Guidance

7. Living well in older years

Updated 25 October 2019

1. Introduction

The purpose of this chapter, and the mental health and wellbeing JSNA toolkit overall, is to support people developing the mental health and wellbeing content of their local joint strategic needs assessment. It provides easy access to nationally available topic focused information, guidance and knowledge. The chapter text aims to be plain English and ready to be cut and pasted. The numerous links to external sites should all be current, relevant, and provide access to material that contributes to the JSNA process.

Although mental health conditions are prevalent in later life, they are not an inevitable part of ageing. Most older people are not depressed and often are less dissatisfied than younger people. However, mental health problems in older people tend not to have the same level of priority compared to that of their younger counterparts, and yet are distressing for individuals and their families. Mental health problems in older people, contrary to popular belief, are as treatable as mental health problems in younger people.

A JSNA relating to older people’s mental health should consider:

• what is the local prevalence of mental health conditions among older adults and how does this compare against the local demographic profile?
• are there local inequalities in the prevalence of mental health problems among older adults?
• how many older adults have long term conditions, and how many have one or more physical health conditions alongside a mental health problem?
• how many older adults are in demographic groups that often have complex or extra mental health needs?
• what are the common risk factors among older adults and how do these compare with the local demographic profile?
• what community assets are available in the local area to improve older people’s mental wellbeing and resilience?
• what local older adult mental health services are available and how does their use compare to need?
• does social care provision meet the mental health needs of older adults?

1.1 Productive healthy ageing

Productive healthy ageing is about enabling improved health and wellbeing, increasing independence, and resilience to adversity. It also includes having the ability to be financially secure, engaging in social activities, being socially connected with friendships and support, and enjoying life^{[footnote 1]}.

Mental health and wellbeing of older people should be seen within the context of the whole person. Public Health England (PHE) has adopted the World Health Organization (WHO) framework of ageing, part of the WHO global strategy on ageing and health. The framework recognises that the ageing process can start over a long period of time and that there are opportunities to intervene across the life-course to maintain functional ability in older age. It also identifies that average decline in capacity increases with age. When seeking to understand need, the framework describes this in terms of ‘high and stable capacity’, ‘declining capacity’ and ‘significant loss of capacity’^{[footnote 2]}.

WHO has developed guidelines on the integrated care for older people (ICOPE) which outline evidence-based recommendations to prevent, slow or reverse declines in the physical and mental capacities of older people.

1.2 The older population

Older age is generally considered to be 65 years and above in most developed countries^{[footnote 3]}, and then subdivided into young-old (65 to 74), old (75 to 84) and old-old (85 and over).

By 2035, almost a quarter of the population in England will be over the age of 65 and the number of people aged 85 and over will be almost two-and-a-half-times larger than in 2010^{[footnote 4]}. There will be some local variation in these numbers and proportions, for instance more rural areas will often have a population structure that has a larger proportion of older people than the England average^{[footnote 5]}.

Although ‘older age’ does not necessarily reflect ‘functional ability’, understanding the size of older population provides some basis for commissioners to plan services that meet the needs of older people now and in the future^{[footnote 6]}.

1.3 Mental health of older people

Mental health problems in older people are common and are often more apparent in settings such as hospitals and care homes. For example, in a 500-bed general hospital on an average day, estimates suggest that 330 beds will be occupied by older people, of whom 220 will have a mental disorder, 100 will have dementia and depression, and 66 will have delirium^{[footnote 7]}. Depression affects 4 in 10 people living in care homes^{[footnote 8]} and in nursing homes around 1 in 10 residents have psychotic symptoms such as delusions and hallucinations^{[footnote 9]}. A third of people using specialist mental health services are older people, yet they currently only make up 18% of the general population^{[footnote 4]}, ^{[footnote 8]}.

Depression is the most common mental health condition in older people^{[footnote 10]}. It can sometimes lead to dementia and treatment resistant depression which can be associated with cerebrovascular disease^{[footnote 10]}. Depression is associated with:

• personal suffering
• high level of physical health problems, including frailty
• social isolation
• risk of suicide
• increased health and social care costs^{[footnote 10]}

Concentrating on depression can also help to identify and address anxiety that is another common mental disorder in older people^{[footnote 10]}.

