Age UK’s report ‘Hidden in plain sight: the unmet health needs of older people’ says the current provision of mental health services and support is grossly insufficient to meet the current and future needs of a rapidly ageing population.
There are currently 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 to 4.3 million because of the growing numbers of older people in our society.
But Age UK has found that the NHS England is failing to provide people aged over 65 with anything like adequate access to the talking (or ‘psychological’) therapies which are now generally regarded as the most effective and appropriate treatment for this distressing illness.
The NHS ‘Improving Access to Psychological Therapies (IAPT) Programme’, which was set up in 2008 to help people struggling with mental health issues to access talking therapies, continues to miss its extremely modest target of 12% referrals being older people by almost half. At the present rate of progress Age UK estimates it would take a generation – until 2031 – before the original referral target is met.
This is despite the fact that older people usually respond extremely well to talking therapies: the recovery rates for patients aged over 65 who have completed a course of talking therapy through the IAPT programme are actually better than for those for younger people.
The charity’s report, which included responses from a series of Freedom of Information requests sent to 55 Mental Health Trusts in England, also found that 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, even though there is growing awareness of the impact of poor mental health on an older person’s physical health and vice versa.
For example, a report by The Kings Fund published in 2012 warned that mental health problems needed to be recognised for the role they play in reducing people’s ability to manage their physical health. It estimated that by interacting with and exacerbating physical illness, co-morbid mental health problems cost the NHS between £8 billion and £13 billion in England alone each year. (iii)
Age UK is calling on the NHS to make sure plans are in place across the country to improve the access of older people to talking therapies and that strategies are developed to help the many older people suffering with both physical and mental health problems.
Caroline Abrahams, Charity Director at Age UK, said: “Unfortunately our research makes it hard to avoid the conclusion that older people are routinely seen as ‘second class citizens’ by our mental health services, with many denied access to the best and most effective treatment if they are coping with depression, even though the evidence shows they often do really well on it if given the chance.
“This is extraordinary and frankly it is also completely unacceptable in the twenty first century. We understand the acute pressures on mental health services but they do not justify what look to us like engrained, systemic failings so far as older people are concerned.
“The fact that one in three mental health trusts do not have proper strategies in place to support older people with both mental and physical health problems means significant numbers are likely to be missing out on the joined up help they need, and that the NHS may be failing to use its funding as effectively as it could. This seems a criminal waste when the service is under such evident duress.
“Whatever the underlying reasons for such poor performance – and some will say it is ageism, no more, no less – it is certainly time for our mental health services to up their game when it comes to helping older people, and we look to NHS England to provide the strongest possible lead.”
Dr Amanda Thompsell, Chair Faculty of Old Age Psychiatry, said: “For too long, older people’s mental health has taken a back seat to their physical health needs. Sadly, this means that much mental illness goes unrecognised and untreated. Financial resourcing is part of the problem, but our acceptance of outcomes for the old that we would never tolerate in younger people is also to blame. The report by Age UK is an important contribution to combatting the hidden ageism that so often is at the root of this problem.
“This paper offers practical suggestions as to how this important issue can be improved and highlights the need for specialist mental health services for older people across the county – something which is simply not the case at present.”