As I hurtle towards retirement, with only a few weeks remaining of my time with VHS, I have been encouraged (thanks, team!) to pen a valedictory blog. I suppose the customary approach to this would be to reflect (in a slightly self-congratulatory way perhaps) on the many highlights and achievements that the team and I have seen over the past 12 years. However, listening to the radio in the shower this morning inspired me to change tack.
BBC Good Morning Scotland presenter Gary Robertson was interviewing Andy Bell, Chief Executive of the Centre for Mental Health. They are a mental health charity working in England and together with Age UK have just published Mental Health in Later Life – a literature review on related needs, services and policies in England.
It didn’t matter to Gary that the report’s evidence was gathered in England, he was interested in what the findings tell us about mental health in later life in general, and what lessons we can draw from them. Andy explained that the literature review demonstrates how mental health in later life has been on the margins of policy and practice for many decades, that opportunities to promote good mental health and wellbeing in later life are too often missed, and that support to address older people’s mental health difficulties is too often lacking.
Andy told Gary that ageist attitudes and assumptions about mental health in later life underpin a system that discriminates against older people. Too often, older people are excluded from services and support that could help their mental health and therefore their quality of life. The report shows there is a pressing need to challenge ageism relating to mental health in our health and care system, because older people have the right to expect equitable provision of mental health support. For that, we need investment in effective interventions, and a health and care workforce (across the system, not just the mental health workforce), with the skills, knowledge and understanding to meet their diverse needs.
So, by now I am jumping up and down in the shower, shouting at the radio, ‘yes!’ and ‘exactly!’ and, ‘VHS and our members have been saying all this for years!’ – but also, ‘aha, finally a good topic for my blog…’
During my time at VHS there have been frustrations, not least when third sector evidence about needs, gaps and solutions is ignored or dismissed. One of my biggest frustrations has been our failure, so far, to do enough to persuade policy makers in Scotland to take older people’s mental health, including serious mental health conditions, seriously.
Back in 2019 we began a collaboration with Change Mental Health (formerly Support in Mind) and a group of other third and public sector colleagues, to scope what happens to people with mental health conditions (other than or alongside dementia) once they become 65. Our main concern was for people who already have serious mental health issues like depression, schizophrenia or bipolar disorder, because we were told that for some people the experience of turning 65 was like ‘falling off a cliff’. Mental health services and support that they relied on as an ‘adult’ could disappear once they were designated as an ‘older person’, because the NHS healthcare system for older people is different. We already had a rich, anecdotal picture of the difficulties many older people with mental health issues experience in relation to services, but could we compile some hard evidence to prove it?
Working with other stakeholders, including an eminent old age psychiatrist, Scottish Care, Faith in Older People and the Mental Welfare Commission for Scotland we pulled together a picture of under-diagnosis, under-provision, poor transitions from ‘adult’ services to ‘older people’ services, and discrimination. With the help of NHS Health Scotland (now part of Public Health Scotland) we conducted a literature review, which confirmed what we knew already, that very little official data is gathered about older people’s mental health, mental illness or access to mental health services. And there isn’t a great deal of published research either.
We published our own literature review and a series of discussion papers, compiling these in March 2020 into one document, Falling Off a Cliff, Discussion Paper and Evidence . We repeatedly tried to draw policy makers’ attention to the issues, through our responses to various policy consultation papers and through meeting with various Scottish Government officials. However, armed as we were with imperfect data and patchy research results, we failed to convince government of the need for radical improvement or change.
By this point, Scotland had been catapulted into the Covid-19 pandemic, and everyone’s attention, our own included, was diverted elsewhere. Unless, of course, you happened to be an older person with serious mental health problems, now also struggling to cope with lockdowns and the accompanying withdrawal of even more services and support. In March 2021 we published a powerful blog by Donald Macaskill, Chief Executive of Scottish Care, reflecting on the impact of the pandemic on mental health and on the neglect of older people’s mental health.
Donald wrote, ‘I remember speaking to someone who had lived with chronic depression most of their adult life and had received good supports until they got to 65 years of age. Then almost overnight, he told me, it felt like the system was abandoning him and the supports he had been used to changed and disappeared: “It was like standing at a window and seeing everything and everyone who had helped you live your life, especially in the down times, walk down the street and wave goodbye. I felt really alone.” ‘
The Centre for Mental Health’s report jolted me back to the work we had initiated with Falling Off A Cliff and to VHS’s role and responsibilities as the national intermediary for health in the third sector – to our member organisations, like Change Mental Health and Faith in Older People, and to all those people whose health and wellbeing depends on organisations like ours caring enough to raise the issues, fight for improvement, and secure change. Older people’s mental health is not an issue VHS can ever walk away from. Perhaps this is the opportunity to reach out to the Centre for Mental Health, and to get our previous stakeholders back together. With renewed collaboration and with the added leverage of a cross-border partner, this time round VHS could just succeed in securing a better deal for mental health in later life.
Time to finish this blog and look up Andy Bell’s email address…
Claire Stevens has been Chief Executive of VHS since August 2012. She retires at the end of March 2024.
