Realising the potential of Improving Access to Psychological Therapies for older adults

Thank you for your editorial regarding improving access to psychological therapies (IAPT) for older adults.¹ As discussed, this topic is particularly relevant in the COVID-19 pandemic. Indeed, if we are to be proactive about mental health promotion with our older population, current circumstances can act as a platform to start discussions.

I read with interest the barriers to uptake of IAPT, particularly that pertaining to the misconception that depression is part of normal aging. The misattribution of symptoms as part of the aging process is what I have since seen described as the ‘understandability phenomena’, which may prevent older people from seeking help when depressed.² The manifestation of physical rather than emotional symptoms seen in older adults with depression² mean that GPs need to be vigilant towards atypical presentations and be mindful that it can be difficult to detect depression in this population.

The editorial suggested social isolation as a risk factor for depression¹, a circumstance no doubt perpetuated by the COVID-19 pandemic. To aid in the recognition of deteriorating mental health in older patients, we should be able to recognise life events and social situations that can potentially have an impact. To elaborate further, the following factors could contribute to a decline in mental health in older adults: bereavement³; living in care settings⁴; dependence on others³ and the patient as a carer.⁵

I wonder if uptake of IAPT could be improved with an increased knowledge of the situations in which it is appropriate to refer. NHS England suggests that in primary care we can refer to IAPT not only for depression/anxiety, but also for: bereavement difficulties; family/relationship/interpersonal difficulties; difficulty adjusting to health problems and medically unexplained symptoms.³

I would like to direct my colleagues to the RCGP mental health toolkit, which has a plethora of useful information in the section regarding mental health in older adults. I would also encourage interested individuals to look at the strategies local CCGs have undertaken to increase uptake of IAPT. Good practice seen nationally includes the appointment of Older People’s Mental Health Champion’s and the implementation of integrated physical and mental health care.⁶

References

1. Laake JP, Majeed N, Walter K. Realising the potential of Improving Access to Psycholigcal Therapies for older adults. Br J Gen Pract 2021,  71 (702): 8-9. DOI: https://doi.org/10.3399/bjgp21X714365 (Accessed 24/1/2021)
2. Laidlaw K, Kishita N, Chellingsworth M (2016) A Clinicans Guide to: CBT with older adults. UEA. Link: www.uea.ac.uk/documents/746480/2855738/CBT_BOOKLET_FINAL_FEB2016(7).pdf (Accessed 27 Jan 2021)
3. Mueller C, Thompsell A, Harwood D, Bagshaw P, Burns A (2017) Older Peoples Mental Health The Practice Primer. NHS England. Link: www.england.nhs.uk/wp-content/uploads/2017/09/practice-primer.pdf (Accessed 26 Jan 2021)
4. RCGP (2014) Management of Depression in Older People: Why this is important in primary care. Link: www.rcgp.org.uk/clinical-and-research/resources/toolkits/~/media/97B6C76D1B1F4FA7924B7DBD2044AEF1.ashx (Accessed 27 Jan 2021)
5. England E, Llanwarne N, Chew-Graham C. Top Tips: Diagnosis and Management of Common Mental Health Problems in Older People. NHS England and NHS Improvement. Link: www.rcgp.org.uk/-/media/Files/CIRC/Toolkits-2017/Mental-Health-Toolkit-2017/Top-Tips-for-mental-health-problems-in-older-people.ashx?la=en (Accessed 28/1/2021)
6. Stickland N, Gentry T (2016) Hidden in Plain Sight: The unmet health needs of older people. Age UK. Link: www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/reports-and-briefings/health--wellbeing/rb_oct16_hidden_in_plain_sight_older_peoples_mental_health.pdf  (Accessed 26 Jan 2021)