By Donald Macaskill, Chief Executive of Scottish Care.
One of the saddest consequences of the Covid pandemic has been its impact, not least through lockdowns, on the mental health of tens of thousands of individuals. There is thankfully a wide and extensive acceptance of these impacts and a shared resolve across politics and society to do something about it.
I am also pleased that there is a growing recognition of the mental health impacts of the pandemic upon older people. This last week has seen an excellent article in the British Medical Journal on this very subject. But in a general sense, both societally and politically, the mental health distress and damage on older people has unfortunately been a lot less written and spoken about and yet it is, I would suggest, of equal criticality as the mental health impacts upon children, young people and those of middle age.
I was reflecting on these realities in preparing for a contribution this coming week at a roundtable organised by Voluntary Health Scotland and the Open University. The session is entitled Falling Off a Cliff at 65: serious mental health issues in later life. It is painfully clear in their work that the mental health of older people have been significantly impacted by the pandemic and lockdowns.
Undoubtedly, there has been in the last decade a growing awareness of the significance of dementia and delirium in the mental health of older Scots. The problem is, as those of us who work in older people’s care and support, know only too well, mental health and distress in older age goes way beyond these two conditions.
I wrote a blog on this subject some four years ago and sadly not a lot has changed. There has always been a risk that the focus on dementia has taken our eye off other mental health and life enduring challenges faced by older Scots. The absence of a distinct focus on older people’s mental health issues in the 2017 national strategy was particularly disappointing.
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.”
That sense of abandonment is evident in the research undertaken by the VHS and the Open University and sadly it is the experience of too many once they have reached the age of 65 that it is like ‘falling off a cliff’ in terms of service provision. By March 2020 both organisations had gathered a level of evidence, but then paused their work due to Covid-19. You can read their initial report here. I am pleased it is starting again not least because the problems remain and have undoubtedly been exacerbated by the pandemic.
When I speak to frontline staff in the community and from what people tell me the pandemic has resulted in a worrying deterioration in the mental health of older Scots. Whilst there has been an understandable and appropriate focus upon the impact of lockdown on people in care homes, there has been less focus on the impact upon older people in the community.
People who might before have developed routines which enabled them to be connected to others and therefore to maintain their mental health have had those connections limited or severed. There has been an exponential growth in loneliness and isolation; self-help groups and therapies have stopped or become limited; and the reality of digital poverty for older people has meant on-line and virtual equivalents have not been an option for many.
Speaking to community nursing staff I hear stories of significant dehydration as people have neglected their nutrition and wellbeing, of increased confusion, loss of memory and motivation, increased frailty and depression. There is a growth in the number of people falling and losing weight. I have heard too many stories of older people separated from family contact, disconnected and downcast, alone and empty, isolated and too often ignored.
The mental health impact of Covid on older age is profound and shaming. This was already a population more likely to experience health inequalities, more likely to be socially isolated for longer periods of time and to suffer more profound impacts from the requirements to shield and protect. All that we developed as tools for connection and protection have been used less by those of older age. This is a population much less likely- partly through frailty but also through fear, to exercise and self-motivate, to fight the black dog of the night through the light of activity and exercise. Depression has clearly increased to worrying levels and reports of self-harm at anecdotal level are deeply worrying.
Before Covid we needed to get much better at supporting people who have life enduring mental health challenges to transition from adult to older people services. This includes properly resourcing the older people care sector to train and equip staff to both recognise and to deal with mental health issues and challenges beyond dementia and delirium, and also to give greater priority to enable the development of new models of support which can cater for individual and particular mental health needs in older age. With age comes so many losses over which the individual has little control but around which it behoves society to provide support.
But much more than that we have to as a whole society take older people’s mental health seriously. We have to accept the crippling reality of hurt that is the daily grind of too many and has been for decades. Mental ill health is sadly not solely the experience of youth.
We need to get better at finding those who need to be found, naming the hurt and answering the plea. We need to remember deep inside that agony has no date by which it is spent, distress no destination at which it departs, depression no age by which it is managed. For too long we have swallowed the myth that age conquers the mind and its ravages, that with experience comes coping and with chronology challenges diminish. Mental illness has no use by date, it does not lessen as bone and muscle decline, it merely changes its whisper to shout louder in another tongue. What age seems to do is to increase absence and heartache for too many at just the time that some in society seem to consider that the expense and effort of support is best offered to others. Scotland has the opportunity to put the mental health of all our citizens first and foremost in our recovery from Covid, and a focus on older people’s mental health issues has to be central to that effort.
The model and actor Cara Delevingne beautifully captures the necessity that is the challenge to all of us – to be open to find, regardless of age, those who need accompaniment to journey through the landscape of the mind.
Who am I? Who am I trying to be?
Not myself, anyone but myself.
Living in a fantasy to bury the reality,
Making myself the mystery,
A strong facade disguising the misery.
Empty, but beyond the point of emptiness,
Full to brim with fake confidence,
A guard that will never be broken,
Because I broke a long time ago.
I’m hurting but don’t tell anyone.
No one needs to know.
Don’t show or you’ve failed.
Always okay, always fine, always on show.
The show must go on.
It will never stop.
The show must not go on,
But I know it will.
I give up. I give up giving up.
I am lost.
I don’t need to be saved,
I need to be found.
Depression by Cara Delevingne
Dr Donald Macaskill is the Chief Executive of Scottish Care