Old problems, new solutions

The National Clinical Director for Older People’s Mental Health and Dementia previews NHS England and Age UK coming together at Expo to dispel the myths around older people’s mental health:

As now seems to be tradition, let’s start with some statistics.

Up to four out of ten people over the age of 65 experience mental health problems. Depression is both the most common and most treatable mental illness in old age, affecting one in five older people in the community. This figure doubles in the presence of physical illness and trebles in hospitals and care homes. Nor should we forget that older people also experience severe mental illnesses.

About one fifth of all suicides happen in older people. Risk factors include: being male, being widowed, increasing age, social isolation, physical illness – present in up to 80 per cent of cases – pain, alcohol misuse and depressive illness past or present.

Why do we cite these statistics and facts, and what do they ultimately tell us?

Firstly that mental health problems among older people are prevalent and serious. Secondly, that the overlaps and relationships between physical and mental ill health become arguably even more pronounced in older people, meaning that taking a joined-up approach is vital – a major theme running through all of our mental health presence at this year’s Expo. And thirdly – perhaps most importantly – that mental health problems in older people can and should be treated.

This of course relies on professionals as well as families and carers doing everything they can to support improvements in the identification and management of older people’s mental health problems in primary care and beyond, such as through the provision of expert older adult liaison mental health staff working on general hospital wards.

There are some inspiring examples of work underway across England to address what is now increasingly accepted as a fundamental health inequality. I was delighted that NHS England provided funding for this excellent film produced by Age UK Camden to raise awareness among older people of the benefits of talking therapies with a view to boosting their access rates to these services.

I participated in a ground-breaking conference in Leeds organised in June by the national IAPT programme in conjunction with Yorkshire and the Humber Clinical Network to develop a collective understanding around how IAPT services can increase access for older people and share best practice examples of current work being undertaken with older adults and carers.

We heard about Tees, Esk and Wear Valleys NHS Foundation Trust’s creation of Older People’s Champions among their staff working in North Yorkshire; leaders from Sheffield Health and Social Care NHS Foundation Trust and local IAPT services described their collaboration involving the Older Adult Community Mental Health Team and the University of Sheffield to design and evaluate a group treatment for Generalised Anxiety Disorder (GAD) for older adults; the organisation Mothertongue presented on their cutting-edge efforts to develop culturally and linguistically sensitive professional counselling services for people from black and minority ethnic communities.

The primer we are launching at Health and Care Innovation Expo 2017 is aimed primarily at supporting colleagues working in primary care teams, particularly GPs.  90 per cent of older people consult their GP at least once each year which makes primary care the setting with the most potential to drive improvements in care and support.

We know that there is a risk among both professionals and the public of automatically attributing symptoms of mental ill health to ‘old age’, or considering an unwell patient’s situation as beyond repair and an inevitable sign of terminal decline.

We hope this primer is one tool which will help to shift this mind-set so that whenever we talk about ‘healthy ageing’, or ‘ageing well’, we think about the mental as well as the physical health of older people and how both can be treated with the right knowledge, skills and attention to help someone lead a better and fuller life. Our rapidly ageing society makes turning this ambition into a reality an urgent necessity.

I am grateful to the co-authors of the primer and all colleagues at NHS England, NHS Improvement, the Royal College of General Practitioners, the Royal College of Psychiatrists and the British Geriatrics Society who have supported the development of this publication and contributed so ably to its drafting. I am also grateful to Age UK for their partnership in our Expo 2017 session as well as in our longer-term campaign to improve older people’s access to talking therapies.

The challenges are very real but I am confident that across local and national organisations we now have the right momentum and commitment to drive genuine progress together.

  • Professor Burns will be speaking on Tuesday September 12 at the Pop Up University 8, from 3pm to 3.45pm. A free printed copy of the primer will be available for all those who attend.
Professor Alistair Burns

Alistair Burns is Professor of Old Age Psychiatry at The University of Manchester and an Honorary Consultant Old Age Psychiatrist in the Greater Manchester Mental Health NHS Foundation Trust. He is the National Clinical Director for Dementia and Older People’s Mental Health at NHS England and NHS Improvement.

He graduated in medicine from Glasgow University in 1980, training in psychiatry at the Maudsley Hospital and Institute of Psychiatry in London. He became the Foundation Chair of Old Age Psychiatry in The University of Manchester in 1992, where he has variously been Head of the Division of Psychiatry and a Vice Dean in the Faculty of Medical and Human Sciences, with responsibility for liaison within the NHS. He set up the Memory Clinic in Manchester and helped establish the old age liaison psychiatry service at Wythenshawe Hospital. He is a Past President of the International Psychogeriatric Association.

He was Editor of the International Journal of Geriatric Psychiatry for twenty years, (retiring in 2017) and is on the Editorial Boards of the British Journal of Psychiatry and International Psychogeriatrics. His research and clinical interests are in mental health problems of older people, particularly dementia and Alzheimer’s disease. He has published over 300 papers and 25 books.

He was made an honorary fellow of the Royal College of Psychiatrists in 2016, received the lifetime achievement award from their old age Faculty in 2015 and was awarded the CBE in 2016 for contributions to health and social care, in particular dementia.

Leave a Reply

Your email address will not be published. Required fields are marked *


  1. Kassander says:

    “A Practice Primer on Mental Health in Older People”

    A ‘rather good’ publication (litotes) – the structure/organization is most helpful and was easily followed and understood by this ordinary member of the public.
    A very few hyper-links didn’t work but a search engine found a suitable alternative.

    Congratulations to all concerned with this excellent publication.

  2. JL says:

    As someone suffering from severe mh problems who reached the age of 65 recently Suddenly it seems like I’ve become a forgotten person. There seems no awareness that as someone already suicidal my approaching old age and chronic pain that I’ve been afflicted with for 2 years now has had a huge impact on me. No joined up thinking between mental and physical services. No thought about how I am dealing with the increasing isolation and hopelessness. It’s the middle age men who die by suicide but they forget as this article says old people are high risk too. Now I get no support for my mental health. I can’t be helped anymore. Support is short term only and I needed to identify goals and aims to have that. But I don’t know where my life is going. retirement is one of those milestones in life. You have to reassess life. what on earth are you going to do with the next possibly 30 years. I’ve lost my mobility – that is hard to come to terms with too. It’s a loss.