1.4 Access to and use of mental health services

Depression and other mental health conditions in older people often go underdiagnosed and undertreated. However older people with mental health problems are likely to respond to treatments as well as or better than the younger population^{[footnote 6]}, ^{[footnote 9]}. A greater proportion of older people (42%) complete treatment than their working age counterparts (37%)^{[footnote 11]} after being referred to Improving Access to Psychological Therapies (IAPT) services.

Additionally, older people achieve good outcomes from IAPT treatment, sometimes better than people under 65. For instance, in 2014 to 2015, 56% of over-65’s showed ‘reliable recovery’ after receiving psychological therapies compared with 42% of working age adults^{[footnote 11]}. Planners and commissioners should ensure the full range of services for mental health problems are available for older people^{[footnote 6]}.

The NHS Long Term Plan (January 2019) outlines measures for the NHS to improve the provision of mental health support for older people with a range of needs and diagnoses, including common mental disorders and severe mental illness. This applies across all mental and physical health services and settings, including IAPT, community, crisis and liaison mental health care as well as new models of integrated care for older people living with frailty. The publication of the NHS Mental Health Implementation Plan 2019 to 2020 up to 2023 to 2024 (July 2019) follows the NHS Long Term Plan, outlining a framework of delivery to transform mental health care, including specific guidance on older people’s mental health.

2. Prevention

2.1 Overview

A JSNA relating to mental health problems in older people will benefit from a focus on:

• protective factors and how to further develop them
• risk factors and how to mitigate against them
• the prevention of the onset and development of mental health problems

Older people experience complex social, psychological and physical factors that influence the pattern, cause, diagnosis, treatment and prognosis of mental health conditions^{[footnote 14]}. Older people who have experienced any of the following are at a greater risk of a decline in their independence and wellbeing:^{[footnote 15]}, ^{[footnote 16]}

• their partner died in the past 2 years
• they are a carer
• they live alone and have little opportunity to socialise
• recently separated or divorced
• recently retired (particularly if involuntarily)
• unemployed in later life
• on low income
• have recently experienced or developed a health problem
• have had to give up driving
• have an age-related disability
• are aged 80 or older
• if they are subject to different levels of discrimination
• have dementia
• have delirium
• they have been subject to abuse
• they have experienced alcohol and substance misuse
• if they are taking multiple prescribed medications (polypharmacy)

The Mental health: environmental factors and Mental health: population factors chapters of the Knowledge guide, although largely considering all age adults, reflect risk and protective factors that influence all individuals and communities and will be of relevance to older people.

Some priority areas to focus on in the prevention of mental health problems in older people include loneliness and social isolation, frailty, and carers.

2.2 Loneliness and social isolation

Although linked, loneliness and social isolation are not the same. People can be isolated yet not feel lonely, equally they can be surrounded by others and feel lonely. Loneliness is a subjective state defined as a ‘negative emotion associated with a perceived gap between the quality and quantity of relationships that we have and those we want’^{[footnote 17]}. While, social isolation is an objective state defined as the ‘quantity of social relationships and contacts between individuals, across groups and communities’^{[footnote 18]}.

While loneliness and social isolation can affect all ages, older people are especially vulnerable. Being lonely or isolated can lead to deterioration in health and wellbeing and is a symptom of common mental disorders. Over one million older people regularly feel lonely and nearly half of all people over the age of 75 live alone^{[footnote 19]}.

Initiatives which aim to address social isolation and loneliness are particularly important in older age and can have significant benefits. Mental health services: cost-effective commissioning guidance provides details of cost-effective group activity and signposts interventions which address loneliness to improve the mental health of older people.

Important challenges in addressing loneliness in older people include:

• reaching lonely individuals
• understanding their needs
• supporting lonely individuals in accessing services^{[footnote 17]}

Interventions to address loneliness should consider the above. Direct interventions often focus on supporting and maintaining existing relationships and may also concentrate on improving access to transport and technology. Support should also be given to help build new social connections, which may include both group-based and one-to-one approaches. There should also be some focus on psychological approaches that support individuals to change their thinking about relationships^{[footnote 17]}.

Examples of how to deliver the above interventions effectively include^{[footnote 17]}:

• neighbourhood approaches
• asset-based community development
• volunteering which can give older people a sense of purpose and self-esteem and assist in meaningful interaction with others^{[footnote 20]}
• age positive approaches which focus on understanding ageing and leading an active lifestyle as well as ending stigma around old age

2.3 Frailty

Frailty is a distinct health state related to the ageing process in which multiple body systems gradually lose their in-built reserves thus individuals are less able to cope with and recover from illness and accidents^{[footnote 21]}, ^{[footnote 22]}.

