The Transition and Recovery Plan is also supported by the Mental Health Equality and Human Rights Stakeholder Forum. The purpose of this Forum is to identify and highlight relevant equality and human rights evidence and research in relation to mental health policy. The Health and Social Care Alliance Scotland (the ALLIANCE), Age Scotland, See Me and Voices of eXperience (VOX) are all Forum members.
Context The Scottish Government has made a commitment to provide equal opportunities to access effective mental health support and services. To achieve this, they have published the Mental Health Transition and Recovery Plan. Within this plan is an action to fully understand and respond to the wide-ranging mental health impacts of COVID-19 on older people.
Theperiod.purpose of the event was to gather information and insight from people with lived experience, and those who support and work with older people. This report is a summary of the discussions held at the event and will be fed back to the Scottish Government to aid their understanding, inform policy, and help ensure mental health policy is equalities and human rights focussed.
Older People and Mental Health CONSULTATION EVENT REPORT August 2021
What are older people’s experiences of mental health issues, and how does this compare to other age groups?
What has been the impact of the pandemic on older people’s mental health?
people and mental health consultation event report 25 August 2021 1
Introduction On Wednesday 25th August 2021, the ALLIANCE, Age Scotland, See Me, and VOX held a consultation event to discuss older adults’ mental health as well as people’s experiences of mental health and social care service before and during the pandemic
The questions discussed were:
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What have older people’s experiences of accessing mental health services been like during the pandemic?
The event was attended by 29 people, including older people and those who work with and support older people. Using the feedback gathered during the event we have been able to draw out key themes that provide insight into older people and mental health.
What are older people’s experiences of mental health issues, and how does this compare to other age groups?
Access to services
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Both loneliness and isolation were mentioned by participants as important to understanding older people’s experiences of mental health. It was also noted that this was a prevalent issue even before the pandemic which has likely exacerbated loneliness and isolation. Participants also discussed that feelings of loneliness and isolation are caused by different reasons, meaning that the response to tackle them requires nuance. For example, telephone befriending services made some people feel supported but certainly didn’t work for everyone. Practical activities were also seen as important to tackling feelings of isolation.
Two broad themes can be identified from the discussions about older people’s experiences of mental health issues, and how they compared to other age groups. These were loneliness and isolation, and access to services.
What were older people’s experiences of accessing mental health services and social care like before the pandemic?
There was a general consensus that it’s easier for younger people to discuss mental health and therefore access support. The word ‘stoicism’ was used by several
Loneliness and isolation
What are the experiences of different population groups amongst older people, for example based on sex, gender identity, ethnicity, sexual orientation, location, household income, etc?
It was also clear from discussions that older people who are often unpaid carers experience feelings of isolation due to their caring role. Lack of respite was reported to be a key issue for older people’s mental health.
It’s also important to recognise that there is a generational dimension to digital exclusion, which can mean that some forms of support and services are not accessible for those older people who do not want to, or cannot, access the internet.
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What has been the impact of the pandemic on older people’s mental health? The pandemic has clearly had a huge and varied impact on older people’s mental health. Many of the groups noted that the impact of lockdown further exacerbated issues that already existed such as loneliness and isolation. In some cases, this was due to digital exclusion as services adapted to provide online support, however, the stay at home message also impacted people’s confidence to go outside. Nevertheless, the points about loneliness and access to services and how these two relate is nuanced and complex. From the event discussions, a picture also emerged of the move to phone/digital services as being of benefit for some people, because it has allowed more control and less time needing to be taken up by an in-person appointment. Also, the link between physical health and mental health should not be forgotten as we continue to recover from COVID-19.
The most common issue that participants raised was the impact the pandemic had had on statutory services such as care at home and day care services, with many seemingly closing overnight. In many cases, older people’s mental health worsened
One discussion group also noted recent research, which found that older people lose a range of mental health support services when they turn 65 and felt that they had been pushed out of services. Further information on this research can be found here: Falling Off a Cliff at 65: Discussion Paper and Evidence (vhscotland.org.uk)
participants to describe older people to emphasise what is seen as a generational difference and additional barrier to accessing support and services; it was also used to describe older people feeling that they did not want to ‘be a bother’ or a ‘burden’, especially when “others are having such a terrible time and the NHS is overstretched.”
Stigma is clearly an issue for older people experiencing poor mental health who may struggle to ask for help. Some of the participants also reported fear in coming forward in case they were deemed to have lost the ability to make decisions for themselves, therefore losing control over their own lives.
Impact of COVID-19 on statutory services
while statutory services struggled to adapt and cope with increased demand. Examples were given of people who had unnecessarily been sectioned who wouldn’t have been previously. Event participants also discussed the lack of transparency over how statutory services prioritised people who needed support during lockdown, with some feeling they had been abandoned and left to cope on their own.
Lockdown messaging
It’s clear that the stay at home message had impacted older people’s mental health, as well as the constant negative news cycle. Whilst the public message of staying at home was clear and important to public health, it had a huge impact on older people having a knock on effect on trips and falls, and people afraid to access support.
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There was praise for third sector organisations who stepped up to support people who had fallen through the gaps. Local self-help groups and mutual aid groups were also found to be very helpful. Digital exclusion As services adapted to provide online services, many older people struggled to receive support and there was as a general feeling that everything would only now be available online. Some participants felt there was a lack of awareness around how to help people get online and how to provide support for those who were new to this Astechnology.wellasdifficultly
around learning how to use new technology, for many older people a major barrier was the cost – including buying new equipment, paying for broadband, and paying for mobile phone data. For older people with mental health issues these barriers seemed insurmountable. Access to food Stress and anxiety were also caused by the difficulty in accessing food during the first lockdown. Many older people struggled with online shopping due to digital exclusion, delivery fees that negatively impacted finances, and access to culturally appropriate foods. For those that did qualify for food parcels provided by their local authority, many found they were not varied enough to meet the nutritional needs of older people. These issues all have a real impact on mental health and wellbeing, demonstrating the negative impact the pandemic has had on older people.
One participant noted that although the decision to shield was outwith their control, the result was they were linked into other forms of support which was positive. However, others noted that many older people were missed out from the shielding list and therefore were left to cope on their own. For some, the resulting isolation made it difficult to open up about their mental health and easier to hide difficulties or avoid conversations altogether.
One group also felt that care was less aspirational for older people, particularly for those living with dementia. Changing the national narrative around mental health to include older people was thought to be a good place to start.
What were older people’s experiences of accessing mental health services and social care like before the pandemic?
What have older people’s experiences of accessing mental health services been like during the pandemic?
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Another participant raised how the various lockdown cycles impacted mental health differently with the second lockdown as much more challenging due to the changes and less clear guidance. The confusion about what was, and wasn’t, allowed had an impact on mental health.
Participants all agreed that although statutory service provision before the pandemic for older people was better, it was still not easy to access with the term ‘postcode lottery’ being the best way to describe provision.
GPs were seen to have an important role in signposting older people to get mental health support. The experience of this, however, is varied with some GPs being more proactive than others. Some participants felt GPs didn’t prioritise mental health over what they considered to be more ‘urgent’ physical issues.
Another issue raised was that before the pandemic, older people were able to access face to face services such as day centres but as these services now start to reopen there are huge waiting lists.
Training for health and social care staff was also raised as important to ensure support for older people is targeted and appropriate, recognising the different mental health challenges faced by older people.
Participants discussed the difficulty in accessing mental health services during the pandemic, with some seeing services either scaled back or removed completely. This was experienced across a multitude of agencies including social work, housing associations, and primary care services.
Reduced access to services was further exacerbated by the increase in demand for mental health services from both those who already receive support and those accessing it for the first time. On the other hand, some participants reported that older people may be reluctant to ask for help because of the many barriers the pandemic
that there were examples of good practice such as a joint venture between health and the police that provided a quick and effective response to those who were in crisis. It’s clear, however, that preventative work has in most cases been dropped as the focus shifts to crisis management.
Digital exclusion was again raised as an issue, with some older people struggling with data limits, unable to afford expensive equipment and no support to learn how to use them. One participant highlighted that many older people are worried about scams and that this is a major barrier for them getting online.
What are the experiences of different population groups amongst older people, for example based on sex, gender identity, ethnicity, sexual orientation, location, household income, etc?
Older people and mental health consultation
event report 25 August 2021 6
Participants discussed the intersectional nature of older people’s experiences with mental health. Religion Participants raised the fact that many community groups such as churches have not been able to meet socially due to the pandemic. Being able to be a part of an understanding community is so important to mental health and the fact this is missing has been very difficult.
Participantscreated.didnote
Whilst some struggled with online services, there were those who found it worked well for them and suited their needs. Some third sector organisations found they were able to reach more people than they had previously and planned to change their delivery model to incorporate a hybrid model of online and face to face support.
have also presented a challenge in terms of accessing information and support. This can also lead to people whose first language is not English being excluded from decision making and solutions. For example, information about vaccines in different languages has only more recently become widely available, and it is also difficult for those who have literacy issues.
Gender Most unpaid carers are women and finding out how to best support this group’s mental health is essential. Loneliness and isolation are a real struggle for unpaid carers, who often struggle to access support for themselves which negatively impacts their mental health.
Veterans Participants noted that older veterans can struggle to ask for help and will likely say ‘they’re fine’ on the phone, but this is often not the case when follow up is done face to face. Services supporting veterans are finding there is a significant amount of pressure to cope as not all face to face services are operational, meaning it’s harder to do outreach work. Participants noted that for seldom heard communities it is important to co-produce solutions together.
More informal means of support that men often rely on, such as going to the pub, will take time to get back to normal. More established groups like Men’s Sheds also found the guidance on whether they can meet in person confusing, with some opting for a more cautious approach. These outlets are very important for men in order to deal with feelings of loneliness and isolation.
Ethnic minorities
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The cultural differences that older people from ethnic minority groups experience means that there can be stigma around mental health problems, which must be Languageconsidered.barriers
Gypsy Travellers were also mentioned as a group who have historically struggled to access support and services. One participant noted that service provision before the pandemic was poor but now it feels like they’ve totally disappeared.
Ensure people are at the centre, that their voices, expertise and rights drive policy and sit at the heart of design, delivery and improvement of support and services.
About Age Scotland Older people and mental health
The Health and Social Care Alliance Scotland (the ALLIANCE) is the national third sector intermediary for a range of health and social care organisations. We have a growing membership of over 3,000 national and local third sector organisations, associates in the statutory and private sectors, disabled people, people living with long term conditions and unpaid carers. Many NHS Boards, Health and Social Care Partnerships, Medical Practices, Third Sector Interfaces, Libraries and Access Panels are also members. Our vision is for a Scotland where people of all ages who are disabled or living with long term conditions, and unpaid carers, have a strong voice and enjoy their right to live well, as equal and active citizens, free from discrimination, with support and services that put them at the centre.
About the Partners About the ALLIANCE
The ALLIANCE has three core aims; we seek to:
Support transformational change, towards approaches that work with individual and community assets, helping people to stay well, supporting human rights, self management, co-production and independent living.
Conclusion As this report indicates, participants had a lot of important points to make and experiences to share about older people and mental health. This covered people’s experiences both before COVID-19, as well as since the pandemic began in Scotland. The partners and participants hope that the Scottish Government finds the information in this report helpful in terms of informing and influencing action to achieve the Mental Health Transition and Recovery Plan.
consultation event report 25 August 2021 8
Champion and support the third sector as a vital strategic and delivery partner and foster better cross-sector understanding and partnership.
About Voices of eXperience (VOX)
VOX Scotland is Scotland’s national voice on mental health – we represent our members’ views to Scotland’s politicians and health professionals to make sure Scotland’s laws and mental health services reflect the needs and interests of those with lived experience of mental ill health. VOX is Scotland’s only national mental health advocacy organisation run by service users for service users.
About See Me See Me is Scotland's national programme to end mental health stigma and discrimination. Facilitating change is what See Me is all about. Working alongside people with experience of mental health problems we challenge stigma and discrimination at its roots - wherever people experience it - at work, through health and social care, in education, at home or in local communities. Our ambition is to influence cultural, societal and behavioural change to bring to an end the stigma and discrimination that prevents people with experience of mental health problems from living fulfilled lives. We are funded by the Scottish Government and jointly managed by SAMH and the Mental Health Foundation.
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Age Scotland is the national charity for older people. We work to improve the lives of everyone over the age of 50 so that they can love later life. We support and enable more than 700 older people’s community groups across Scotland, provide information and advice through our free helpline and publications, tackle loneliness and isolation, provide dementia and veterans training, create age-inclusive workplaces and much more. We work to influence policy makers and run campaigns to make Scotland the best place in the world to grow older.
Gordon Johnston, Voices of Experience (VOX)
Background and scene-setting Ashleigh de Verteuil, Age Scotland Group discussions
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12.40pm Next
What have older people’s experiences of accessing mental health services been like during the pandemic?
12.00pm
What are older people’s experiences of mental health issues, and how does this compare to other age groups?
APPENDIX: Event Agenda Older people and mental health consultation event 11am – 1pm, Wednesday 25th August 10.50am Zoom room open 11.00am
12.10pm
11.20am
Welcome and introduction
11.10am
What has been the impact of the pandemic on older people’s mental health?
What were older people’s experiences of accessing mental health services and social care like before the pandemic?
What are the experiences of different population groups amongst older people, for example based on sex, gender identity, ethnicity, sexual orientation, location, household income, etc? Break Feedback from group discussions steps, thanks and close Gordon Johnston Meeting ends people and mental health consultation event
12.50pm
report 25 August 2021 10
This event is being organised to consult older people with lived experience of mental health issues – whether people have used mental health or social care services, or not – and individuals and organisations that support or work with older people who experience mental health Theissues.Scottish Government has indicated a commitment to provide equal opportunities to access effective mental health support and services, and has an action plan to achieve this One of the actions in the Scottish Government plan is to fully understand and respond to the wide-ranging mental health impacts of COVID-19 on older people.
About this event
Older people and mental health consultation event report 25 August 2021 11
The Health and Social Care Alliance Scotland (the ALLIANCE), Age Scotland, See Me, and Voices of eXperience (VOX) have organised this event to discuss older adults’ mental health and – if used – people’s experiences of mental health and social care services. We will share the event report (no-one will be identified) with the Scottish Government to aid their understanding, inform policy, and help ensure mental health policy is equalities and human rights focussed. END.