Older people’s mental health

The NHS is committed to ensuring that older adults with functional mental health needs, including depression, anxiety and severe mental illness, have consistent access to high-quality mental health care. This commitment is reflected in NHS Operational Planning Guidance, the Medium Term Planning Framework and the Model Neighbourhood Framework, and aligns with the 10 Year Health and Plan for England.

A key focus is on neighbourhood health, reducing unwarranted variation in access, and improving outcomes for older adults who face the greatest challenges, including those living with frailty, long-term conditions, cognitive impairment or complex mental health needs.

Older people’s mental health (OPMH) runs as a ‘silver thread’ across all adult mental health priorities. This spans NHS Talking Therapies, community mental health services, neighbourhood health models, frailty hubs, crisis care pathways, mental health emergency departments, suicide prevention and staying safe initiatives, inpatient and rehabilitation services, and discharge and flow planning.

Systems are expected to plan for improvements in access and treatment that reflect local population need and demographics. All adult mental health services should remove upper age limits, ensure pathways are inclusive of older people, meet access and waiting time ambitions, address inequalities, and deliver care based on need rather than age, including for those with physical health co-morbidities, frailty, cognitive impairment or complex social needs.

Access to specialist older people’s mental health expertise should likewise be determined by need, not age. This aligns with the forthcoming Modern Service Frameworks (MSFs), including those for severe mental illness, frailty and dementia. Services should take an integrated approach,  bringing together mental health, physical health, social care, and voluntary and community sector partners, with a focus on supporting people to stay well, avoid unnecessary hospital admission, and experience timely discharge when inpatient care is needed.

NHS Talking Therapies for anxiety and depression

Not everyone who is older is frail, disabled or in need of care. That said, certain long-term conditions become more common with age — including heart disease, diabetes, chronic obstructive pulmonary disease (COPD), stroke, dementia and Parkinson’s disease — and the likelihood of living with multiple LTCs also increases with age. Many of these conditions are additionally associated with a higher risk of depression.

NHS Talking Therapies is expanding to better serve people with long-term conditions through dedicated ‘NHS Talking Therapies Long Term Conditions Services’, which are currently in development. These services will ensure that people with long-term conditions have the same access to NICE-recommended psychological therapies as everyone else. Integrated care systems must ensure these services are accessible to older adults, embedded within neighbourhood health models and frailty pathways, and designed to meet the specific needs of older people.

Further information on the NHS Talking Therapies for anxiety and depression programme can be found here: NHS England » NHS Talking Therapies, for anxiety and depression

Crisis and acute mental health

Integrated care boards should ensure older adults have equitable access to the full range of crisis mental health services, including NHS 111, crisis resolution and home treatment teams, mental health emergency departments, and neighbourhood-based crisis services, with access to appropriate specialist expertise where needed. Crisis pathways should include interventions that help reduce avoidable hospital admissions and support older people to remain at home. They should also align with staying safe from suicide principles across both community and inpatient settings, recognising that older adults may have distinct needs within these pathways.

Commissioners should ensure that inpatient mental health services are accessible to older adults, with attention to appropriate environments, rehabilitation pathways and proactive discharge planning. Reducing unnecessary lengths of stay should be a clear priority, supported by community step-down provision and neighbourhood-based support. To tackle inequality, systems should actively monitor data on access, experience and outcomes for older people using these services.

Community mental health

Older adults are best supported through integrated primary, community and neighbourhood mental health models that offer greater choice, continuity and personalised care, and help people live well in their communities. This approach is set out in the Community mental health framework for adults and older adults and reflected in current NHS operational planning priorities and the Medium Term Planning Framework.

As part of the transformation of community mental health care, older people’s mental health staff are expected to work closely with primary care, community services and wider neighbourhood teams, including through multidisciplinary teams. This means contributing to neighbourhood-level planning and delivering proactive care for high-priority cohorts, such as people with moderate to severe frailty, those living in care homes, housebound individuals, and people approaching end of life.

Community mental health services for older adults should be aligned with:

  • neighbourhood health models and frailty pathways
  • neighbourhood 24/7 mental health hubs
  • urgent community response and community rehabilitation services (including minimum 12-hour, 7-day community urgent care offers)
  • enhanced health in care homes
  • mental health crisis services, including mental health emergency departments
  • NHS 111 (including reasonable adjustments to support the needs of older people)
  • voluntary and community sector support

This integrated approach supports proactive, coordinated care and helps prevent escalation to crisis or hospital admission. Older people living in care homes should benefit from joined-up working between community mental health services, primary care and care home teams.

Neighbourhood and primary care teams are expected to use population health management approaches to identify older people at risk of poor outcomes, and to provide proactive, personalised support through neighbourhood multidisciplinary teams and pathways such as frailty. Older adults are included within adult community mental health access and waiting time ambitions, and services should be designed around need rather than age.

For further information, please refer to:

Resources

NHS England supports the delivery of high quality, inclusive mental health care for older adults through a range of national guidance, training resources and improvement tools. These resources support clinicians, commissioners, services and system partners across community, crisis and inpatient settings.

Core guidance

Resources for integrated care boards, providers and services

Workforce development and training

Lived experience and improvement resources