It is estimated 1 in 10 people aged 65 and over are defined as frail. Frailty increases with age. For example, approximately 1 in 4 people aged 85 years and over are living with frailty^{[footnote 23]}, ^{[footnote 24]}.

Frailty is closely associated with depression; each condition may be a risk factor for the development of the other^{[footnote 25]}. Prevention and early identification is imperative in frailty, prevention can be achieved through exercise and good lifestyle choices^{[footnote 26]}. Falls are a common concern in older people and can negatively affect mental health outcomes. However, they are not inevitable and there is much that can be done to reduce the chance of a fall, such as leading an active lifestyle^{[footnote 27]}. For example, improving muscle function and balance may not only reduce the risk and fear of falling, but also improve self-confidence, help maintain mobility and independence, and have beneficial effects on social connectedness^{[footnote 28]}.

2.4 Carers

The mental health of older carers is an important aspect to consider in depression of older people. Older carers are at increased risk of their mental health needs being missed or not given the right attention which can have detriment effects on their health and wellbeing. A campaign led by Carers Trust to raise awareness of older carers’ needs highlights issues affecting carers over the age of 65.

NHS England’s Carers toolkit includes a template memorandum of understanding designed to support health and social care organisations to work together to support carers.

2.5 Understanding local population: data sources

Mental health and wellbeing JSNA profile

In risk factors include:

• older people living in poverty (IDAOPI) (region, county and UA, district and UA, ward, CCG)

In protective factors include:

• life expectancy at 65: male, female (region, county and UA, district and UA)

Although there is some suggestion that older people experience more complex social, psychological and physical factors there is also value in considering the risk factors and protective factors domains containing adult age metrics on:

• socio-economic deprivation
• homelessness
• housing quality and security
• debt and low income
• poor physical health
• wellbeing
• physical activity
• social interactions
• use of outdoor space
• quality of indoor space

Other important data sources

The older people’s mental health data catalogue is a gateway to a range of relevant intelligence including:

• a section focused specifically on intelligence relating to prevention that highlights risk and protective factors

• data organised into sub-themes which focus on more specific topics such as loneliness and productive healthy ageing

The Productive Healthy Ageing profile (June 2019) provides comparative data and trends at local, regional or national level on a wide range of issues including many relevant to older people’s mental health. The content is grouped into 5 domains, with the following particularly relevant to prevention of mental health problems.

Optimise health and reduce risks early

• heathy and disability-free life expectancy at age 65

• health related quality of life age 65 and over

• healthy and risk behaviours

• NHS health checks and interventions.

Improve wellbeing and wider determinants of health

• aspects of wellbeing

• employment, finance and deprivation

• housing

• social isolation (including older carers) and engagement

• community assets.

The tool also has further resources sections providing links to important documents and websites, including examples of local healthy ageing needs assessments and initiatives.

The Projecting Older People Information System (POPPI) estimates the effect of a range of long-term conditions including mental health conditions and provides projected numbers of older people in local authority areas by:

• those living alone
• those living in care home
• provision of unpaid care
• their ability to carry out domestic tasks and self-care

Resources for estimates of loneliness in older people include:

• Age UK heatmap of risk of loneliness in people aged 65 and over
• Insights into loneliness, older people and well-being produced by ONS focuses some of the risk factors associated with loneliness such as living alone, housing tenure, marital status, ill health and support networks

The PHE: mental health promotion return on investment tool provides cost-effectiveness assessment of interventions to address loneliness and to protect the mental health of older people.

Local data collection

Inclusion of locally collected metrics could form an important element of a JSNA on older people’s mental health. Local areas may focus on collection of metrics around wellbeing and community assets to help understand resilience of older people. Understanding local needs for wellbeing data provides guidance on this. Local community and voluntary organisations will have data and information to contribute towards this understanding.

Older people who self-harm are at increased risk of dying by suicide compared to other age groups^{[footnote 29]}. Guidance exists on local suicide prevention planning. The guidance advises local authorities how to:

• develop a multi-agency suicide prevention partnership
• make sense of local and national data
• develop a suicide prevention strategy and action plan

2.6 Evidence and further information

The following documents and supporting materials provide some evidence of what works, policy direction and guidance with a focus on prevention.

