In this blog, we hear from our colleagues in The OPTIMAL team, a clinical psychology led implementation team in Glasgow working with older adults coping with mental health challenges. 

Mental health difficulties are common in older people. For instance, 1 in 4 people over 65 experience depression. Yet, less than 7% of referrals for psychological therapy are for older people and 85% of older people with depression don’t seek treatment from the NHS. This has led clinicians to wonder: why aren’t more older people accessing help from NHS mental health services?


What do local older people say?


As part of our work, we asked local older people for their views on why older people don’t seek help for their mental health:


“… I think with older people… they can get to the point of being, “Oh no, you don’t talk about that” because when they were a lot younger, it was a case of “Oh no you don’t talk about this and you don’t talk about that…”


“I come across quite a few men… and it’s about, a case of failure? They feel they’ve failed if they have to ask for help because they are supposedly to be the macho breadwinner… and if they are that low in mood and feeling that bad then they are not going to ask for help.”


“… when I got referred to services it was something I had never heard of until I went to see psychologists and psychiatrists and things like that… “


“…anything to do with mental health, it’s a case of, you think you are on your own.”


“Some folk worry, about other folk seeing them, and their mental health used to be kept under the carpet… so that would put you off.”


“”…they’ve got the courage to go to the GP and then they feel as if they are getting put to the side, you know? … And like that I’ve heard people quote, eh, “Old age doesn’t come by itself”. “Oh just take yourself to your bed and be good to yourself”. I mean that’s like giving up!”


What are the barriers to accessing services?


As the quotes above show, there are a number of barriers which might prevent older people accessing services.

One barrier is Stigma. People over 65 grew up in a generation where mental health was not talked about openly. Although mental health is talked about more openly now, many older people may still be worried about what other people may think about them seeking help.

Another barrier is cohort beliefs. People over 65 come from a generation where people believed that if you have a problem, you should cope with it stoically, without having to rely on help from others. This is known as a cohort belief. Because of this cohort belief, some older people won’t tell anyone that they are struggling. They might ‘put up’ with their problems and difficulties for a long time without seeking help.

Another barrier is a lack of knowledge about mental health difficulties. Many older people report that they simply don’t know much about mental health difficulties such as the symptoms of depression and anxiety. In addition, they often don’t know about the services available and how to access them.

Finally, several studies have suggested that GPs are less likely to refer older people for psychological therapies than younger people. While we don’t fully understand the reasons behind this, some studies have found that GPs may have misconceptions that older people will be less likely to benefit from therapy or have ageist beliefs that depression is “inevitable” in old age. Of course some older people have a very helpful experience at their GP practice however there appears to be some variability.


Who are we and what are we doing to try and help?


The OPTIMAL (Older People’s Psychological Therapies Implementation, Measurement and Long-term sustainability) team is a clinical psychology-led implementation team. Our aim is to raise awareness of mental health difficulties in older people, the mental health services available, and to help teams deliver more psychological therapies to older people. We aim to try to overcome some of the barriers older people face in accessing services.

To reach this aim, we have been raising awareness with GPs, Practice Nurses, Housing Associations and older people in Greater Glasgow & Clyde.  With the help of local older people we have developed leaflets, posters and other resources to promote awareness and services. We are now hoping to test out the impact of these resources in a small number of GP practices to start with. We have also been creating new therapy groups within mental health services which are specialised for older people’s needs.

By continuing our work, we hope that more older people will feel confident seeking help for mental health difficulties and distress.