Old problems, new solutions

04 October 2017

Alistair Burns is Professor of Old Age Psychiatry and Vice Dean for the Faculty of Medical and Human Sciences at The University of Manchester. He is the National Clinical Director for Dementia and Older Peoples’ Mental Health, NHS England. This blog was originally published on the NHS England website. He will be speaking at the upcoming BGS Autumn Meeting in London.

As now seems to be tradition, let’s start with some statistics. Up to four out of ten people over the age of 65 experience mental health problems. Depression is both the most common and most treatable mental illness in old age, affecting one in five older people in the community. This figure doubles in the presence of physical illness and trebles in hospitals and care homes. Nor should we forget that older people also experience severe mental illnesses.

About one fifth of all suicides happen in older people. Risk factors include: being male, being widowed, increasing age, social isolation, physical illness – present in up to 80 per cent of cases – pain, alcohol misuse and depressive illness past or present. Why do we cite these statistics and facts, and what do they ultimately tell us?

Firstly that mental health problems among older people are prevalent and serious. Secondly, that the overlaps and relationships between physical and mental ill health become arguably even more pronounced in older people, meaning that taking a joined-up approach is vital – a major theme running through all of our mental health presence at this year’s Expo. And thirdly – perhaps most importantly – that mental health problems in older people can and should be treated.

This of course relies on professionals as well as families and carers doing everything they can to support improvements in the identification and management of older people’s mental health problems in primary care and beyond, such as through the provision of expert older adult liaison mental health staff working on general hospital wards.

There are some inspiring examples of work underway across England to address what is now increasingly accepted as a fundamental health inequality. I was delighted that NHS England provided funding for this excellent film produced by Age UK Camden to raise awareness among older people of the benefits of talking therapies with a view to boosting their access rates to these services.

I participated in a ground-breaking conference in Leeds organised in June by the national IAPT programme in conjunction with Yorkshire and the Humber Clinical Network to develop a collective understanding around how IAPT services can increase access for older people and share best practice examples of current work being undertaken with older adults and carers.

We heard about Tees, Esk and Wear Valleys NHS Foundation Trust’s creation of Older People’s Champions among their staff working in North Yorkshire; leaders from Sheffield Health and Social Care NHS Foundation Trust and local IAPT services described their collaboration involving the Older Adult Community Mental Health Team and the University of Sheffield to design and evaluate a group treatment for Generalised Anxiety Disorder (GAD) for older adults; the organisation Mothertongue presented on their cutting-edge efforts to develop culturally and linguistically sensitive professional counselling services for people from black and minority ethnic communities.

The primer we launched at Health and Care Innovation Expo 2017 is aimed primarily at supporting colleagues working in primary care teams, particularly GPs.  Ninety per cent of older people consult their GP at least once each year which makes primary care the setting with the most potential to drive improvements in care and support.

We know that there is a risk among both professionals and the public of automatically attributing symptoms of mental ill health to ‘old age’, or considering an unwell patient’s situation as beyond repair and an inevitable sign of terminal decline.

We hope this primer is one tool which will help to shift this mind-set so that whenever we talk about ‘healthy ageing’, or ‘ageing well’, we think about the mental as well as the physical health of older people and how both can be treated with the right knowledge, skills and attention to help someone lead a better and fuller life. Our rapidly ageing society makes turning this ambition into a reality an urgent necessity. I am grateful to the co-authors of the primer and all colleagues at NHS England, NHS Improvement, the Royal College of General Practitioners, the Royal College of Psychiatrists and the British Geriatrics Society who have supported the development of this publication and contributed so ably to its drafting. I am also grateful to Age UK for their partnership in our Expo 2017 session as well as in our longer-term campaign to improve older people’s access to talking therapies. The challenges are very real but I am confident that across local and national organisations we now have the right momentum and commitment to drive genuine progress together.

Download the primer here: A Practice Primer on Mental Health in Older People



What a great publication , really humane and full of gems - I esp like the question 'does your imagination ever play tricks on you', and the advice that a patient whom you find perplexing might be psychotic - this has also been my experience with occasional patients with encephalitis who are 'just not right' but don't feel like ordinary delirium.Thank you team, I'll use this a lot!

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