Policy context

The 2023 Joint Strategic Needs Assessment (JSNA) recommended that ‘the increasing numbers of older people should encourage the whole system in Cambridgeshire and Peterborough to focus on prevention of ill health and disease, in order to reduce future demands on healthcare and other services. This is wider than just an NHS responsibility, it requires all parts of the public sector to enable healthy living and disease prevention’ (PHI team, 2023).

The last needs assessment focusing specifically on older adults’ mental health was in 2014. Relevant points in previous needs assessments and strategies around older adults’ mental health are summarised below:

Year	Strategy	Key points
2014	Cambridgeshire Joint Strategic Needs Assessment (JSNA): Older People’s Mental Health	Focused on depression and dementia and stated that many older adults with these conditions had not been diagnosed and/or had their diagnosis recorded in primary care. Predicted that the number of older people with dementia and depression would rise substantially from 2012 to 2026. Found that there was substantial variation in referral rates to older people’s mental health services across the county, the reason why was unclear. Service improvement ideas from service users and carers included community-based and practical support, such as with maintaining relationships and applying for benefits; and a greater focus on positives rather than diagnosis. Information and training for families and carers and people with mental health conditions, and being able to consistently see the same health professional, were also considered important.
2018	Cambridgeshire & Peterborough All Age Dementia Strategic Plan 2018 – 2023	Stated that rates of referrals into access for psychological therapies for older adults, and rates of contact with secondary mental health services for older adults with no inpatient stays, were some of the lowest in England in Cambridgeshire and Peterborough CCG. Highlighted the coordination of both physical and mental health care as one of the biggest gaps in dementia care; and set ‘well-coordinated care that addresses physical and mental health and social care needs in a seamless way’ as a key outcome. Planned to use public health campaigns to raise awareness of how dementia can be prevented by keeping mentally and physically healthy.
2022	All Age Carers Strategy 2022 to 2026	Set supporting the ‘emotional and psychological wellbeing of carers’ as a key priority area, in response to local carers reporting that their own needs and wellbeing can be overlooked.
2022	Joint Health and Wellbeing Integrated Care Strategy	Aimed to increase the number of years people spend in good health and reduce inequalities in preventable deaths before age 75; including through a focus on early intervention and prevention to improve mental health and wellbeing.

The working-age adults chapter of the mental health needs assessment summarised key policy for adults mental health, including the Joint Health and Wellbeing Integrated Care Strategy and the Patient Carer Race Equality Framework (PCREF).

National policy

In the NHS Long Term Plan (2019), older people’s mental health was embedded across all aspect of adults’ mental health. The Plan proposed that all adult mental health services should remove upper-age cut offs; and stated that access to specialist older adults’ mental health services should be needs-based (such as considering physical and mental health comorbidities) rather than use age as a threshold. It said that NHS services should provide integrated care and support for mental and physical health needs, which may include support from social care and voluntary and community sector organisations; and set out the development of community multidisciplinary teams to work with older people and those with frailty (NHS, 2019).

Specific aims in the Long Term Plan relating to older people’s mental health were (NHS, 2019):

NHS Talking Therapies: local areas should address inequalities in access for older people and translate findings from the expansion of the long-term condition (LTC) pathway into frailty pathways.
Community mental health: older adults ‘will be supported through new and integrated models of primary and community mental health care, which will enable them to have greater choice and control over their care, and to live well in their communities’.
Crisis and acute mental health: older adults should be embedded in all crisis and acute mental health care commitments. On top of this, areas were encouraged to improve physical health support within community-based mental health crisis teams and mental health inpatient units.

Alongside this, the NHS Community Mental Health Framework recognised that there should be a focus on improving the transition period from general adult mental health services to specialist older adult services. There is no national strategy for the prevention of mental ill-health in older adults (Centre for Mental Health & Age UK, 2024).

References

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