Update from Alistair Burns, NHS England’s National Clinical Director for Dementia and Older People’s Mental Health.
There have been some developments in the last few months which I
think will be of interest to readers of the newsletter.
The Mental Health Task Force is due to publish its findings in
the next few weeks (by the time you read this, it should have been
published) and the work of the Task Force has explicitly been
across the life course. The Mental Health Task Force reports for
all Arm’s Length Bodies and so not only includes NHS England but
also Health Education England, Public Health England, NHS
Improvement and the Care Quality Commission.
There was a wide consultation to the task force’s call for
comments, with some 20,000 people responding. The generic issues
from the consultation will be familiar to everyone and are around
things like skills of staff, access to services and equality of
provision. Many of the issues raised in terms of general
psychiatry, are equally applicable to older people. We await
the publication of the report with interest.
Aside from the work of the Task Force, there are three issues
which are currently foremost in my mind, and I would consider
important for us as a profession to tackle. First, the
clinical rationale and evidence base for the recognition and
treatment of depression in older people. I think it is fair to
reflect that the therapeutic nihilism which often accompanies
depression in older people among some professionals is not
dissimilar to that which can surround dementia. The
assumption that depressive symptoms in the presence of
physical ill health or impoverished social circumstances is
understandable and, therefore, that they do not merit treatment is
still prevalent. Identifying people with depression is
crucial and there has been a suggestion that there be an older
person’s depression CQUIN in general hospitals similar to the
dementia CQUIN. Even its critics would acknowledge that this has
garnered support and has raised the profile of
Dementia. It could be that a similar three stage
approach of identifying depression, assessment and then treatment
and referral could be helpful.
Second, loneliness. We all know that loneliness and
isolation, although strongly associated, are not the same; the
former referring to separation from contact, with the latter
representing the subjective experience (Age
UK). Around 10% of older people feel lonely but up to three
times that figure will experience loneliness some of the time. It
has been said that loneliness has the same effect on your health as
smoking 15 cigarettes a day. Loneliness increases with age and to
have children but no contact with them makes you feel more lonely
than having no children at all.
Third, the issue of ageless mental health services for older
people. James Warner and I have suggested that this is an
important issue and have recently written something and quoted some
of the facts about mental health in older people (NHS
- In a 500 bed general hospital, on an average day, 330 beds will
be occupied by older people of whom 220 will have a mental
disorder, 100 each will have dementia and depression and 66 will
- For every 1,000 people over the age of 65, 250 will have a
mental illness, 135 will have depression, of which 115 will have no
- 85% of older people with depression receive no help from the
NHS, and older people are a fifth as likely as younger age groups
to have access to talking therapies but six times as likely to be
- The number of older people being treated in the improving
access to psychological therapies (IAPT) programme rose from 4% to
6.5% (2008/9-2013/14), still short of the articulated goal.
- While 50% of younger people with depression are referred to
mental health services, only 6% of older people are.
- Around 10% of older people experience loneliness which can be a
symptom course of depression – loneliness has the same health
effects as smoking 15 cigarettes a day.
- 20% of men and 10% of women are drinking alcohol in harmful
amounts – the latter is a 100% increase over the past twenty
We have addressed the recent study which showed that older
people’s needs are not met as well in generic services making the
case for a specialist old age provision (British
Journal of Psychiatry).
In terms of dementia, we have now, to all intents and purposes,
achieved the two thirds diagnosis admission nationally, which is
great news (the current figure is 66.5%). Thank you to
everyone who has contributed to this significant piece of work. It
allows us now to adapt the conversations about dementia towards
looking at diagnostic support and the benefits that brings. I am
sure everyone would agree that should be a priority for us and that
post-diagnostic support makes the big difference to people with
dementia and their carers.
Along with that we have the opportunity to look in a slightly
different way at what we are doing in dementia and we have begun to
socialise the idea of the wellbeing pathway i.e. if we started with
one of the five things we could do with dementia and their carers
we have developed the ideas of:
- preventing well
- diagnosing well
- supporting well
- living well
- dying well
These align neatly with the dementia ‘I’ statements and the
various NICE guidelines and quality standards and also the Prime
Minister’s challenge on dementia and the OECD (The Organisation for
Economic Co-operation and Development) which has taken an
international interest in dementia.
Finally, I am a bit short of pictures these days (for a number
of reasons) but found this one on my phone. It is clearly from a
country railway station in a place that I was visiting but I have
forgotten where. Does anyone recognise it or has the pictorial
forensic skills to identify it?
Click on the image for a larger version