UK: Older adults under-referred for mental health therapies

The research was conducted as part of the south west of England ‘Improving Access to Psychological Therapies’ (IAPT) project.

The researchers analysed over 80,000 mental health treatments in south west England. The analysis showed the percentage of people referred for common conditions such as anxiety and depression reduced with age, and was highest for ages 20-24 and lowest for 70 to 74-years-old.

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

The authors suggest a number of 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.

Being frail or housebound can prevent access to mental health care, which is often designed for those who are fully mobile, and in addition does not take account of the reluctance of older people to accept a mental health diagnosis. The authors also cite attitudes of professionals as an additional barrier to older people receiving mental health therapies.

Study author Richard Byng of Plymouth University Peninsula Schools of Medicine and Dentistry 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 receive 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 William Henley of Exeter University Medical School, said the research is an important step towards improving mental health services for older people, who have a right to high-quality treatment. “IAPT has 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.”

Variation in referral and access to new psychological therapy services by age: an empirical quantitative study: British Journal of General Practice. DOI: 10.3399/bjgp17X691361