Older Mind Matters

Older people’s mental health: Everybody’s business or nobody’s business?

Improving Access to Psychological Treatments (IAPT) is the name of an initiative which was designed to offer talking treatments to adults with depression and anxiety. Note the term adults. It was aimed at (so-called) adults of working age (whatever that means!) in order to get them back to work. It appears to have made little impact in making talking treatments available to older people, and the IAPT four year plan of action published in 2011 notes that only 4% of people using IAPT services over a 12 month period between 2008 and 2009 were over 65 years of age, whereas, based on the prevalence of depression, that figure should be about 12%, ie older adults are significantly under-represented.

The Plan of Action recognises the need to ensure that older adults have improved access to psychological treatments and the foreword states that the benefits of talking treatments need to be broadened:

“to people with long-term physical or mental health conditions. We can no longer have a health service that treats people physically but leaves them struggling mentally.”

This is part of a wider picture. It seems to me that older adult health and social services tend to concentrate on the body (physical treatments, physical health) at the expense of neglecting emotional and psychological health and treatments, and residential and nursing homes concentrate on making the body more comfortable as the expense of psychological comfort and well-being. Yet we can’t separate one from the other. Our mental health affects how we deal with challenges to our physical health. Our physical health inevitably affects our mental health.

‘No health without mental health’ is a strapline that says it all (it’s also the title of a Department of Health policy document published in 2011). But we all know the problem with everybody’s business* – if you’re not careful it becomes nobody’s business. How do we stop that happening with older people’s mental health?

*Note: Everybody’s Business was also the title of a document which aimed to set out a blueprint for old age psychiatry services. How many people remember that and how influential was it on a scale of 0 to 10?

2 comments (Add your own)

1. Michael wrote:
An interesting point about talking therapies which led me to check our own services. We have a figure of 5%. This is not because older peopple are excluded from these services because they are not. We have older people specialists in the service who understand their needs. Older people can also self refer, so they aren't relying on their GP to refer either. This leaves me to conclude that it's all about stigma, knowing the service is even there, how to access it or what the service can do for people.

I remember Everybody's Business well (?2005) and see that it is still cited. It's difficult to gauge it's influence except to say that everyone seems to know about it.

Tue, November 27, 2012 @ 4:34 PM

2. David Jolley wrote:
Well yes – I have to be with you that we don’t want people to be excluded from therapies simply because of their age. Our friend Claire Hilton has previously taken up arms on this particular issue of talking/listening therapies. Such a combination of angel voices should certainly be persuasive, but as we are learning again from the response to the Leveson Report
‘There are none so deaf as those who do not want to hear.’

But dare I hesitate and counter with a thought that we are become complicit with the trend to worship specialisation in everything and to believe that only specialists can perform tasks or therapies competently.
Respectful, informed, listening and talking are essential components of every good caring interaction between human beings. They should be essential skills owned by every clinician.
Availability, accessibility and continuity of care were the principles with Tom Arie gave us in identifying the core attributes of psycho-geriatric services and the teams working within them.

The risk is that this modest but workable ambition has been undermined by a false premise that only the very best (highly qualified, backed by publications which establish an evidence-base by double blind clinical trials) is good enough. There will never be enough and there will be queues and frustrations for patients, deskilling and demoralisation for front-line clinicians and pressure to spend more and more money when there is a limited pot available.
What we need is a more realistic approach which produces and supports rounded clinicians within all disciplines and at all levels. We must see people who come to us as multi-dimensional wholes: physical, psychological, spiritual and social and we all must be trained to respond with care and competence to all these dimensions. In this we require education and on-going reference to experts, but it is a false model which limits delivery of care and therapy to a disjointed matrix of super-specialists with gaps at interfaces all-but inevitable.

This argument is age-blind – it applies to all age groups, and to all genders, cultures and faiths

Sun, December 2, 2012 @ 6:06 PM

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