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Into Perspective: Mental health provision for older people in care

How can mental health provision be improved for older people in care?

The World Health Organization (WHO) stated in December 2017 that over 20% of adults aged 60 and over are living with a mental health or neurological disorder. Access to this information reflects the growing acceptance that a mental health decline is as detrimental as that of physical health in older people and has been a motivating factor for increased investment in sector mental health services. Despite this, we know that the UK has an ageing population and mental health provision must grow exponentially to match the increased demand – according to the Office for National Statistics (ONS), by mid-2045 it is expected that there will be over three million people aged 85 or over.

Always person-centred

Although this is a term that the sector is now inherently familiar with, the importance of person-centred care cannot be overlooked in the continued development of mental health provision for older people in care. For example, the basic acknowledgement that different people’s mental health needs will be positively stimulated in different ways must remain at the fore of planning activities in care homes. The National Institute for Health and Care Excellence (NICE) argues that ensuring older people are regularly participating in meaningful activities is one of the most effective ways of promoting good mental health. Better still, older people should be encouraged to take the lead in choosing the activities they would like to do based on their own interests and life experiences. In addition, following Government’s recent announcement that there are no longer any nationally set direct restrictions on visiting in care homes, friends and families of older people in care should take part in activities wherever possible to maintain key social relationships and overall wellbeing.

Preserving identity

Regarded as an extension of person-centred practice, celebrating individuality when interacting with residents is another critical avenue to be explored in the improvement of mental health provision for older people in care. Care home staff have a pivotal role to play in this aspect of service delivery and ensuring they are equipped with strong interpersonal skills and the ability to spot the signs of deteriorating mental health should be an important part of any provider’s long-term plans to improve their services. The Royal College of Nursing (RCN) is encouraging healthcare professionals and nurses to think about the language they are using to approach the topic of mental health with residents, as some older people may be put off by terms such as ‘depression’. Using informal language is suggested as a more impactful tool for initiating conversations about mental health and much will be down to staff members’ attitudes towards building genuine relationships with these individuals and their preferences if long-lasting improvements are to be made to service delivery.

Quashing stigma

In its 2019 Policy Position Paper on Mental Health, Age UK outlines several barriers to older people seeking mental health support. The paper reports that only one third of older people say they would visit their GP if they felt depressed and less than half of older people experiencing bereavement say they would be interested in counselling. Despite society’s increased awareness of mental health and its impact on older people in care as a result of the COVID-19 pandemic, there remains a stigma associated with the topic. Age UK continues by arguing that ingrained beliefs about older people, especially assumptions about older males, fuel discrimination in accessing mental health services. Destigmatising older people’s mental health must dictate efforts to improve residential provision. 

Focus on connections

Efforts to improve mental health provision for older people in care should focus on prevention. This does not mean preventing all mental ill-health, or indeed other age-related conditions like dementia. But it does mean putting into place practices that will help to keep the greatest number as well as possible. These should aim to increase people’s opportunities to engage in meaningful social connection.

Every year, the Mental Health Foundation co-ordinates Mental Health Awareness Week. The theme this year is loneliness, which is a complex issue affecting people at all stages of life. The week, which runs from 9th-15th May, aims to raise awareness of the impact of loneliness on our mental wellbeing and the practical steps we can take to address it.

The later life programmes that we develop at the foundation are based around peer-support groups. They are designed to foster social connection for the benefit of mental health. Making more such groups available to people in care will give them opportunities to connect with neighbours, making new relationships and deepening existing ones. The content of these groups should be co-produced with participants, so that they reflect their interest and lived experience.

To deliver groups like these in residential settings requires resources to train and support staff, and allocate their time accordingly, which has implications for how care is publicly funded and commissioned.

Delivery of such group sessions inside and outside of residential care settings also means addressing the digital divide, and making the devices, internet access and support available for people to get online. The Foundation is currently running a project called Picture This, which supports people in later life to get online and participate in arts-based peer groups. The aim is to support older people to improve their digital communication, their confidence and their quality of life. It has been transformative for many participants, enabling them to connect with family, friends and with each other.

These preventative measures, taken together, should form a core part of any effort to improve mental health provision for older people in care.

Dr Ben Plimpton, Project Manager for Empowerment and Later Life, Mental Health Foundation

As ever, detail is key

The Association of Mental Health Providers, along with the vast majority of the sector, believes that mental health provision for older people in care can best be improved by addressing the two major crises of funding and workforce.

The mental health social care sector is in the midst of a workforce crisis, with regular reports of the need for urgent funding to meet the overall rise in wages, to retain skilled staff and to continue to deliver services safely.

The white papers, People at the Heart of Care: Adult Social Care Reform White Paper, and the recent Health and Social Care Integration: Joining up care for people, places and populations are both steps in the right direction.

Together they highlight the need for reform of the crucial elements for good care and support that we have long advocated for as an association – namely, choice, control, quality, accessibility and a joined-up approach which places people who use social care services at the front and centre – but as ever, detail is key.

Without detail of how such reform will be achieved, or the funding to make those changes happen, it is far less likely that such good intentions will become reality.

So often, the topic of adult social care omits its importance to mental health and wellbeing.

Across mental health, there needs to be greater Government understanding of that importance, as well as the essential role of the workforce in achieving this, taking into consideration their extensive knowledge, skills and experience.

I recently wrote that, ‘Only by working together can we truly transform and improve the health and wellbeing of our nation.’; that is as true for those in elderly care as it is for all with poor mental health.

What is needed is a collaborative approach – Government working together with voluntary, community and social enterprise (VCSE) organisations – to shape and reshape planned reform, to help those working in the area of elderly mental health care and to enable those most in need to lead fulfilling lives.

Kathy Roberts, Chief Executive, Association of Mental Health Providers

About Kathy Roberts

Kathy Roberts is the Chief Executive of Association of Mental Health Providers, the only national representative organisation for voluntary and community sector mental health service providers and was…

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also the Chair of the Advocacy Topic Group for the Independent Review of the Mental Health Act.

About Dr Ben Plimpton

Dr Ben Plimpton is Project Manager for Empowerment and Later Life at the Mental Health Foundation. He has nearly a decade of experience facilitating later life peer support groups – primarily in hou…

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sing settings but also the community. He holds a PhD in psychology from the University of Hertfordshire.

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