Improving services and support for older people with mental health ...

Improving services and support for older people with mental health problems
“It helps me to be able to talk to someone… even having
someone that I could get hold of on the phone would be good…
I feel I should get help to keep things going rather than waiting for
things to go wrong before I get support.” 224
Current Government policies promote independence and well-being for older
people, with a shift of resources from acute, hospital-based services to preventative,
community-based care closer to people’s own homes. While previously, prevention
was viewed in terms of avoiding admission to acute hospital or long-term care,
numerous policy documents now identify prevention with the promotion of well-being.
In practice the shift to prevention is proving difficult. Intense pressure on resources has
forced social services to concentrate on those people with the highest levels of need,
inhibiting the shift away from acute services. 225 Low-level support services are losing
out. Robust quantitative evidence for the cost effectiveness of prevention is lacking. 226
The long-term nature of prevention precludes evidence of immediate benefit and
obvious incentives to act are limited.
The Government’s Social Exclusion Action Plan (2006) highlights the importance of
prevention and points out that ‘early intervention to prevent problems can be seen as
having two meanings: early in terms of age or early in terms of the onset of a problem
– whatever the age of the individual.’ 227
Early intervention in mental health however is interpreted as intervention at a young age
rather than an early stage in the onset of a problem. Ageist attitudes may lead people
to believe that it is less important to prevent problems in older people because it is ‘too
late’ for them. Yet prevention is not only possible, but also beneficial to people of
all ages.
The tendency to equate older people’s mental health with dementia may inhibit
the focus on prevention of mental health problems in later life. Dementia is often
seen as inevitable in later life and therefore not ‘preventable’ in the way that people
would usually understand the term, despite evidence that the risks for some types of
dementias can be reduced.
4.2 Depression and anxiety
Depression and anxiety often occur together in later life. They affect significant numbers
of older people across all settings. The risk factors for late life depression are very well
established and they point to the actions that are needed.
4.2.1 Risk factors
Later life is a time of considerable change, marked by life events and transitions such
as retirement, physical illness, bereavement and death. While some experiences can
be positive, they can also result in loss – of income, health, role, status, purpose,
confidence, sense of self, family and friends.
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