Depression and Mental Health Problems in Older People

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Depression and Mental Health Problems in Older
People

• Claire Martin Consultant Clinical Psychologist,
  Secondary Care Bensham Hospital, Gateshead
• Sarah Grainger RMN, Cognitive Behaviour
  Therapist, Gateshead Primary Care Mental Health
  Team
• 22/1/13

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Overview

• Quick quiz
• Mental health epidemiology older people
• Barriers to accessing mental health services
• Identifying depression with older people
• Psychological therapy services in Gateshead for
  older people

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• Quiz True or False?
• It is normal for older people to feel depressed a
  good deal of the time.
• Memory problems might be a sign of depression.
• Memory loss is inevitable in later life.
• Older people are more likely than younger people
  to say I am depressed
• A complete medical evaluation is needed to rule
  out physical reasons for depression.

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• Quiz continued
• 6. There is a higher suicide rate among the
  elderly than among younger adults.
• 7. It is common for older people to talk about
  potential suicide.
• 8. Health professionals often have difficulty
  diagnosing depression in the OP
• 9. Older people have no interest in, and are
  incapable of, sexual activity.
• 10. Older people are generally fearful of death

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Approximately 1 in 4 older people
experiencesignificant mental health symptoms
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About half of those older people experiencing
significant symptoms of depression who go to see
their GP get offered treatment
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Less than 2 of those older people experiencing
significant symptoms of depression who go to see
their GP and get offered treatment will be
referred for primary or secondary care
psychological therapy
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The scale of mental health problems in OA

• 40 of older GP attendees have a mental health
  need.
• 25 present with MH as a primary need
• (Source UK STATISTICS MENTAL HEALTH OF OLDER
  PEOPLE)

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Depression
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Percentage of psychiatric population over 65
(Woods Clare 2008)
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• Older people living in the community show roughly
  the same rates for depression and anxiety as
  younger people.
• Depression in high risk groups
• Residential homes 40
• Receiving home care support 26
• Carers of people with dementia 23

The scale of depression in OA
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What are the barriers?

• Some symptoms of depression may be attributed to
  normal physiological changes
• May seem like a normal reaction
• Hopelessness (patient and professional)
• Time

• Physical health problems and somatic complaints
• Smiling depression
• Less overt sadness
• Stigma

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• Forgetfulness
• Agitation or retardation of movement
• Fatigue and sleep problems
• Feelings of worthlessness or guilt
• Thinking/concentration difficulties
• Somatic complaints or preoccupation
• Thoughts of death or suicide

Depression Symptoms common in older people
So,
to
So, depression can present similarly to dementia
in the early stages
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• Increased likelihood of multiple somatic
  complaints
• Cognitive deficits more pronounced, subjective
  poor memory
• Less likely to complain of sadness
• More likely to present with generalised anxiety,
  nervousness and irritability
• Higher rate of delusional ideas

Differences between older and younger adults
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Screening for Depression

• 1. Have you been bothered by feeling
• down, depressed or hopeless in the past month?
• 2. In the past month, have you often been
• bothered by having little interest or pleasure
  in doing things?
• 1 or 2 YES possible depression

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Screening for Depression

• Consider using standard measures
• Hospital Anxiety and Depression Scale
• PHQ 9
• Listen out for any statements indicative of low
  mood such as You must have people much worse
  than me, I just cant be bothered and ask more
• Observe non verbal signs such as reduced self
  care, head bowed, slowed down, agitation
• Excessive disability from physical health

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Treatments for depression

• CBT has been shown to be as effective with older
  adults as it is with younger age adults.
• IPT
• CAT
• Psychodynamic psychotherapy
• EMDR
• Counselling
• .. No reason why OP cannot benefit from any
  intervention offered to other adults

