There are over 1.1 million people aged over 65 in London (12% of the population), and approximately 500,000 of these are over 75.
The prevalence of common mental health disorders, such as depression and anxiety, is 11.5% for those aged 65-74 (15% for women, 8% for men), and 9% for those aged over 75 (11% for women, 5.5% for men) [APMS, 2014].
Covid-19 has also increased levels of anxiety and loneliness in this age group (Please see COVID & Older People section of these resources). On average, 5% of those accessing IAPT services in London are over 65, suggesting that there is unmet need in this population group.
In 2018 the service worked with the Health Innovation Network (an academic health science network) and Lewisham to increase referrals from older people, using the following behavioural science techniques:
- A letter to GPs – informing practices about the referral rates to IAPT services, prevalence of common mental health issues amongst older adults, the benefits of referring to IAPT and how to make a referral.
- Patient prescription leaflets – providing information on older adults and common mental health problems, how IAPT services helped and how to self- refer to IAPT services. The leaflets were given to patients by GPs, practice nurses or social prescribers.
The two interventions piloted during this project did not provide enough evidence to demonstrate that their use increased older adult referrals to IAPT. Key to the success of the interventions is the engagement of CCG commissioners, GPs and practice nurses. The availability of these health care professionals to participate in the tasks allocated was challenging throughout the project. The report provides a few other suggestions on how referrals could be increased for older people.
Kensington & Chelsea:
Work closely with Open Age, a charity that supports over 50s to sustain their physical and mental fitness and maintain an active lifestyle. Together they have identified that most older people referred to IAPT need Older People’s Mental Health or specialist services, rather than IAPT. They have held outreach workshops, and supported older people to access technology.
Has an integrated care service for over 65s called My Care My Way, involving a team of GPs and other health and social care professionals. It provides staff training to identify when people may have more needs – including MH needs.
During the first national COVID-19 lockdown the service contacted all over-70s who were shielding to ask if they needed any MH support; most reported that they did not require any additional support but appreciated the phone call.
In the third lockdown, the service identified people over 70 and began proactively contacting them with new questions re: how are they coping without family/friends and asked whether they needed any support from IAPT or other organisations. This approach intended to prevent these people’s mental health deteriorating.
Have a specific older adult workstream, and have an older adult lead (a clinical psychologist, as their training covers older people). The service used to have an assistant clinical psychologist who did outreach work (e.g. with Age Concern) to increase referrals, however the funding for this was taken out so they no longer have this post. As a result, access rates have fallen for older people.
Havering have a predominantly older white British population and so the IAPT service have created an older adult group at step 2 to target this population.
Older adults tend to engage well with the service, but referral rates are not high. The service set up ‘aging well’ group sessions jointly run by a CBT therapist and a nurse from the Whittington. The groups had a walk, then went to a cafe to have cake and a bit of psychoeducation. Feedback was very positive, however IAPT recovery rates didn’t improve much, therefore the groups are no longer running.
Camden & Islington
Are linked in with Age UK and the local Somali elders group.
Guidance for increasing access for older people can be found here.
ThriveLDN resources for older Londoners
Nationally there is a social media campaign with Age UK to encourage older people to speak to their GP or self-refer to talking therapies if they are struggling with their mental health. As well as working to promote NHS England’s new Help Us Help You mental health campaign assets, the campaign includes videos of older people speaking about their experiences of the pandemic and content on the Age UK website to help break down the barriers to accessing talking therapies.