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Discrimination and misplaced stoicism: why older people's mental health gets overlooked

One in five older people suffer from depression, yet their mental health problems often go unrecognised and they are much less likely to get psychological help than younger people. A government target, set in 2011 – for older people in England to make up 12% of referrals to psychological therapies – was missed by a mile. “It was supposed to be achieved in five years, but it’s still only 6.7%,” says Tom Gentry, head of health influencing at charity Age UK. “At the current rate of improvement, it would take another 15 years to get there.”

Statistics like these have been widely seen as a result of age discrimination by GPs, who bear the main responsibility for referring patients to improving access to psychological therapies (IAPT) programmes, which provide NHS talking therapies for anxiety and depression. Dr Liz England, mental health lead at the Royal College of General Practitioners, doesn’t deny the charge. “There is age discrimination, but I don’t think it’s deliberate,” England says. “We’ve become fixated on dementia in older adults as the one mental health issue to focus on, and common mental health problems of anxiety and low mood get neglected.”

A study in the British Journal of General Practice found that while older people were much less likely to be referred to IAPT, when they were given the opportunity they were likelier both to attend therapy clinics, and to benefit from them, than their younger counterparts. Rates of referral – mainly from GPs – peaked at nearly 23% for 20–24-year-olds, declining to just 6% for 70–74-year-olds.

England points out that a misplaced stoicism about mental health – common among older people – is partly to blame. She calls for a more diverse response with nurse-led clinics and imaginative ways of encouraging older people to raise mental health concerns. “An average GP at the coalface sees an older person with a number of physical conditions, so things such as low mood and anxiety tend to get pushed to the back of the queue,” she says.

However, Amanda Thompsell, who chairs the old age faculty at the Royal College of Psychiatrists, says that GPs could do more with their 10-minute consultations: “Depression increases the risk of physical health conditions, such as heart disease and strokes. It’s not an effective use of time if the patient simply comes back and presents with more physical illnesses,” Thompsell says.

“All you need to do is ask two simple questions: have you felt depressed recently? And have you felt unable to take an interest in doing things?” she adds “It takes hardly any time and if the answer to either of these questions is yes – you can always ask them to book another appointment or see the practice nurse.”

The Guardian – Friday 13th October 2017