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Well? Issue 4: Spring/Summer 2004
enabling recovery
The World Health Organisation predicts that by 2020 depression will be the second greatest disease burden in the Western World. Recent figures suggest that 10-15% of people over 65 are affected by depression and, as people live longer, it's clear that depression in this age group is a major issue.
Well? Enabling Recovery
Ilena Day, National Co-ordinator for Depression Alliance Scotland (DAS), asks what Scotland should be doing to help older people recover from depression.
"The good news is that the prognosis for older people with depression is just as good as in other age groups--provided the appropriate treatment and support is available," she says. "Recovery is personal and what recovery means to the individual will vary from person to person."
There are, however, some common and prevailing themes reported to DAS on a regular basis. These include:
Stigma
Many older people have lived in a generation when showing feelings was discouraged and mental ill health was viewed as a "weakness". Such stigma and lack of understanding about mental ill-health can prevent people from discussing their problems with their doctor or family and friends. As in all other illnesses, early detection of depression is important to promote recovery as soon as possible.
Lack of information
Older people and their carers report a need for basic information about depression in later years, how to access help, and how to address potential problems associated with the ageing process.
Difficulty in accessing services
Good relationships with professionals can be fundamental to a person's recovery. However, problems are frequently reported in this area which is, for many, a focal point for accessing other services.
Lack of a range of interventions
Fear of an over-reliance on pharmacological and other medical interventions is a common concern. Older people with depression are having difficulty accessing an adequate range of support services to help address their many needs, and there is clearly a lack of other interventions such as psychological, social and practical support.
Physical health
Older people are more susceptible to physical health problems and therefore may be at increased risk of developing associated depression. Mobility and sensory impairments can be additional complicating factors, which may restrict participation in activities, contribute to feelings of frailty and add to concerns regarding personal safety.
Loss
Older people are more likely to experience loss in a variety of ways, making them more vulnerable to the onset of depression. Loss can be through bereavement, loss of caring responsibilities or social contact, family breakdown, adjusting to retirement, loss of financial status, perceived loss of skills and confidence and, for those who may need to move into supported care, loss of a home and familiar surroundings.
Isolation
Isolation and a lack of social support or community spirit are often reported. These can be exacerbated when a person lives in a more geographically remote area with poorer transport links and service provision.
Financial status
Financial difficulties can sometimes impinge on an older person's recovery. The benefits and appeals process can be lengthy, complex and stressful while levels of disposable income also affect choices of activities and other social opportunities.
Ilena continues: "Programmes such as the National Programme for Improving Mental Health and Well-Being, 'Choose Life' and 'Doing Well by People with Depression' have enabled additional funding streams to be allocated to mental health, while the 'see me' anti-stigma campaign is doing some excellent work and will progress towards tackling stigma in more specific groups.
"We've also seen significant progress in the last year with the creation of the Mental Health Division within the Scottish Executive to provide a greater focus and priority to mental health issues. The creation of Community Health Partnerships should also improve joint working between, and across, sectors to enable people to access a range of appropriate service provision.
"However, when considering the key messages from people in Scotland affected by depression who contact us for information and support, it's clear that real differences are yet to be felt on the ground."
Here are some recommendations highlighted by DAS:
Anti-stigma education on mental ill-health needs to have a specific focus on people in older age groups and on employment practices.
Support for older people needs to cut across sector boundaries and include voluntary organisation support, self-help strategies (such as diet and exercise), social and financial support (housing issues, benefit claims), psychological support and medical needs being addressed through the health services.
Increased service provision including 24-hour, seven-day-a-week provision, better outreach support, community-based services and respite care for people with depression.
Routine general practice screening for physical health problems in older people should be extended to also include screening for mental health problems.
Mental health specific training for all health care professionals to improve the detection and management of depression in older people.
A review of how the voluntary sector is funded and a recognition of the sector's ability to provide a unique range of support, services, interventions (including social opportunities) and community-based involvement.
Older people need to have choices and be involved in the planning, design, commissioning, delivery and evaluation of services if they are to have confidence in these as treatment options.
Depression Alliance has produced a booklet about Depression in Older People with useful information about the illness, treatments and sources of support.
Contact:
Ilena Day, Depression Alliance Scotland
t: 0131 467 3050
e:information@depressionalliance.org
www.depressionalliance.org
Joint Inquiry into Mental Health in Later life
Age Concern and the Mental Health Foundation (MHF) are collaborating on a wide-ranging inquiry into the mental health of older people across the UK. The inquiry is designed to address the full spectrum of issues affecting mental health in later life, as opposed to focusing purely on dementia which, although a vitally important area, has already been widely researched.
Maddy Halliday is the director, Scotland, and policy director, UK, for the MHF: "Unlike other inquiries, such as for children and young people for instance, inquiries on mental health in later life have always tended to be quite narrowly focused and have concentrated heavily on the challenges facing the dementia services. But this has left other mental illnesses like depression - which is seriously underdiagnosed in older people - neglected and under supported.
"We've always felt that in order to understand how to properly promote mental well-being in later life, a much broader view is required where we can also link to other issues like environment, social inclusion and poverty. So the inquiry is designed to plug a huge gap and will cover mental health promotion, supporting 'at risk' older people and responding to their needs when addressing mental health problems in later life. We'll also be looking at different ages within the older people range, for example 'younger older' people from around age 55, and 'older older' people from around 85 years."
An Inquiry Board has been established, chaired by Dr June Crown, former chairperson of Age Concern England, to steer the work which will link with the National Programme by sharing information, policy analysis and data. A representative from the National Programme team will also be invited to join the Board as an observer.
Mental Health Foundation
t: 0141 572 1662
Scotland National HQ: 0207 802 0300
www.mentalhealth.org.uk
Age Concern
t: 0131 220 3345
Scotland National HQ: 0208 765 7200
www.ageconcern.org.uk
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