I read with interest the barriers to uptake of Improving Access to Psychological Therapies (IAPT), particularly those pertaining to the misconception that depression is part of normal ageing.1 The misattribution of symptoms as part of the ageing 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 means 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 depression, 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: bereavement;3 living in care settings;4 dependence on others;3 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 Royal College of General Practitioners 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 that local clinical commissioning groups have undertaken to increase uptake of IAPT. Good practice seen nationally includes the appointment of Older People’s Mental Health Champions and the implementation of integrated physical and mental health care.6
- © British Journal of General Practice 2021