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Psychological Therapy Services in Gateshead
primary and secondary care
Refer elsewhere
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Stepped Care Model
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Primary Care Pathway
Referral Received Self
Assessment offered (telephone OR face to face)
Assessment Completed
Enter Waiting List for Therapy Step 2 / Step
3a / Step 3b
Discharge Plan Declined Treatment / Signpost /
Not Suitable
Enter Therapy Step 2 / Step 3a / Step 3b
Discharge Plan Declined Treatment / Disengaged
from Treatment / Therapy Complete / Mutually
Agreed Termination
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Primary Care Pathway
Referral Received (Other)
Discharge Plan Signpost / Not Suitable
Triage
Invite for assessment
Client Discharged Declines opt-in
Client Opt-in
Assessment offered (telephone OR face to face)
Enter Waiting List for Therapy Step 2 / Step
3a / Step 3b
Enter Therapy Step 2 / Step 3a / Step 3b
Assessment Completed
Discharge Plan Declined Treatment / Disengaged
from Treatment / Therapy Complete / Mutually
Agreed Termination
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Treatments and Roles

• Step 2 Low intensity Psychological
  interventions, supported self help
• Step 3 Primary Care Mental Health Worker, High
  Intensity CBT, IPT, CAT Therapy, Personality
  Disorder Worker, Mindfulness based CT, Stress
  busters

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Accessibility

• Choice of telephone and face to face appointments
  offered
• Clients have a choice of location with a wide
  range of venues across Gateshead
• Home visits provided where necessary
• Out of hours appointments

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Secondary Care Psychology Services for Older
People

• Staff 4.2 wte psychologists trainees
• Clinical Work
• About 500 referrals 3500 contacts per year, 64
  referrers, 200 different
• locations
• Teaching and Training
• Teaching to Newcastle, Teesside and Lancaster
  Clinical
• Courses, MRCPsych, MSc in CBT and Recovery in
  Psychosis
• and Complex Mental Health, Cognitive Analytic
  Therapy
• Practitioner Diploma, Systemic Therapy Diploma,
  Balint Groups
• for GPs, Introduction to CBT and Older Adults,
  Conferences
• 6 Clinical and 2 Research Trainees per year, 2
  CBT Trainees
• Service Developments
• Gateshead ABI Community Rehabilitation Team,
• Psychological Interventions with Older People,
  Memory
• Protection Service
• Research
• In collaboration with the Centre for the Health
  of the Elderly,
• MRC 85 Study, North East Centre for Age
  Related Eye

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Referral Sources

• Gateshead Health

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Types of Referral

•  

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Clinical Roles

• All staff see patients with a range of problems -
  this maintains flexibility and efficiency within
  what is a small department (5 qualified staff).
• The main role for the department is in working
  with complex presentations with dedicated time
  for the liaison service and dual care ward,
  mental health inpatients, and the challenging
  behaviour service.

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Clinical Roles

• There is strong provision of specialist
  individual psychological therapies with trained
  practitioners in Cognitive Behavioural Therapy,
  Cognitive Analytic Therapy, Systemic/Family
  Therapy, Psychodynamic Therapy, Compassion
  Focussed Therapy and Eye Movement Desensitisation
  and Reprocessing.
• There is strong provision of specialist
  neuropsychological assessment and rehabilitation.
• Provision of clinical supervision to Gateshead
  Health Staff including members of Liaison Team,
  Sunniside Unit, Challenging Behaviour Service,
  Community Nurses, Younger People with Dementia
  Team, Gateshead Primary Care Mental Health Team

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Clinical Psychology Services for Older People in
Gateshead
Northumberland, Tyne Wear Mental Health NHS
Trust
This information pack includes the following
Service portfolio Referral Criteria Referral
Forms Patient Information Leaflets
Clinical Psychology (Older People) Bensham
Hospital Fontwell Drive Gateshead Tyne
Wear NE8 4YL
Phone [phone] Fax [phone] Head of
Service E-mail daniel.collerton_at_ghnt.nhs.uk Websi
te www.gatesheadhealth.nhs.uk/clinicalpsycholog
y
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Questions

• Thanks for listening
• Any queries now?
• Contacts
• Sarah Grainger Primary Care Mental Health Team
  0191 2832541 sarah.grainger_at_sotw.nhs.uk
• Claire Martin, Clinical Psychology for Older
  People, Bensham Hospital 0191 4456690
• claire.martin_at_ghnt.nhs.uk