Age UK’s new report on the state of mental health care for older people in England, Hidden in plain sight: the unmet mental health needs of older people, sheds new light on the current state of NHS mental health services for those in later life.
The scale of the problem surrounding old age mental health cannot be underestimated. An estimated 1 in 4 people over the age of 65 live with a common mental health condition such as depression or anxiety, rising to a staggering 40 per cent of people living in care homes. Yet the Royal College of Psychiatrists has estimated that nearly 85 per cent of older people do not receive any help.
Although issues around loneliness, financial insecurity and dealing with major life changes are all risk factors for older people’s mental health, this in no way means depression is, or should be treated as, a normal or inevitable part of ageing.
Physical ailments can also cause, exacerbate and even obscure mental health problems and so a system able to provide holistic care is vital. However over a third (37%) of Mental Health Trusts in England have no policies for providing integrated care for people over the age of 65 with both mental and physical health needs.
Overall, as our report makes all too clear, the mental health of older people is under-recognised and under-prioritised. And without urgent action this is a problem only set to get worse as our society continues to age. In total are currently around 3 million people over the age of 60 living with depression in the UK – a figure that is set to increase by a third over the next 15 years.
Talking therapies are a highly successful method of treating problems with mental health and the dedicated NHS Improving Access to Psychological Therapy programme (IAPT) is intended to seek out and deliver this type of treatment to those who most need it.
In 2011 the Department of Health set a target for 12 per cent of referrals through the IAPT programme to be for people aged over 65. Five years later this target isn’t close to being met, with referral rates nationally of only 6.1 per cent. Furthermore, our survey of Clinical Commissioning Groups, the local organisations that set up NHS services in an area, found that only three (of the 130 CCGs that responded) had set specific targets around increasing the proportion of older people accessing IAPT.
The issues for older people are not limited to access either. Older people often wait longer for referrals, particularly for old age psychiatry which has seen waiting times increase over the past five years from an average of 22 days in 2011/12 to 26 days in 2015/16 for example.
It’s a critical time for mental health services – historically a ‘Cinderella service’ within the NHS there is now a growing and welcome focus on ensuring people living with mental health conditions receive the same level of care as those with physical conditions. It is vital that older people, and old age services, are not overlooked.
There is a clear and pressing need to make progress on IAPT targets for people in later life. The NHS needs to ensure plans are more widely in place to improve the access over 65s to talking therapies and to develop appropriate strategies to ensure both the physical and mental health needs of older people are met.
Implementation of the Mental Health Taskforce recommendations is also an important opportunity to make some real progress. This should include setting up a work stream dedicated to meeting older people’s mental health needs.
Equally there is more that needs to be done locally to ensure health and care commissioners understand and address the prevalence of common mental health conditions among the over 65s in their areas. Appointing an “older people’s mental health champions” to provide expert input and oversight may be an effective way forward.
However most importantly, all services should be appropriately funded and equipped to deliver fully integrated care that addresses mental and physical health together. With these measures, Age UK believes the needs of older people can be far better met.