01 / 11 / 2016
Hidden in plain sight: The unmet mental health needs of older people
Age UK, October 2016
‘Hidden in plain sight’ is the latest report from Age UK and it details the unmet mental health needs of older people. The report describes latest findings from the Adult Psychiatric Morbidity Survey – highlighting the common under-treatment of mental health conditions and the wide inequalities in access to this care. It is estimated that depression affects 22 percent of men and 28 percent of women aged 65 or over, and 40 percent of older people in care homes. The Royal College of Psychiatrists, however, has estimated that 85 percent of older people with depression receive no help at all from the NHS.
Age UK makes a number of recommendations to ensure that older people’s mental health gains not only parity of esteem with physical health concerns but parity with other age groups as well, these recommendations are defined below.
Loneliness, financial insecurity and dealing with major life changes may all represent risk factors for older people’s mental health. By 2021, the number of people in the UK aged 65 and over is expected to rise by 12 percent. A larger older population is likely to mean more people experiencing mental health conditions who could benefit from treatment. The report goes on to further highlight the incorrect societal assumptions that many of the symptoms of mental health conditions are simply part of growing older and that older people are less likely to seek help - fewer than one in six older people with depression ever discuss this with their GP.
Age UK have previously revealed that older people with common mental health conditions were much less likely to be receiving talking therapies compared to younger age groups. Moreover, people over 75 were six times more likely to be prescribed tranquilisers or similar drug therapies.
The 2008 Improving Access to Psychological Therapies (IAPT) programme aimed to increase the number of people accessing talking therapies. In 2011 the Department of Health set a target of 12 percent of referrals through the IAPT programme being people aged 65 and over. Five years on, the report says it is still not close to being met, with national reporting showing it is currently at 6.1 per cent - at the current rate of growth the target will take 15 years to achieve.
Recommendation: ‘Implementation of Mental Health Taskforce recommendations should include a work stream dedicated to meeting older people’s mental health needs. This should include ensuring wide use of the new CQUIN for depression in older patients.’
The report also says that the above lack of urgency is reinforced by the findings of a survey of clinical commissioning groups (CCGs). Only 3 CCGs had set specific targets around increasing the proportion of older people accessing IAPT.
Recommendation: ‘Local health and care commissioners should fully understand the prevalence of common mental health conditions among the over 65s in their areas. Each clinical commissioning group and local authority should consider appointing “older people’s mental health champions”.’
The paper describes the longer waiting times of older people for mental health treatment – especially old age psychiatry, where waits have increased from 22 to 26 days since 2011/12. The King’s Fund estimates that around 50 percent of people aged over 50 and 80 percent of those over 65 live with one or more long-term conditions. It also notes the lack of supporting policy or overarching strategy in almost 40 per cent of mental health trusts for supporting the co-morbidities of those with both physical and mental health conditions. Many older people live with both, and these are often inter-related – Age UK calls for these to be addressed together with integrated care, as failing to do so can undermine an older person’s ability to recover from an illness or deterioration in their health.
Additionally, the report looks at Crisis Care. Figures for older people detained in police stations and hospitals under the Mental Health Act suggest that mental health crisis care is not always adequately dealing with their needs. People aged between 60 and 89 were most likely to be detained under the Mental Health Act in 2014/15.
Recommendation: ‘All services should be appropriately funded and equipped to deliver fully integrated care that addresses mental and physical health and comorbidity.’