There are many dimensions to mental health inequality, but one that is often hidden is the paucity of support or attention we give to mental health in later life. While older citizens have, on average, better mental health than younger generations, poor mental health is still common in later life, it’s affected by inequalities, and support for it is sparse compared with levels of need.
At a recent roundtable, Centre for Mental Health brought together experts by experience and professionals to explore the workforce we need to offer people in later life the right support for their mental health. With an ageing population, this has never been more important. Yet we heard that the health and social care workforce for mental health in later life is diminishing, or at best stagnating. And unless we have a plan to build it up, the gap between need and provision will get even bigger over the next decade.
Research has found that systemic ageism overshadows mental health in later life. Mental health policies and services tend to favour younger age groups and sideline those who are seen as being beyond ‘working age’. Older people’s mental health is not valued, needs are not identified, and potentially effective treatment isn’t offered. Older people’s mental health services are sometimes separate from those for younger adults (which can make them marginal to the mainstream) or they’re tacked onto all-age services (which often means they lack the specialist knowledge of how to meet the distinctive needs of older citizens). In both cases, mental health in later life is rendered invisible. Older people aren’t asked about their mental health and don’t know there’s support for it. And older people’s mental health services are hidden from policymakers’ view, leaving an accountability gap that puts investment and quality at risk.
At the roundtable, we heard about the ways in which older people’s needs are distinctive and why we need a workforce with the specific capabilities and resources necessary to meet them. Older people may, for example, need adjustments to adapt to hearing loss, reduced mobility or digital exclusion. They are more likely to need support with physical health and cognitive decline, especially but not only in inpatient settings. So we need workers who are trained and supervised to work well with older people, in spaces that are accessible, with the necessary equipment. It’s also critical that we have a multi-disciplinary workforce, with each profession able to practise its unique role and where they are all valued equally to contribute to meeting people’s needs.
To identify mental health needs quickly, it’s essential that GPs, social workers and other professionals who see older people routinely are confident in having conversations about mental health and know where to go for extra help when it’s needed. They need to be able to overcome obstacles to help-seeking, for example by proactively asking older people ‘how they are’ in ways that encourage openness, rather than closing down conversations about emotional wellbeing, and by positively encouraging access to support that older people may be more reticent about than younger generations.
As is the case for other age groups, there’s potential to develop peer support for mental health in later life. Mental health is made in communities, so building community assets and resources can help to prevent mental health problems. Valuing older people as active contributors to community wellbeing could have multiple benefits, including to younger generations. The voluntary, community and social enterprise sector will be a key part of this, and its services and workforce should be valued equally to those in the NHS and social care.
There is also an opportunity to explore skill-sharing between mental and physical health care teams for older people. These can help to build the skills and knowledge of physical health workers about mental health and vice versa, giving individuals more rounded support and reducing gaps in care. With the arrival of ‘neighbourhood’ working at scale in the NHS, joined-up teams where both mental and physical health staff were present and valued equally could make integration a reality rather than a far-off aspiration. Some areas are now taking steps to integrate mental and physical health support, for example in frailty or dementia services. But these are still the exception.
Finally, at a policy level, we need to address the invisibility of mental health in later life. National strategies and workforce plans need to set out clear expectations and measurable ambitions, not just vague aspirations (as was the case in the Long-Term Plan). As with other (intersecting) dimensions of inequity, we need good data to inform policymakers, commissioners, providers and citizens alike about how well older people’s mental health needs are being met, where there are gaps, and what outcomes services are achieving. Transparency does not guarantee accountability, but it makes it a lot easier, especially if it is linked to access and quality standards.
We can do better for mental health in later life. It will benefit older people now, and every generation to come, if we consider a mentally healthy later life as an ambition we can all aspire to achieve.
Dr Lucia Franco, PhD in Psychology awarded at Brunei University of London shares her insights on the huge potential for older people to contribute to mental health services.
Many older people could greatly contribute to provide the type of support needed in mental and physical health for older people. Often one of the consequences of retirement, after an active life of various achievements and skills, is a feeling of loss of value and identity, this is one of the factors contributing to psychological decline.
Older people, myself included, may have physical disabilities, but many of us still have a sound mind and a lot of experience and wisdom that younger people don’t have. The vast body of knowledge of older people is being entirely disregarded and not utilised for what it is.
We can’t work and contribute like younger people if we have disabilities or various infirmities, however, often we know more than most about medical matters through our own experience. Whilst some of us have been professional, we may not all know about psychology and medicine, but we know how to provide empathy and understanding. We can give advice to people on different matters. We can help young people journey through life feeling supported and understood.
In working at the Recovery College, I more than once argued that the ageing population should be given the chance to work as and when they can, and contribute to provide training, and in general I have been arguing that our knowledge is very valuable, something that can only be achieved through a lot of experience.
Feeling able to be valued, and be enabled to contribute to society, at whatever level possible, would provide a sense of wellbeing for older people, and can be a source of great help to societal problems. In older times the old person was respected for his/her wisdom, now this seems to be gone.
It would need further consideration in all its aspects and possibilities, including seeking the advice of older people. I personally know many people my age (70 years old) and above who could be capable of participating in this type of work.
