.