Promotion

OLDER PEOPLE: THE RETIREMENT YEARS 197
Within the UK, England, Wales, Scotland and Northern Ireland have approached
the strategic development of mental health promotion from different perspectives.
England does not have a national mental health promotion policy. Instead two national
service frameworks (NSF) have been published as long-term strategies for improving
health of older people and mental health of the population at large (DoH 1999, 2001).
Unfortunately, it seems that the promotion of mental well-being among older people
has fallen between two stools and is consequently covered fairly superficially in the
two documents. In the Mental Health NSF older people are not mentioned specifically,
even though there is opportunity to include older people under ‘vulnerable or socially
excluded groups’ or as ‘carers’. Where the Mental Health NSF has been used as a vehicle
for developing local mental health promotion strategies older people have for most
part not been one of the priority target groups.
The focus of mental health promotion in the NSF for Older People, which sets out
‘to promote good mental health in older people and to treat and support those older
people with dementia and depression’ (DoH 2001: 90) is almost entirely on the management
and treatment of mental illness, such as depression, and a large part is devoted
to the care of dementia. Tackling social isolation, providing bereavement support and
suicide prevention are also raised as ways of improving mental health. The promotion
of physical activity is specifically mentioned as a means of promoting social interaction
and mental well-being. Other wider initiatives which could impact on mental health
are also suggested, such as home improvements, policies to reduce fear of violence and
crime, affordable and accessible public transport, road safety, and policies to ameliorate
the consequences of disability for those living alone. However, no evidence of the
effectiveness of the proposed interventions is provided.
The final report on older people from the Social Exclusion Unit suggests that social
relations and participation need to be supported by reducing the prevalence of social
isolation, improving access to leisure, learning and volunteering, preventing homelessness
and enabling older people to ‘remain active and independent for as long as
possible’ (Social Exclusion Unit 2006: 13).
Initiatives to tackle ageism, such as Better Government for Older People have
started to produce a cultural shift in our perceptions of older people. The Better Government
for Older People (BGOP) programme was established in 1998 to improve
public services for older people by better meeting their needs, listening to their views
and encouraging and recognizing their contributions (Hayden and Boaz 2000). The
over-arching notion of ‘independence and well-being’ is taken forward through a focus
on: housing and the home; neighbourhoods; social activities, fun and social networks;
learning and leisure; getting out and about; income; information; health and healthy
living; employment; lifelong learning; mental health services; black and minority ethnic
older people; age diversity (Better Government for Older People 2005). Although not
initially set up specifically to improve and maintain older people’s mental health, the
programme seems to have had a major impact on participants’ mental well-being simply
through its ethos of participation and policy influence and the types of activities that
have evolved as a result.
One of the BGOP ‘off-shoots’ has been Moving Out of the Shadows (MOOTS), an
initiative intended to ‘harness the voices of older people who experience a range of
mental health problems, to inform and influence future policy, practice and experiences’