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A Lead Psychological Wellbeing Practitioner explains what the Steel City is doing to tackle mental health care for pensioners:
Ten million people in the UK are aged over 65 and yet older adults are under-represented in Improving Access to Psychological Therapies (IAPT).
Only 6.5% access IAPT nationally, and just 6% in Sheffield where the service exceeds 12,000 people entering treatment each year. Data indicates that, once referred, a greater proportion of older adults complete treatment and achieve better outcomes.
Launched in 2008, Sheffield IAPT service is integrated into primary care with psychological wellbeing practitioners, cognitive behavioural therapists and counsellors based in 85 GP practices across Sheffield.
Offering a wide range of National Institute for Clinical Excellence recommended evidence-based treatments, Sheffield IAPT aims to increase access to under-represented groups to promote equality and offer effective, evidence-based interventions to meet the needs of diverse patient populations.
Generalised anxiety disorder (GAD) is a common disorder in older adults, with prevalence rates estimated between 3.4% and 6.3%. NICE recommends pharmacotherapy, cognitive behavioural therapy (CBT) or applied relaxation to treat GAD in adults (NICE, 2011).
Older adults are found to prefer psychological therapy over medication for the treatment of anxiety conditions. Currently, one-to-one CBT is offered to older adults presenting with symptoms of GAD in Sheffield IAPT. Research suggests there is no difference between group and one-to-one treatment for GAD in older adults; furthermore, the benefits of group therapy include reduced social isolation and shared empathy, which are relevant for older adults given reductions in mental wellbeing associated with loneliness.
The IAPT service worked with Sheffield Older Adult Community Mental Health Team (OACMHT) and the University of Sheffield in designing and evaluating a group treatment for GAD for older adults to increase access and treatment choice.
The group was termed the Older Adults Overcoming Worry Group and it ran for two hours a week for 12 weeks. The group was based on a treatment protocol used in IAPT for the one-to-one treatment of GAD. The treatment protocol had encouraging results, with continued improvements after treatment with working age adults in group and individual settings, and older adults individually. Older adults with GAD who accessed Sheffield OACMHT and IAPT were offered the group for treatment of GAD to help understand, manage and reduce symptoms.
A total of three Overcoming Worry Groups were set up, representing 37 participants, 28 patients from IAPT and nine from OACHMT. Patients were asked to complete outcome measures at three time points: at the beginning of the group, at the end, and at an eight-week follow-up. Patients and facilitators completed short interviews at the end of treatment and many patients described their treatment as an enjoyable and social experience.
Almost half described coping better than expected with group-based treatment. Data indicated that attending the group made a big difference in reducing anxiety symptoms, with a 70% recovery rate.
In summary, the protocol shows real promise as a treatment for GAD in older age.
Dr Shonagh Scott, Principal Clinical Psychologist, and Dr Manreesh Bains, Senior Clinical Psychologist, of Sheffield OACMHT, said in their feedback: “The group has highlighted the importance for clients of having a group facilitator who has knowledge and expertise in the specific challenges of later life and who are able to draw on a wealth of clinical experience to illustrate concepts within the model with older adult-specific examples.”
It was a really good opportunity to shadow and learn ways of adapting groups to meet the needs of older adults. I realised the importance of ensuring materials and case examples were specific to this patient group. Facilitators were warm and empathic; the group was delivered at a good pace, which facilitated conversations and learning.
The research study and working in collaboration has provided older adults in Sheffield with an opportunity to participate in an effective treatment for GAD and contributed to the evidence-base for the effectiveness of GAD group-based treatments for older adults. This development is very important for improving access and contributing to an evidence base and also providing a group therapy option for older adults, which has many other benefits for this patient population such as the reduction in social isolation.
Sheffield IAPT and OACHMT will continue to work together to improve access and treatment choice for older adults. This will enable them to enhance referral pathways and supervision structures for staff, contributing to better quality care and patient experience.
The IAPT service, OACMHT and others will continue to work to achieve objectives set out in the Five Year Forward View for Mental Health.