Ageism fuels health inequalities

Overlooked mental health needs

The UK population is ageing rapidly, with the number of people aged 65 and over growing by nearly half in the past 30 years. If a person in later life does not have dementia, their mental health needs can often be overlooked even though depression affects 22% of men and 28% of women over 65.

An estimated 85% of these older people with depression will receive no help at all from the NHS.

People in later life have the highest suicide rate for women and second highest for men. Experiences common for this age group include: physical illness, loss of independence and bereavement, all of which can trigger mental health problems such as depression. In the UK, 21% of older people are chronically lonely which can have a detrimental effect on their health including the onset of depression, dementia and other degenerative conditions such as heart disease.

The role of peer support groups

The Mental Health Foundation has a decade of expertise in co-producing intergenerational peer support and self-management initiatives, from groups in schools to the Standing Together project, facilitating peer groups in the later life housing sector.

The Standing Together Project aims, through setting up peer groups, to improve emotional health, address loneliness and build community connections amongst older people living in supported housing schemes. Over the project’s two and a half year run, we have worked with over 300 people. To the best of our knowledge, nobody taking part in the groups had been referred to a talking therapies service.

Only a tiny percentage of people over 90 receive talking therapies

Launched in 2009 the ‘Improved Access to Psychological Therapies’ (IAPT) programme was designed to expand access to evidence-based talking therapies for people experiencing mental health issues such as depression. Despite being a service for all ages, only 7% of people in treatment are over 65, though they make up 20% of the population. This unequal distribution of treatment gets worse with age, with a tiny number of people over 90 years old being referred nationally, even with this being the fastest growing demographic group.

GPs have been found to prioritise younger people in their referrals.*

There is also a misconception that older people do not want to access this type of treatment. Evidence produced by the Royal College of Psychiatrists, (RCP) contradicts this. A cohort of 1,602 participants over the age of 60 were asked what type of intervention they would prefer if diagnosed with depression. A substantial majority (57%) said they would prefer counselling or psychotherapy to antidepressant medication (43%). In addition, older adults who are referred for psychological therapies take up the treatment at higher rates than working adults (74% vs 68.2%) and show better rates of recovery.**

Ageist perceptions fuel health inequalities

As a society we have a number of ageist perceptions. Media clichés such as, ‘bed blocker’ keep ageism thriving. The Royal Society of Public Health Report, that Age Old Question cites that millennials (aged 18-34) have by far the most negative attitudes.

It states that 25% of millennials believe that “it is normal to be unhappy and depressed when you are old.”

Many GPs have also found that depression can be seen as an inevitable part of ageing and in less need of treatment.***

The Royal Society report highlights these ageist perceptions that in turn fuel health inequalities. This can mean that services that prioritise addressing the mental health needs of people in later life are not commissioned. It is estimated that up to between 25-40% of care home residents experience depression yet there are no services to meet their needs.

For those that do end up on an older people’s psychiatric ward, if they experience a serious physical health issue, there are no services commissioned to enable an appropriate doctor to visit them on the psychiatric ward. Sometimes, they have to be sent in an ambulance to A&E.

Mental health services that reflect changing demographics

It is very well established that we are an ageing society. We need to be able to provide appropriate mental health services that are not rooted in inter-generational ageist misconceptions.

There is evidence to suggest that peer support groups can help to increase social connectedness. In the Standing Together project, people can look visibly healthier and happier after attending a group. Over the six months of weekly sessions there’s time to build the relationships and trust you need to have deeper conversations. An older person who attended a workshop reflecting on the groups said:

Sometimes it’s a relief to talk about mental health, bereavement and loss. Timing of having these conversations is important to get right. There’s a lot of publicity around mental health at the moment, and the fact that people talk about it reduces the stigma.

Building resilience

This work is being sustained with a peer support product for the later life housing sector and local authorities. Using peer support groups to strengthen people’s skills and assets in collectively sharing ways, helps them maintain good mental health. This builds resilience and prevents people needing to access mental health services that are currently not equipped to meet the needs of our ageing population.

We have just been awarded a substantial grant to facilitate the Standing Together group in Wales.

*Collins, N., & Corna, L. (2018). General practitioner referral of older patients to Improving Access to Psychological Therapies (IAPT): An exploratory qualitative study. BJPsych Bulletin, 42(3), 115-118. doi:10.1192/bjb.2018.10

**Thompsell, A. (2018, June). National Update for Older People’s Mental Health: Are we achieving the 5YFV for Older Adults? Presentation at IAPT for Older People: Improving Access and Outcomes, London, UK.

***Royal Society for Public Health. (2018). That Age Old Question: How attitudes to aging affect our health and wellbeing. London, UK.

Jolie Goodman is the Programmes Manager for Empowerment & Later Life at the Mental Health Foundation

Have you been affected by any of these issues?

If you have been affected by any of the issues described in this blog, or simply need someone to reach out to, you can call Independent Age’s freephone helpline for information and advice on 0800 319 6789. You can also contact the Mind helpline for information and advice on 0300 123 3393, or text 86463.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the policy or position of Independent Age.