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March 2013
How to make IAPT more accessible to Older People: A Compendium 3
Contents
Ministerial Foreword 5
Acknowledgements and
copyright
Members of the DCP Faculty of Psychology of Older People
Age UK Camden
Foreword by Minister
In February 2011, the Government published Older people are more likely to feel isolated
‘No health without Mental Health’: a cross and vulnerable, even unaware of the services
Government mental health outcomes strategy that exist locally that could help them combat
for people of all ages. Here we set out our depression and anxiety. Those that have
approach to improving the mental health and accessed talking therapies have shown good
well-being of the nation. ‘Talking Therapies: recovery rates with most completing their
A Four Year Plan of Action’ accompanied the therapy sessions. It is important we encourage
mental health strategy and set out our policy more older people to feel confident in accessing
priorities in this area. One of these priorities is these services.
the continued expansion of the IAPT programme
including amongst other things improving I know that local services are very willing to
access for older people. reach out to local communities. The examples
in this document, give some insight into
We know from the data and evidence from what works by for example targeting specific
service users that IAPT psychological therapies networks or generally using more flexible and
work across the age range and have achieved innovative approaches to attracting older
good recovery rates since inception. We people. I would encourage you to adapt or
also know that there is a significant under- adopt them locally in order to change the
representation of older people accessing IAPT current patterns of under-representation by older
services. It is important that this is addressed. people in IAPT services.
We should, moreover, remember that from
October 2012 this Government outlawed age
discrimination in the delivery of health and
care services. Norman Lamb MP
Minister of State for Care and Support
How to make IAPT more accessible to Older People: A Compendium 7
Introduction
1. Green,S.A., Poots,A.J.,Marcano-Belisario,J., Samarasundera,E., Green,J., Honeybourne,E., and Barnes,R. (2012) ‘Mapping mental
health services access: achieving equity through quality improvement’ Journal of Public Health; doi: 10.1093/pubmed/fds071.
How to make IAPT more accessible to Older People: A Compendium 11
Gateshead
“helps you cope with things...
The Gateshead service developed leaflets,
posters and a laminated aide memoire for
to deal with transitions”
referrers (see appendix 1 and appendix 2).
These detail how depression and anxiety This involved a dedicated senior PWP who
may present in an older person with specific raised awareness of older people and common
symptoms to look out for, and things that mental health problems with staff across primary
older people will commonly say when trying and secondary NHS care, social services and
to describe anxiety and depression. They also the non –statutory sector.
describe briefly how talking treatments are
effective for working with older people and the A range of interventions were developed to
importance of referring to the IAPT service, or improve the experience of IAPT for older people.
specialist older people services.
Following the campaign the percentage of older
people accessing the service increased from 5%
Buckinghamshire – Healthy Minds
to 10%
A poster campaign promoting IAPT to older
people has been conducted including post Camden and Islington
offices and bus stops. Adverts about IAPT
were included in council booklets sent to every Developed older adult specific leaflets and
household in the county and on the back of promotional materials to use in ‘pop-up’
supermarket till receipts. promotional visits to older people’s community
services such as day centres and sheltered
The Healthy Minds quarterly GP newsletter accommodation. Articles in the local press have
encourages referrals and gives examples of advertised older people’s stories of receiving help.
work with older people. A training session
for 40 GPs on ‘Improving the well-being of This work has been done jointly with IAPT
older people’ was delivered at the annual GP workers and older people specialists who
refresher programme. provide supervision and consultancy within the
IAPT service.
Along with other initiatives described below
Buckinghamshire has seen an increase in Lessons
referrals for older people from 4-5% to 9-10%.
■■ it is possible to get an increase in referrals
Mid Essex ■■ general publicity campaigns need to be
repeated
A CQUIN funded programme (2011-2012) was ■■ self – referrals can be increased but tend to
undertaken to raise awareness and enhance be via a recommendation
access through outreach work with older people ■■ tailor the materials to your specific audience –
referred into IAPT. consult them
12 How to make IAPT more accessible to Older People: A Compendium
Camden and Islington have developed a ‘Living psychological therapies for people with LTC
Positively in Later Life’ group programme and/or MUS.
offering 3 or 6 sessions to groups of older
people in community settings including sheltered An evaluation of the Pathfinder sites will
accommodation, day centres, health centres be carried out by September 2013 by an
and carers centres. As part of this project efforts independent evaluation agency. This will include
have been made to engage underrepresented reviews of service models and care pathways,
local populations, for example offering a group patient centered assessment, clinical and
to Greek Cypriot older people with adapted economic outcome measures, pathfinder
materials and working with an interpreter. workforce competency, and LTC/MUS training.
