You can’t have failed to see the increase in attention on mental health issues across the country as councils, educators, health services, etc are being asked to do more to support children and young adults with mental health problems.
This is a tremendous step forward in our nation’s recognition and action on such an important issue. While much of the focus is on the mental health of younger generations, consider older people too, not only do they experience stress factors common to all people but also factors more common in later life like managing multiple long term conditions that can lead to a loss in capacity and a deterioration in functional ability.
One in four people aged over 65 live with depression and 40% of people aged 85 or over live with debilitating depression that affects their ability to engage in daily activities and prevents them from being able to participate in community life.
At Community Connectors we support people in Glasgow over the age of 60 and their mental health is an important part of our work. This thought piece is designed to share some of the approaches we have found to be successful in helping people access the right support at the right time.
At the heart of our work is a focus on creating meaningful conversations that help people consider their options and deepen their understanding of mental health as well as the support and strategies that can enable them to live the life they want.
“Good mental health is fundamental to thriving in life.
It is the essence of who we are and how we experience the world. “
– The Mental Health Foundation
Current service provision
The third sector in Glasgow has lots of great support services where innovative, person centred work is being done around mental health and wellbeing and we work with them regularly to access support for older people but there are gaps and barriers to accessing support.
Recognising the challenge
For every 100 people with depression, only 50 seek treatment and only 25 are diagnosed.
Evidence tells us that older people not only benefit from psychological therapies but are actually more likely to engage with and complete the process than people of working age. The challenge lies in getting older people to these services, especially statutory support where the process can present barriers for some.
Our colleagues in Primary Care Mental Health report consistently low referral rates for people aged over 65 to psychological therapies which doesn’t accurately reflect the need that we know exists within the community.
So, with support available, what are the barriers to accessing these resources?
Addressing the barriers
Over the last few years and through hundreds of conversations we’ve had with older adults experiencing mental health challenges, we’ve built a clear picture of the pitfalls that can prevent older people from accessing services and many of these stories have common themes. Fears of stigma, lack of information and an absence of stability in people’s lives affecting their ability to engage with services and meet eligibility criteria are some of the central themes.
We often meet a lack of awareness, not only of what mental health means but also how common it is and so we see many older adults coping with mental health challenges in isolation for fear of stigma. As a society we’re only now developing a shared vocabulary around mental health whereas older adults tend to talk about low mood and “living on their nerves” and report as feeling like it’s just part of getting old and something they just have to “cope with”. People tell us that they’re resistant to speak to health professionals or people in their life because the perceived stigma leaves them in fear of being dismissed as “losing their marbles” or that they’ll be given pills to “dope them up”.
One of the most common barriers we encounter is where people are struggling with addictions or living in chaotic circumstances, often with complex health conditions meaning they struggle to maintain consistent engagement with services. The end result is a risk of being ineligible for support and falling through the gaps which can only lead to further decline.
In many ways the third sector is able to plug these gaps by delivering community based supports, enabling people to achieve the level of stability needed to engage more proactively with statutory support.
The nature of our service means that we’re always mapping provision across the city and we’ve built an extensive picture of what’s on offer. This enables us to make the best use of the services and support on offer for older people and this makes a massive difference to the people we work with because for those without support to access services there can be many roadblocks along the way.
Our service has developed and grown in response to our experiences working with people facing mental health issues. Our support has been tailored to maximise our client’s chances of regaining a sense of control and choice in their life by helping them identify potential triggers and exploring options that can help them cope and create more stability.
Our work is centred around three key areas:
- Meaningful conversation: exploring misconceptions, fears and gaps in knowledge.
- Preparing people to consider and engage with the support on offer.
- Stabilisation of life circumstances to support focus on mental health.
This work can happen in stages or simultaneously depending on a person’s journey and it may not even happen in this order. Being a person-centred service, we commit to being led by the client and working at a pace that suits them so you might notice some overlap in the work described at each stage. This gives us a framework to be as flexible as we can in how we work, recognising that no two people’s journeys are the same.
