Change that leads to better lives

"What do you expect at your age!” Mental Health in Later Life – Striving for Equality

Here at NDTi, we have been working, along with others, to get mental health in later life back onto the agenda, for well over a decade now.

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This neglected issue was sadly brought in to very sharp focus this week with the publication of the long-awaited Mazars report commissioned by NHS England into all deaths at the Southern Health NHS Foundation Trust since April 2011. Among many other extremely disturbing findings, which are discussed in more detail here, only 0.3% of unexpected deaths of older people with mental health problems were investigated.

We published a paper and held a round table event earlier this month, bringing together older people, policy makers and ‘influencers’ to understand better why the common mental health problems experienced in later life are not higher on the agenda.

We discussed what would help in tackling stigma, ageism and age discrimination in communities and services. How can we support older people so that they have a voice with which to influence change in their own lives and more widely? How can we encourage neighbourhoods and communities to be welcoming and inclusive? How do we ensure that older people access timely and responsive age-appropriate mental health and other services and supports, which meet their needs and aspirations?

The conversation was extremely rich with some inspiring ideas. We considered building on what we know contributes to good mental health in later life: positive relationships, opportunities to participate and contribute and building resilience so that people can cope with major life changes and the impact of cumulative losses. We discussed supporting people who develop mental health problems in later life as well as those who have grown older with them to plan ahead and stay in control. Ageism and age discrimination were big topics.

One thing that came through loud and clear was the need for a vision of what good mental health in later life looks like, reflecting the diversity amongst older people. Other key issues were the need for up-to-date data on the common mental health problems experienced by older people and evidence on what is working and not working.

We are really pleased to be able to work with a group of people who are interested in working with us, collaboratively, to develop a broad vision, and pull together a plan of action to tackle some of the intractable problems. We have committed to pulling together the next steps and will be sharing them shortly.

So what do we know already about the problem we are seeking to address?

Evidence shows that older people are not getting the help or treatment they need for depression and other mental health problems. For example, only 0.5% of people aged 65 and over and 0.2% of people aged 85 or over get referred to talking therapies (for example counseling) for treatment of depression or anxiety. This compares to 2.2% people aged 20 to 64. This is despite the evidence that older people benefit just as much from talking therapies as their younger counterparts. What gets in the way is perceptions on the part of older people themselves and those working with them about the relevance of such services and supports.

Evidence shows that alcohol misuse among older people is a real and growing problem with almost half a million alcohol-related hospital admissions for people aged 65 and over and people aged 55 to 74 having the highest rate of alcohol related deaths of all age groups.

Depression and alcohol misuse are just two examples of mental health issues experienced by older people that get overlooked. Older people also experience other mental health problems, for example post-traumatic stress disorder, psychosis, schizophrenia and bi-polar disorders and yet levels of awareness and understanding about them remains low.

Through our most recent work in this area, including a three year project developing the voice, visibility and influence of older people with lived experience, we were struck by the levels of stigma that exist at all levels, including amongst older people themselves and the ageism that is rife in communities and more widely, making it very difficult for older people to be seen and heard in any decision making about their own care and support and also more widely.

So the challenges are many and varied, but the good news is we have a coalition of willing partners. We’ll be developing our plan of action over the coming months, so watch this space!

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