Older People’s Mental Health

The NHS Long Term Plan and NHS Mental Health Implementation Plan 2019/20 – 2023/24 set out that the NHS will ensure consistent access to mental health care for older adults with functional needs (i.e. depression, anxiety and severe mental illnesses).

Older people’s mental health (OPMH) is embedded as a ‘silver thread’ across all of the ‘adult’ mental health Long Term Plan ambitions, including Improving Access to Psychological Therapies (IAPT), community-based services for people with severe mental illnesses (SMI) and crisis and liaison mental health care.

As part of the delivery of the Long Term Plan, all areas will need to plan to achieve improvements in access and treatment for older adults in line with local demographics within all appropriate mental health services. All adult mental health services will be expected to remove upper-age barriers to access. Access to specialist older people’s mental health support will be based on needs and not age, for example the presence physical and mental health co-morbid needs, cognitive issues and/or frailty or end of life care needs.

Services will deliver this through an integrated approach focused on the person’s identified care and support needs across mental and physical health, social care and voluntary sector boundaries.

Improving access to psychological therapies (IAPT)

Local areas will be expected to plan to meet the needs of their local population to address inequalities in IAPT access for older people. To support this, areas must ensure that IAPT services meet the needs of older carers and people living with dementia and/or frailty, including those living in care homes. Sustainability and Transformation Partnerships(STPs)/Intergrated Care Systems (ICSs) should translate the learnings from the IAPT-LTCs expansion into frailty pathways.

See here for information on the IAPT Programme.

Crisis and acute mental health

The needs of older adults are embedded in all adult crisis, acute and liaison mental health Long Term Plan commitments. For further information on the commitments, please visit the crisis and acute page.

Community-based mental health crisis response teams will work closely with ‘physical health’/Ageing Well Urgent Community Response services to provide coordinated rapid response, assessment, admission avoidance, and discharge support functions for older people with multimorbidity and/or frailty. This will help ensure that no underlying need is missed. OPMH staff will provide mental health input into ‘physical health’/Ageing Well Urgent Community Response services, including intermediate care delivered at home or in community beds. For further information on the Ageing Well Urgent Community Response services, please visit the Ageing Well pages

Areas will be encouraged to improve physical health support within mental health inpatient units e.g. through liaison geriatricians. In some areas, intermediate care units and psychiatric inpatient units for older people will be better integrated. In general hospitals, older adult liaison staff will be encouraged to provide mental health support to acute frailty services.

Community mental health

Older adults will be supported through new and integrated models of primary and community mental health care, which will enable them to have greater choice and control over their care, and to live well in their communities. Further detail on the new community-based offer is outlined in the Community Mental Health Framework for Adults and Older Adults, and further information is available on our Community Mental Health Services page.

As part of the transformation of community mental health care, OPMH staff will be expected to work closely with ‘physical health’ and other older people/Ageing Well staff, including through multidisciplinary teams (MDTs) within primary care networks (PCNs), supporting GPs, primary care and community staff with identifying, assessing and treating mental health problems in older people with multiple physical and mental health conditions (also known as ‘multimorbidity’) including frailty and social care needs. This will also benefit older people living in care homes through the roll out of the Enhanced Health in Care Home Model.

From 2020/21, PCNs will use population segmentation, risk stratification tools and local clinical intelligence to identify older people with moderate frailty and/or multimorbidity at risk of adverse outcomes, offering them proactive and holistic support through community MDTs as part of the Anticipatory Care service offer.

For further information on the Anticipatory Care and Enhanced Health in Care Homes models, please visit the Ageing Well pages.

Resources

  • NHS England and NHS Improvement have published A Practice Primer on Mental Health in Older People for colleagues in primary care, in particular GPs, which highlights symptoms often attributed to ‘old age’ but where a mental health diagnosis and follow-up is more appropriate. The publication is supported by the Royal College of GPs, the Royal College of Psychiatrists, the British Geriatrics Society and Age UK.
  • For IAPT training resources for older people visit the University of East Anglia resources webpages for videos and guidance.
  • The older people’s IAPT Positive practice guide provides best practice guidance to therapists and top tips on commissioning IAPT services for older people. It is currently being refreshed in partnership with Age UK and is expected to be published in early 2020.

See how IAPT psychological therapies can help older people affected by depression or anxiety, including those with a long term condition, in this NHS England animated video.

For more information on IAPT talking therapies visit the NHS website.