We always start with a conversation that helps us get to the heart of what matters most to a person and what they would hope to gain from our time together. This conversation can span as many as 11 areas of a person’s life using our ‘Good Conversations’ model, supported by the Community Connectors Wheel (see below), and helps us build a clear picture of a person’s assets and challenges as well as their hopes and desires; the most important thing to us is knowing we’re being led by the person’s best hopes.
It’s not surprising that it can take time for people to speak openly and so we spread our initial conversations over a series of meetings to help people get clear on what they want us to know. Rapport is built over time and it’s only with trust that people start to open up about their challenges with mental health. It’s usually from this point that we start to tailor our support.
Meaningful conversations: exploring misconceptions, fears and gaps in knowledge
“mental health challenges are not just a part of getting old and no one has to just ‘cope’ with it.”
When we talk to older people, they give us small hints of information along the way that tell us how they’re feeling. Usually they’ll talk about feeling low and not having the energy to go on or they’ll describe themselves as “a worrier” or “living on my nerves”. These small hints give us an opening to listen and be curious about the specifics of their day to day experiences and give us an idea of how aware they are of mental health, what they may have tried already and what supports might be of help to them.
These conversations help us identify any coping strategies they may have – without necessarily realising it – and any gaps in knowledge or misconceptions about mental health they might have. We’re also looking to spot any maladaptive coping mechanisms they might have developed in an attempt to feel better. Smoking and drinking alcohol are two common examples of maladaptive coping but there are often multiple factors at play including poor pacing/sleep strategies; even concealing mental health issues for fear of stigma is a form of maladaptive coping and counter-productive to a person’s long term wellbeing. It often becomes clear at this stage why people aren’t yet accessing or have failed to successfully access support which gives us a better chance of working together with the person to help them move forward.
What might you see happening at this stage?
Once we build that rapport and open up the conversation, we’re able to ask permission to share some of the information available to us and the knowledge out partners have shared. This can include:
- Putting names to feelings i.e. speaking to people about the symptoms of anxiety, depression or panic attacks to help people consider that what they are experiencing is as much a health condition as any other with the same right to support.
- Describing the factors that can affect a person’s mental health such as grief, loss, trauma, insomnia or lack of ability to self-manage other conditions to help people make sense of what they might be experiencing and to make any connections with the potential factors involved.
- Sharing information on what evidence is out there about what works to give our clients some reassurance and hope that there are approaches that can help.
- Talking to people about the different kinds of therapeutic interventions and what is required to access these services to help consider options and what might be best suited.
- Speaking to people about the statistics surrounding mental health to help normalise what’s going on for them and reduce stigma.
- Providing information and supporting people to access peer support groups and literature to reassure them that there are people in similar circumstances, and that they are not alone in managing their condition.
- Making people aware of help lines and crisis teams to highlight the support available to them in times of crisis.
- Providing information on relaxation and mindfulness techniques and similar resources to raise awareness and support people to explore self-management strategies.
Why would we choose to invest time here?
We want to enable people to better understand what’s going on for them, what supports are available and to highlight that mental health challenges are not just a part of getting old and no one has to just “cope” with it.
Going through this process is often reassuring for people; to hear that they aren’t alone and that their condition is just as able to be treated as any other brings us to a place where we are able to help people consider where they want to go with their newfound understanding and insight.
Preparing people to consider and engage with the support on offer
“An informed and empowered person is more likely to take real advantage of the support on offer”
In our experience, once a person is better informed about their mental health, they can become more open to the idea of taking the first steps towards accepting support.
At this stage our work mainly centres around preparing people to work collaboratively with services and helping embed the learnings they’ve gained so far that will help them, not only feel more confident in accessing services, but make the best use of the support on offer. We want to focus on minimising unnecessary setbacks that could be detrimental to a person’s progress.
What might you see happening at this stage?
- Recapping on the person’s best hopes and what they would like to change to support people to focus on the benefits of accessing supports and to increase motivation for action.
- Providing more detailed information on services that can support them in achieving their best hopes. This helps create a clear picture of what a person can expect from the provision on offer but also understand what will be expected of them. We try to include clear examples of the type of activity they would be participating in, the time required and any questions likely to be asked during the referral or assessment processes.