These groups have raised awareness and led In addition there will now be a separate analysis
participants to self-refer into the IAPT service. of the data to focus on those who have used the
services who are aged 64 years and over.
Lessons
From simple demographics we would expect
that addressing the specific needs of people with
■■ simple adaptations to session length or
co –morbid long term conditions will address the
venue can help older people access low
needs of a large group of older people with up to
intensity interventions
50% of people being seen in LTC/MUS pathfinder
■■ some groups of older people may be sites being over 64 years old.
underrepresented and this can be addressed
by targeted groups Below are some examples of how the LTC/
■■ insomnia is a concern for many older people MUS pilot sites are addressing the needs of
with common mental health problems and older people.
insomnia groups may be perceived as less
stigmatising than other low intensity groups Durham and Darlington
4. Learning from specialist services How do we increase access for older people
to psychological therapies?
Pre-dating the IAPT Programme there were
a few examples of specialist primary care ■■ Routine monitoring of referral sources to
services for older people. These services have ensure continuity of referrals
a considerable number of years experience ■■ Active follow-up with referral sources that
both in providing services to older people and appear to have reduced their referral rates
in promoting the service to the wider health ■■ Routine liaison with and promotion of the
and social care network to ensure older people service to GPs, other primary care health
get access. Some of the lessons learned are and social care professionals, and voluntary
summarised here:- agencies (e.g. attend practice meetings,
send out newsletters & flyers of any service
Salford updates)
■■ Routine liaison with the local Functional and
This multidisciplinary team of clinical
Organic CMHTs to ensure that psychological
psychologists, counselling psychologists,
therapies at primary care level are available
counsellors, and an occupational therapist has
for clients being stepped-down or for clients
been running for more than a decade.
for whom secondary care interventions are
not appropriate
Types of referral
■■ Offer awareness training on older people’s
mental health needs to other primary care
People with moderate to severe mood problems
health and social care professionals
associated with or exacerbated by age-related
needs and problems. For example people ■■ Routine administration of a service-evaluation
with anxiety, depression, stress, or relationship questionnaire to clients to monitor service-
difficulties associated with the adjustment/loss user perspectives on the service we offer
issues that are more prevalent in later life. These ■■ Service-user evaluation audits to ensure
can be adjustment to retirement, multiple physical that clients’ views are taken into account
health problems, caring for spouse or parent with when planning any service changes or
age-related needs or dementia, mild cognitive developments
impairment. The service also sees people with
anxiety, depression and other mild to moderate How do we make our service accessible for
mental health problems in later life that are older people?
more suited to therapies adapted to account for
sensory, cognitive, and physical abilities. ■■ Enable people to opt-out of the service rather
than opt-in
■■ Routinely offer people a choice of home
“it certainly worked for me I versus clinic appointments
am happy again and looking ■■ Where possible, arrange initial appointments
forward to the future” by telephone and then follow-up this initial
contact by written letter
16 How to make IAPT more accessible to Older People: A Compendium
■■ Offer people reminder calls (with their that they will be seen for assessment and
consent) so that appointments are less likely treatment as quickly as possible
to be missed ■■ Not routinely sending the opt-in pack to older
■■ Do not routinely discharge after a certain people without a prior conversation with
number of DNAs/cancelled appointments a member of staff to ensure that they are
■■ Follow-up DNAs/missed appointments (if happy to complete questionnaires before the
appropriate) by contacting GPs/carers/client face-to-face session
in case these were due to memory problems, ■■ Adjusting the frequency and pacing of
physical health problems, or illness therapy sessions according to the needs of
■■ Adapt our publications/materials so that both older adults. For example giving extra help to
contact and format are appropriate for older complete the mandatory data set if needed
people ■■ Offering home visits to older adults who have
■■ Use standardised outcome measures that mobility issues and / or unwilling to attend
are appropriate for older people appointments in clinic
■■ Close liaison with other primary care health ■■ Employing a consultant clinical psychologist
and social care professionals so that the who has a special interest and expertise in
client’s mental health needs are assessed working with older adults to provide clinical
and formulated within the wider health & supervision and consultation for IAPT
social care setting workers
■■ Training sessions on working with older
adults for both High Intensity and Low
South London and Maudsley (SLAM) Intensity therapists
The Late Life Primary Care Psychological
Therapy project in SLAM predated IAPT but The service has helpfully adapted the lessons
has subsequently merged with Southwark they have learned, from working over time to
IAPT to provide a service to older people. The increase the numbers of older people accessing
experience of the project helped shape practice their service, into an audit tool to help services
within IAPT Southwark to help increase access benchmark how accessible they are to older
for older people through:- people – see appendix 3.
