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Older people under-referred for mental health therapies

Attitudes of GPs cited as possible ‘barrier’ to access

Jo Carlowe

Tuesday, 06 June 2017

Older people are under-referred for mental health therapies, new research reveals.

A large research study from the Universities of Plymouth and Exeter show that older people are not being referred for mental health support nearly as frequently as their younger counterparts despite achieving better outcomes when they are referred.

The study* is published today in the British Journal of General Practice.

The researchers analysed over 80,000 mental health treatments in South West England as part of the Improving Access to Psychological Therapies (IAPT) Evaluation Project initiative. The analysis revealed that the percentage of people referred to mental health therapies for common conditions such as anxiety and depression reduced with age, from the highest for ages 20-24 to the lowest for the 70 to 74-years-old bracket.

This despite the facts that low mood and anxiety are more common in mid to old age and that older people may be more likely to benefit from 'talk therapies' than younger age groups, with more than three-quarters of people around the age of 64 experiencing significant clinical improvements in their symptoms as a result of such therapies.

The authors of the study suggest that there are a number of multiple factors which may lie at the heart of the under-referral of older people to mental health care. 

Older people may see a stigma in requesting mental health help or may prefer to try to deal with the problem themselves. They may also have multiple health conditions which could lead to a reduced recognition of mental health issues, and they are more likely to be prescribed medication for common mental health problems.

However, being frail or housebound can prevent access to mental health care which is often designed for those who are fully mobile, and does not take account of a reluctance of older people to take on the label of a mental health diagnosis. 

The authors also cite the "attitudes of professionals" as an additional barrier to older people receiving mental health therapies.

A lead author on the study was Professor Richard Byng at Plymouth University Peninsula Schools of Medicine and Dentistry. He said: "What we found striking was the fact that, although older people would benefit the most from 'talking therapy' they were least likely to be referred to it - despite the fact that GPs are the most frequent referrers to these types of services, and this age group is more likely than any other to have regular contact with their GP. We would suggest that GPs should do more to discuss mental health problems with their older patients and increase awareness of the different therapy options that are available.”

Co-author Professor William Henley, of the University of Exeter Medical School, said: "This research is an important step towards improving mental health services for older people, who have a right to high-quality treatment. The Improving Access to Psychological Therapies (IAPT) programme has successfully expanded access to treatment for people with anxiety and depression, with 900,000 adults now accessing services each year. This research enables us to explore what barriers to treatment remain by analysing data that is routinely collected during consultations, ultimately making a positive impact on people's lives.”

Commenting, Professor Helen Stokes-Lampard, chair of the Royal College of General Practitioners, said: “Mental health issues can affect anyone at any age, and all our patients’ deserve high quality mental health care at every stage of their life.

“We know that access to certain therapies, such as talking therapies, can really benefit some patients with mental health conditions - particularly our older patients, as highlighted in this study - so it’s concerning that as our patients get older, they are experiencing greater difficulty in accessing them.

“Unfortunately, it is increasingly the case that these important services aren’t readily available in the community, where they would be of most benefit, so GPs simply cannot refer our patients onto them when need them, or patients face significant delays even when they are referred. 

“We need more mental health services in the community. We need a greater variety of services in the community and we need GPs and our teams to have better, easier and quicker access to them.

“Mental health is an enduring priority for the College, and as part of our general election manifesto Six Steps for Safer General Practice, we are calling on the new government, whatever its persuasion, to honour the pledges in NHS England’s GP Forward View, including for every GP practice to have access to one of 3,000 new mental health therapists, as a matter of urgency.”

* Pettit S, Qureshi A, Lee W, et al. Variation in referral and access to new psychological therapy services by age: an empirical quantitative study. Br J Gen Pract 5 June 2017; bjgp17X691361. DOI: 10.3399/bjgp17X691361

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