- Facilitating coaching sessions to help people think through what they feel is most important to share with a service or practitioner. For those that find it useful we can help prepare notes to act as an aid on the day.
- Providing buddy support to attend services for those who are still apprehensive or nervous about engaging. This involves either a volunteer buddy or a practitioner supporting the person on the first couple of appointments.
- Supporting clients to unpack their experiences with post-appointment conversations where we ask reflective questions to help people consider the benefits of the support, what they found most useful or to consider anything that was a surprise or unexpected. This is also an ideal opportunity to help embed learnings.
Why would we choose to invest time here?
We want to optimise people’s chances of having a positive experience when taking those first steps by reducing any anxiety they might experience but also by increasing their sense of control and choice in the process. An informed and empowered person is more likely to take real advantage of support and when we refer people into already busy services, we want to make sure they’re ready to make best use of what’s on offer given that provision throughout the city is so tight.
Stabilisation of life circumstances to support focus on mental health
So far, the focus has been on supporting people to access support for mental health issues but that isn’t always the best starting point and we appreciate that everyone’s journey is different.
From working with our colleagues in the Older Person’s Therapeutic Intervention Team, we know that therapeutic intervention isn’t always suitable for people in crisis, especially when they are also living in chaotic circumstances or struggling with addictions. In fact, therapy is potentially counter-productive because the person might not be well placed to cope with the trauma they could expose themselves to as part of the therapeutic process. Our colleagues emphasise the importance of stabilisation work to prepare people to engage successfully in the process.
Our focus here is to support people in crisis to identify their main triggers and provide coaching and advocacy to usher in more stable conditions and better coping strategies. Some of the most common triggers for crisis we encounter are housing issues, financial instability – including benefits -, family conflict, long term health conditions, adapting to new diagnosis and addictions to name only a few.
Our colleagues agree that this is the time to focus on building self-esteem, promoting self-management and building meaningful connections for a person to bring a sense of connectedness not just to their wider community but to themselves. We would generally be working with third sector services who offer a range of supports around self-management, relaxation, addiction support, peer support, lifelong learning and resilience building to further people’s chance of achieving a level of stability.
What would you be seeing at this stage?
Every person’s life circumstances are different but here we’ve chosen to share some of the more effective supports we’ve found to have help bring about more stability for our clients.
- Providing advocacy support – in areas such as housing, finance and benefits. This can include working with our colleagues in housing to support people with tenancy sustainment, rent arrears and making applications for more suitable housing. Where financial or benefit instability is a factor we often find that people need the most support around applications, appeals, money management and to attend appointments and understand correspondence.
- Offering places on lifestyle management, peer support workshops or individual coaching surgeries. The typical subjects we cover include, pacing, relaxation, mindfulness, sleep management, time management, planning for relapse and planning for joy. In these sessions we share information in bite size chunks and encourage participants to learn from each other and to gain some practical experience in trying out different strategies to help them decide what works best for them.
- Attending medical appointments with individuals who are struggling to self-manage or understand their condition(s) or who have become disconnected from services in relation to their health. In attending appointments, we want to support people to ask the questions they want and to digest the information being given. We also work with people to plan for medical appointments especially for those who struggle to keep appointments and have been discharged from services previously due to non-attendance.
- Connecting people to activities that support them in gaining the skills, connections and experiences they want. Through our in-depth mapping and ongoing relationship with the third sector, we are able to support people to access a variety of activities that either directly or indirectly support their mental health and help people in building their self-esteem and their sense of connectedness.
Why would we choose to invest time here?
When learning from our colleagues in statutory mental health services we understand that, for therapeutic intervention to be successful, a person needs to have a clearly articulated view of the single outcome they want to achieve. How can we expect this of someone who might only be living day to day, managing crisis and uncertainty? With stability we bring a person to a place where we can support them to step back, reflect and recognise the factors at play in their life and the choices they have available to them.
Over to you
As we said at the start of this piece, we want to share our what we’ve learned from our experiences working with older adults and how we apply it in our day to day practice. Please share this freely with anyone who may be interested in the work we do or find our approach interesting. Get in touch with us to share your own experience and thoughts too and let’s work together to make Glasgow a great place to grow old.