2. This research is in preparation for publication. The treatment manual and further details are available from Penny Rapaport.
18 How to make IAPT more accessible to Older People: A Compendium
Oxfordshire and Buckinghamshire IAPT have adapting self help materials and monitoring
also collaborated with the Alzheimer’s Society to how the service is responding to older people.
develop an online CBT intervention for carers of Having an older people user group will ensure
people with dementia. A randomised controlled the spotlight is kept on older people’s access.
trial supported by Alzheimer’s Society and the
Department of Health is planned to begin in Examples have shown how some routes into
May 2013. services, or initial assessment processes, can
be reviewed to help older people access the
Summary service. Once in the service there are examples
of flexibility of approach e.g. home visiting or
The services described here are not alone adapted self help materials that are useful for
in having begun to address the under older people.
representation of older people in IAPT services,
and we know that initiatives are underway across All the IAPT services described had provided
England. The examples here do demonstrate further training for their staff in working with
some of the key features of a service that will older people. The IAPT Competence Framework
increase access for older people. and Indicative Curriculum for Working with Older
People will ensure that such training is now a
Promoting IAPT to older people, either directly core part of IAPT training, and can be used to
or through those health and social care provide a guide to top up training for existing
professionals who work alongside them, does IAPT staff.
produce increased numbers of older people
accessing the service. The learning from Conclusion
established services is that such promotion
needs to be repeated over time. Improving access to psychological therapies
for older people should be a priority for all IAPT
It is essential to monitor how the service is services. The work outlined in this Compendium
responding to older people – you can measure shows that it is possible to achieve considerable
the success of initiatives by looking at referral increase in numbers accessing the service, and
rates, entry into treatment and recovery rates for the national IAPT data suggests that when older
the group over 64years. people receive treatment they are benefiting
from that treatment.
Referrers will respond well to clear and regular
feedback about how many older people they
are referring and how those older people get
on in treatment.
Resources
■■ COPD – www.cues.celecoventry.co.uk/copdp
■■ Heart Disease –
www.cues.celecoventry.co.uk/heartp
20 How to make IAPT more accessible to Older People: A Compendium
References
Date:
Aspect of service design: Existing actions that already Further actions that could be
facilitate older people’s access: adopted to improve your service:
Aspect of service design: Existing actions that already Further actions that could be
facilitate older people’s access: adopted to improve your service:
3 Modified ‘engagement/filtering’
procedures for getting into your
service.
Older people may be reluctant to opt into
psychological services due to:
1. Being unfamiliar with ‘psychological
treatments’
2. Having internalised ageist ideas
about their value/ability to change
3. Mobility/health problems
4. Higher levels of agoraphobia
Aspect of service design: Existing actions that already Further actions that could be
facilitate older people’s access: adopted to improve your service:
Aspect of service design: Existing actions that already Further actions that could be
facilitate older people’s access: adopted to improve your service:
11 Referral to vocational/
educational/occupational
services:
■■ These should be set up to meet the
needs of older people: opportunities
for voluntary work, engagement in
local community resources/activities.
eg – computer classes for older
people
28 How to make IAPT more accessible to Older People: A Compendium
Aspect of service design: Existing actions that already Further actions that could be
facilitate older people’s access: adopted to improve your service: