Older people, mental health and Ageing BetterMichelle DawsonAgeing Better Middlesbrough Programme Manager

A bit about us

• Middlesbrough and Stockton Mind have been delivering IAPT (Improving Access to Psychological Therapies) for 6 Years• As a mental health charity, we are very interested in

understanding the psychological aspects of successful ageing• A tailored psychological therapies service is part of the

Ageing Better Programme in Middlesbrough

Some of the evidence

• Depression is more then seven times more common in those people with two or more chronic physical conditions (1)

• Fewer than 3% of older adults report seeing a mental health professional for treatment, a rate lower than that of any other adult age group (2)

• A diagnosis of depression in those aged 60 or over increased subsequent mortality by 70% (3)

• The universal message for IAPT services in England is that older people are not accessing IAPT in expected numbers. (4)

Loneliness as a Regulatory Loop• Meta analysis of interventions to reduce loneliness, among studies that

used randomised comparison found that the most successful interventions were those that addressed maladaptive social cognition (compared with interventions that focused on improving social skills, enhancing social support and increasing opportunities for social contact)

• Lonely individuals have increased sensitivity to and surveillance for social threats, preferentially attend to negative social information (5), remember more of the negative aspects of social events (6), hold more negative social expectations (7) and are more likely to behave in ways that confirm their negative expectations. This loop has short-term self-protective features but over the long-term, heightens cognitive load, diminishes executive functioning, and adversely influences physical and mental health and well-being.

Our own experience

1%

19%

24%

20%

20%

12%

4%

0-17

18-25

26-35

36-45

44-55

56-65

65+

Referrals to Open Minds Psychological Therapies Project by age (1.4.14 – 31.3.15)

The Barriers

• Older people’s resilience combined with negative views about seeking help

• Ageism – society seeing it as ‘normal’ for older people to be depressed

• Under-diagnosis• Ignorance about the proven effectiveness about

psychological interventions• Services not adapted to the specific needs of older people• Lack of available services

Some examples . . . • Bob, 80, struggling with depression and anxiety. Accessed

our Open Minds service. Struggled with CBT, didn’t have the cognitive awareness. Preferred a much more softer, open and broader approach.

• Tom, 66, Chinese, lost his wife to cancer and approached our ‘Living Life’ service for help. Benefitted from ad-hoc listening support, brief solution focused therapy and mentoring

• Harry, 72, long term health conditions with caring responsibilities. Refused to engage with ‘therapy’ but is happy to accept mindfulness and relaxation sessions in his home to help with his feelings of anxiety.

What’s important• Staff and volunteers having training and support to identify

when someone needs more specialist help• Having the skills to have the right conversation• Understanding that ‘therapy’ can be broader and more

creative than ‘counselling’ • Building good relationships with local providers and working

with them to ensure what they provide can meet the needs of older people

• Challenging stigma

References(1) Levkoff S, Chen H, Coakley E, McDonel Herr B, Oslin DW, Katz I, Bartels S, Maxwell J, Olsen E, Miles KM, Costantino G, Ware JH (2004)(2)Olfson M, Pincus HA (1996)(3)Dewey ME, Saz P (2001)(4) http://www.iapt.nhs.uk/equalities/older-people/(5) Cacioppo, Norris, Decety, Monteleone & Nusbaum, 2009 (6) Duck, Pond & Leatham 1994(7) Cacioppo & Hawkley 2005