NICE guidance: dementia, disability and frailty in later life: mid-life approaches to delay or prevent onset: guidance covering mid-life approaches to delay or prevent the onset of dementia, disability and frailty in later life. It aims to increase the amount of time that people can be independent, healthy and active in later life.

NICE: older people: independence and mental wellbeing: covers the commissioning of services by local government and other local providers to help encourage and protect mental wellbeing and independence of older people.

Age UK: loneliness in later life evidence review: focuses on loneliness in the community setting.

Combatting loneliness one conversation at a time: part of the Jo Cox Commission on loneliness – this is a call to action from national government with a focus in 3 areas (national leadership, measuring progress and catalysing action). It also highlights the roles of local authorities, businesses, public sector, and local communities.

PHE: mental health promotion return on investment tool: includes information on interventions that address loneliness to protect the mental health of older people.

Living with frailty: a set of resources provided by NHS England for families, carers, community and voluntary sector organisations, and health and care services to support individuals living with frailty.

Providing support for people caring later in life: a toolkit developed by the Carers Trust which aims to help commissioners to identify carers in need and what support they require, offering case studies as examples of good practice.

Age UK falls prevention: information and advice relating to falls prevention.

Better mental health for all: a public health approach to mental health improvement: a report by the Faculty of Public Health which concentrates on how to enhance the mental health of individuals, with a section on mental health interventions targeting later life to reduce isolation, improve mental wellbeing, and prevent onset of mental health problems in older people.

3. Identification

3.1 Overview

A JSNA that includes mental health problems in older people will benefit from a focus on:

• a process to identify people in need for services and local variation in need
• complexity of need and required care
• understanding the relationship between mental health problems and physical health conditions

Around two-thirds of older adults on acute hospital wards have a mental health problem and this is often unrecognised and untreated^{[footnote 30]}. Mental health problems in later life are under-identified by health professionals and by older people themselves^{[footnote 31]}.This can be when the effects of poor mental health and adversity throughout life become evident^{[footnote 8]}.

Older people with depression often present with physical complaints causing fruitless physical investigations, which can result in mental health needs not being addressed. At the same time, many older adults will suffer from physical ill health and this can lead to mental health problems. The risk of developing depression is over 7 times higher in those with 2 or more chronic physical problems^{[footnote 30]}. Older adults with mental health problems and physical disorders use more health and social care services and have poorer outcomes. The interaction of physical and mental health problems is described in more detail in Working age adults.

Depression in older people is commonly associated with a caring role or physical illness and frailty. The presence of depression strongly predicts outcomes in physical conditions such as hip fracture, stroke and myocardial infarction. There is also evidence that depression is a risk factor for heart attacks and strokes. NICE recommend depression screening (case finding) and referral to treatment and interventions in at risk groups^{[footnote 32]}.

Some priority areas to focus on in the identification of mental health problems in older people include care homes and safeguarding.

3.2 Care homes

It is estimated that 14.8% of people aged 85 and over live in care homes^{[footnote 33]}. It is also estimated that depression affects 40% of older people in care homes – this often goes unidentified, and care needs in relation to this are often not met^{[footnote 34]}. The British Geriatrics Society and the Faculty of Old Age Psychiatry of the Royal College of Psychiatrists outline best practice measures and how to overcome barriers to providing integrated care to treat depression in older people in care homes. NICE have published specific guidance on the mental wellbeing of older people in care homes, concentrating on improving mental wellbeing and leading healthy, independent lives^{[footnote 35]}.

3.3 Safeguarding

Safeguarding refers to protecting people’s right to live in safety, free from abuse and neglect. Older adults who are frail or are physically disabled and/or living in a residential care home are at risk of harm^{[footnote 36]}. Abuse in older adults can occur in different forms including sexual, physical, psychological, domestic, financial, and discriminatory abuse^{[footnote 37]}. Age UK recently published a factsheet outlining legislation relating to safeguarding older adults and measures to take if abuse and neglect are suspected^{[footnote 38]}.

3.4 Understanding local population: data sources

Mental health and wellbeing JSNA profile

In prevalence and incidence:

• estimated prevalence of common mental disorders: % of population aged 65 and over (CCG, STP, County and UA)

Other important data sources

The older people’s mental health data catalogue is a gateway to a range of relevant intelligence including:

• a section focused specifically on intelligence relating to clinical diagnoses of depression and related health conditions
• data organised into sub-themes which focus on more specific topics such as hospital admissions and use of the Mental Health Act

The Productive Healthy Ageing profile (June 2019) provides comparative data and trends at local, regional or national level on a wide range of issues including many that are relevant to older people’s mental health. The content is grouped into 5 domains, with the following particularly relevant to identification of mental health problems:

• reverse or live well with a long-term health condition; cardiovascular conditions, chronic obstructive pulmonary disease, cancer overview, musculoskeletal long-term problems, sensory and other communication-related conditions, depression/anxiety, dementia
• enhanced care and support; falls and fractures, independent living support and unmet need in older people, end of life care
• demographics and mortality; demographics, mortality

The tool also has further resources sections providing links to important documents and websites, including examples of local healthy ageing needs assessments and initiatives.

The Severe Mental Illness Profile includes NHS Benchmarking Network data on older people’s use of specialist mental health services.

Commissioners may also want to consider dementia within the remit of mental health and wellbeing JSNAs. A Dementia Profile is available which includes metrics spanning the whole condition pathway. The data sources identified in Working age adults will often apply to all adults and should be considered.

The ‘Adult Psychiatric Morbidity Survey’ provides national data on the prevalence of mental health conditions in the English adult population (aged 16 and over), often including a sub-section for those aged 65 and over. The sampling frame for the survey covers only those living in private households, therefore older people living in care homes are not included.

The Care Quality Commission(CQC) publishes data on performance ratings of social care services regulated by CQC in England.

Local data collection

Further consideration of identification of mental health problems among older people may benefit from use of local knowledge and data. This is likely to include working with primary care, third sector, community and specialist services to obtain and analyse local data.

The Local Government Association and the Association of Directors of Social Services have produced a set of resources to help local areas in their implementation of the Mental Capacity Act. This includes identifying and promoting good practice in the use of the Mental Capacity Act.

3.5 What to do: evidence and further information

The following documents and supporting materials provide some evidence of what works, policy direction and guidance that considers effective identification of need within older people with mental health problems.

NICE: older people with social care needs and multiple long-term conditions Guideline covering planning and delivering social care and support for older people who have multiple long-term conditions. It encourages an integrated and person-centred approach to delivering effective health and social care services.

NICE: mental wellbeing of older people in care homes This quality standard covers the mental wellbeing of older people (65 years and over) receiving care in all care home settings, including residential and nursing accommodation, day care and respite care.

Supporting older people living with frailty A toolkit for general practice to support GPs, practice nurses and the wider primary care workforce with case finding, assessment and management of older people living with frailty.

NHS RightCare frailty toolkit It is designed to support systems to understand the priorities in frailty identification and care, and important actions to take.

Deprivation of liberty safeguards (DoLS) briefing paper Published by the House of Commons Library, this report outlines the introduction of DoLS into the Mental Capacity Act (2005). It highlights changes introduced in 2014 that led to a significantly widened definition of deprivation of liberty, meaning more people were subsequently considered to have their liberty derived. The report provides an overview of recommendations given by the Law Commission in 2017 to repeal and replace the DoLS system with Liberty Protection Safeguards.

Independent review of the Mental Health Act An interim report which outlines the causes of rising detention rates, racial disparities in detention, and concerns that the act is out of step with a modern mental health system as well as any additional issues with the functioning of the MHA.

4. Treatment

4.1 Overview

A JSNA that includes mental health problems in older people will benefit from a focus on the care, support and treatment that is offered and provided. This may include the role of:

• primary care
• IAPT
• specialist mental health services
• use of medications
• social care
• community and voluntary services

Treatment for depression in older people is effective and is beneficial to enhancing the quality of life, improving ability to contribute to families and wider society and reducing dependence. Treatment for depression in older people is largely the same as in younger people^{[footnote 7]} and there is convincing evidence that older people respond well to interventions with a superior recovery rate for IAPT than younger patients^{[footnote 11]}.

The ‘Working age adults’ chapter provides further details of the full range of adult mental health services.

Where people are at risk of decline in physical and mental wellbeing, the NICE quality standards^{[footnote 15]} suggest that tailored, community-based physical activity programmes and activities that encourage social participation should be offered.

The Five Year Forward View for Mental Health recommended expansion of mental health liaison services by 2020 to 2021 including the requirements for teams to have expertise in older adult psychiatry. Liaison services are shown to be particularly cost effective for the older population due to reduced lengths of stay on wards^{[footnote 39]}.

The NHS Long Term Plan aims to make further progress by ensuring a 24/7 community based mental health crisis response for adults and older adults is available across England by 2020 to 2021.

Some priority areas to focus on in the treatment of mental health problems in older people include IAPT services and community centred approaches.

4.2 Improving Access to Psychological Therapies (IAPT) services

IAPT services play a significant role in the treatment of common mental health problems in older age. Planners need to ensure local IAPT services are meeting the needs of older people^{[footnote 7]}. The IAPT manual outlines the model in detail and supports implementation and expansion of IAPT services^{[footnote 40]}.

Data shows that once referred, a higher proportion of older people complete treatment compared to working age adults and show better outcomes in terms of recovery^{[footnote 11]}.

However, barriers exist for older people accessing IAPT services particularly around, perception of whether psychological therapies are helpful, mobility and sensory issues, confidence of professionals delivering IAPT, as well as lack of inclusiveness^{[footnote 11]}.

The NHS Long Term Plan states plans to expand access to IAPT services for adults and older adults with common mental health disorders with a target of 380,000 per year.

4.3 Community-centred approaches

PHE’s Health Matters edition on community-centred approaches for health and wellbeing highlights the importance of community-centred ways of working for all aspects of public health. Themes include being connected with other people and building social capital and highlights that a lack in either can have detrimental effects on mental and physical health.

Improving health and wellbeing by concentrating on community settings and drawing on community assets can increase people’s control over their health and lives^{[footnote 42]}. This includes the social network approach which aims to strengthen communities and social support between people (such as neighbourhood network models that coordinate informal support to older people).

Community-centred approaches can have many positive benefits for mental health and wellbeing, including:

• reducing health inequalities
• supporting people to have a proactive say in their health
• identifying those at higher risk
• creating a more connected and resilient community^{[footnote 42]}

These approaches can lead to better clinical outcomes and improved quality of life. The Realising the Value programme led by Nesta and the Health Foundation produced a guide which concentrates on the implementation of person and community centred approaches, using a framework for understanding and changing behaviour, that can be viewed as being widely adaptable.

The NHS Long Term Plan (2019) outlines new models of community mental health care and community care for older people with moderate frailty. These are aligned with primary care networks and multidisciplinary teams that will help to break down the barriers between primary and secondary (mental health) care as well as supporting closer working with health, social care, local government and voluntary, community and social enterprise (VCSE) providers and commissioners.

4.4 Understanding local population: data sources

Mental health and wellbeing JSNA profile

Many of the service metrics in the JSNA profile come from the new national Mental health services data set (MHSDS) and the Improving access to psychological services (IAPT) data sets. As the reporting from these sources develops, more age specific metrics will be available for inclusion.

In services:

• rate of IAPT referrals per 100,000 population (persons aged 65 and over) (CCG, STP)
• rate of entering IAPT per 100,000 (persons aged 65 and over) (CCG, STP)
• rate of completion of IAPT treatment per 100,000 population (persons aged 65 and over) (CCG, STP)

In quality and outcomes:

• rate of IAPT recovery per 1000,000 population (persons aged 65 and over) (CCG, STP)
• percentage of reliable improvement in people who completed IAPT treatment (persons aged 65 and over) (CCG, STP)

Other important data sources

The older people’s mental health data catalogue is a gateway to a range of relevant intelligence including:

• a section focused specifically on intelligence relating to use of IAPT services and other mental health services
• data organised into sub-themes which focus on more specific topics such as social care and medication

The productive healthy ageing profile (June 2019) provides comparative data and trends at local, regional or national level on a wide range of issues including many that are relevant to older people’s mental health. The content is grouped into 5 domains, with the following particularly relevant to treatment of mental health problems:

• enhanced care and support: falls and fractures; independent living support and unmet need in older people; end of life care

The tool also has further resources sections providing links to important documents and websites, including examples of local healthy ageing needs assessments and initiatives.

Many additional and complementary metrics are also available from:

• NHS England Mental health dashboard
• NHS Right Care focus packs for mental health

The IAPT data set reports offer a range of monthly and annual publications. The IAPT programme is supported by a regular return of data generated by IAPT providers of delivering services to patients. These data are received by NHS Digital and released as statistical publications covering activity, waiting times and patient outcomes such as recovery.

The Mental health services data set (MHSDS) contains record-level data about people in contact with mental health, learning disability and autism services. NHS Digital publishes monthly statistical releases which provide most up to date information about care given to users of NHS funded secondary mental health, learning disability and autism services for all ages in England.

Local data collection

Further consideration of treatment and support services for older people’s mental health will require local action. This is likely to require working with third sector and community services which provide targeted interventions. More detailed assessment of local support services will also require direct contact with providers (social care, NHS and private specialist mental health services) as well as commissioning support units (CSU).

4.5 What to do: evidence and further information

The following documents and supporting materials provide some evidence of what works, policy direction and guidance that concentrates on treatment services.

NHS: adult improving access to psychological therapies programme: older people provides an overview of the specific consideration which should be given to the provision of IAPT services for older adults, including a range of links to specific older adults practice guidance.

PHE: changing risk behaviours and promoting cognitive health in older adults is a summary of reviews supporting the commissioning of interventions across a range of health behaviours for older adults.

Joint Commissioning Panel for Mental Health: guidance for commissioners of older people’s mental health services provides information on developing and delivering local plans and strategies to commission the most effective and efficient older people’s mental health services.

The King’s Fund: making our health care systems fit for an ageing population - a high level resource and reference guide for local service leaders who want to improve care for older people. Selected examples of local good practice, pointers to major reviews and guidelines, and advice about where to start.

Implementing the Mental Health Forward View, chapter 4, adult mental health: common mental health problems (2016) is a report addressing variation in outcomes and access to services for different population groups including older people.

Five Year Forward View for Mental Health: government response (2017) is the government’s response to the work of the Mental Health Taskforce and the 5 Year Forward View for Mental Health report.

Realising the value: person and community-centred approaches to healthcare provides tools and resources to support the health and care system to work in partnership with people and communities.

The ‘Improving access to psychological therapies manual’ is a resource for commissioners, providers, and clinicians of services that deliver IAPT for depression and anxiety disorders in adults. The manual concentrates on the IAPT model and how to deliver it, as well as offering support to further implementation and expansion of IAPT services.

Social prescribing and community-based support is a guide to support people and organisations leading on local implementation of social prescribing.

The NHS Long Term Plan (2019) outlines a series of goals to make NHS fit for the future, which have been drawn together by frontline health and care staff, patient groups and other experts. The plan includes a number of commitments for older people’s mental health OPMH including the expansion of integrated and personalised care and improving access to timely crisis care for older people.

The NHS Mental Health Implementation Plan 2019 to 2020 up to 2023 to 2024 provides a new framework to ensure delivery of the Long Term Plan commitment to transform mental health care at the local level. It outlines a commitment to ensuring OPMH is embedded across all adult mental health services and ensuring access to support is based on needs and not age.

Applying behavioural science techniques to increase referrals of older adults to psychological therapies is an evaluation report by the Health Innovation Network in partnership with 2 south London IAPT providers, who worked together to design and implement behavioural insight interventions to increase older adult referrals to IAPT services. The report aims to assess the effectiveness of these interventions.

5. References

1. Public Health England, 2017. Productive healthy ageing and musculoskeletal (MSK) health ↩

2. World Health Organization. Global strategy and action plan on ageing and health ↩

3. World Health Organization. Health statistics and information systems: Proposed working definition of an older person in Africa for the MDS Project ↩

4. National Population Projections: 2016-based statistical bulletin: A growing number of older people ↩ ↩²

5. Sub-national Population Projections: 2016-based statistical bulletin: The number of older people is projected to increase in all areas ↩

6. Joint Commissioning Panel for Mental Health. Guidance for commissioners of older people’s mental health services (2013) ↩ ↩² ↩³

7. Burns A. Better access to mental health services for older people (2015) ↩ ↩² ↩³

8. Faculty of Public Health, Mental Health Foundation. Better Mental Health for All: A Public Health Approach to Mental Health Improvement (2016) ↩ ↩² ↩³

9. Department of Health. Annual Report of the Chief Medical Officer 2013 - Public Health Priorities (2014) ↩ ↩²

10. NHS England/NHS Improvement. Mental Health in Older People: A practice primer (2017) ↩ ↩² ↩³ ↩⁴

11. NHS England. Adult Improving Access to Psychological Therapies programme: Older people ↩ ↩² ↩³ ↩⁴ ↩⁵

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29. WHO. Mental health and older adults: Fact sheet (2017) ↩

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38. NHS/National Collaborating Centre for Mental Health. The Improving Access to Psychological Therapies Manual (2018) ↩

39. Public Health England. Health and wellbeing: a guide to community-centred approaches (2015) ↩ ↩²