Interventions for common mental health conditions

An earlier section of the mental health needs assessment gives an overview of services supporting people with common mental health conditions (anxiety and depression) in Cambridgeshire and Peterborough.
We know that that many older adults regularly attend primary care but have limited information about how many older people in Cambridgeshire and Peterborough receive mental health support from their GP.
Locally, there has been a recent focus on increasing the number of older adults who access mental health interventions through Talking Therapies.
Older adults may require different types of mental health interventions than younger adults. For example, some older people are more likely to experience adverse reactions to medications due to the impacts of ageing and polypharmacy (Petchey & Gentry, 2019).

Primary care

90% of adults with mental health conditions (excluding those with serious and enduring mental illness) are supported in primary care (Independent Mental Health Taskforce, 2016). An overview of this support is described in chapter 5 of this mental health needs assessment.

Recent national surveys show that 65% of older adults had accessed their GP practice within the past 6 months (Lambert et al., 2022).
Older adults may be reluctant to raise mental health with their GP, with one study suggesting that fewer than 1 in 6 older people with depression ever discuss this with their GP (Mueller et al., 2017). However, research also suggests that when older people do ask for support with their mental health, GPs are one of first professionals that they are reach out to (Independent Age, 2020).
National research highlights that some older adults with depression are less likely to be prescribed antidepressants or be referred to psychological therapy by their GP than younger adults (Walters et al., 2018).

The Cambridgeshire and Peterborough Older People’s Partnership Board has raised concerns around older people’s ability to book GP appointments on the phone and to secure a face-to-face appointment (Older People’s Partnership Board, 2022).

Talking Therapies

Talking Therapies (previously known as Improving Access to Psychological Therapies (IAPT) and later locally as the CPFT Psychological Wellbeing Service) provides treatment for common mental health conditions at the higher levels of the stepped care model. The support offered is described in chapter five of this mental health needs assessment.

National data shows that older adults are underrepresented in Talking Therapies. In 2021, the number of older people with anxiety disorders and/or depression accessing Talking Therapies was just 44% of target for their age group, compared to 75% across all age groups (House of Commons Committee of Public Accounts, 2023).

Studies suggest that older adult often prefer talking therapy over medication as treatment for depression, particularly if they have low-level symptoms (R. Frost et al., 2019).
However, a UK-wide poll of 2,316 older adults found that only half (54%) were aware that the NHS offers counselling (Independent Age, 2020).
In Cambridgeshire and Peterborough, the ‘Feel Brighter’ campaign was launched in February 2023 to improve awareness of Talking Therapies amongst older adults (Cambridgeshire and Peterborough Integrated Care System, 2023).

In Cambridgeshire and Peterborough, Talking Therapies offers support in a range of locations, including bases across the county, community locations and through online appointments. If people are not able to access these, they will instead support people to access home visits through partner agencies. The Psychological Skills Service (PSS) was introduced as part of the Peterborough Exemplar, to meet the needs of people whose mental health needs are too complex for Talking Therapies. This service is not currently available to older adults.

Referrals

The number of referrals to NHS Talking Therapies for older adults increased from 2018 to 2023, with a 35% increase in 2023 compared to the previous year.

Figure 35: Number of referrals of older adults to Talking Therapies, CPFT, 2018 – March 2024. Data source: CPFT

Older adults have made up an increasing proportion of people referred to Talking Therapies has been growing since 2021, although in line with national trends, older adults in Cambridgeshire and Peterborough are substantially less likely to be referred to Talking Therapies than young adults and working age adults.Figure 36: Proportion of older adults in referrals to Talking Therapies, CPFT, 2018 – March 2024. Data source: CPFT

Some of these differences across age group may reflect differences in mental health need: international research highlights that most mental illnesses begin before age 25 (Solmi et al., 2022). Under 18s seeking out mental health interventions are likely to be referred to children and young people’s mental health services through YOUnited rather than Talking Therapies.

Over 60% of all the referrals of older adults to Talking Therapies are women. This is higher than the proportion of females (54%) in the population for this age group.

Starting and completing treatment

In 2022/23, older adults aged between 65 and 74 were no less likely to begin or complete Talking Therapies treatment than people from younger age groups; although adults aged 75+ were less likely to begin and complete treatment. A substantial proportion of people aged 90+ did not enter treatment, although it is difficult to draw conclusions as this was a very small group of just 25 people.

Figure 37: % of referrals to Talking Therapies entering and completing treatment, Cambridgeshire and Peterborough ICB, 2022-23. Data sources: NHS Talking Therapies, for anxiety and depression, Annual reports, 2022-23

Recovery

For those who completed Talking Therapies treatment, reliable recovery rates in 2022/23 were higher for older adults than for younger adults. There was no data for adults aged 90+ due to small numbers of people in this age group completing treatment.

Table 12: Talking Therapies reliable improvement and reliable recovery rates, Cambridgeshire and Peterborough ICB, 2022-23. Data sources: NHS Talking Therapies, for anxiety and depression, Annual reports, 2022-23

Voluntary and community sector support

There is a range of voluntary and community organisations that support people with severe mental illness, including organisations offering social support. This section is not comprehensive but covers one of the largest local organisations, CPSL Mind.

CPSL Mind

CPSL Mind (Cambridgeshire, Peterborough and South Lincolnshire Mind) provides a range of support that promote good mental wellbeing through the Good Life service. This support is detailed in the previous chapter of the mental health needs assessment. In Q3 and Q4 of 2023/24, older adults made up 3.5% of referrals to CPSL Mind, the majority of which were for Qwell. This does not include older adults who accessed drop in services.

Additional resources

References

Full list of references is included at the end of this chapter.