1. Older Adults In Primary Care Mental Health Dr Caroline Yates Partner & Clinical Lead Jo Hague Manager Dementia Carer Training

2. The Issues • High levels of psychological distress • Anxiety & depression in at least 40%of OAs presenting to GPs 50% in general hospital 60% in care homes • Extensive evidence of consistent under use of MH services • Fewer than half of those identified get adequate treatment

3. Suicide • Cornwall 2x the national average for OAs • For every suicide up to 150 attempted • Untreated depression leading cause of suicide • Anxiety also common but under recognised

4. Nationally 4% accessing IAPT services • Equitable access - IAPT aims for 12% • Our referral rate around 6% • Inequity across 70 surgeries 0%- 21% (3months)

5. Recovery rates for older people at least as good as for younger patients

6. Outcomes Recovery Rates • IAPT target - 50% • Our All Ages RR - 48-54% • Our 65+ Recovery Rate 62% Once referred OAs engage well & complete treatment • Caveats (e.g. MDS norms? lower scores at start?)

7. WHY SO FEW? • Generational attitudes and beliefs preventing asking for help • Reluctance to raise Ψproblems with GP • GP appts too short for physical & psychological • Unfamiliar GPs deters from talking • Not aware service available / relevant to them • GPs under-identify mild-mod MH difficulties in OAs • GPs infrequently refer OAs for Ψ therapy • GPs may not view service as ‘appropriate’ for OAs

8. 9 months: A Few Initiatives • Each of 7 locality teams developing own targets & ideas • Engaging with practice nurses, community matrons, OA Complex Care Teams, third sector, hub meetings • Engaging with community groups eg WI, U3A, Age UK, Memory Cafes, Carers, • Royal Cornwall Show

9. GP awareness of screening & service availability • Monthly comparative referral rates for each practice – GP reports & discussion with LM • Targeting low referring practices • Increasing awareness in GP waiting rooms • Publicity • Wellbeing course

10. WI Presentation “No one had heard of us and feedback was that the women would generally not ask for help because they were used to not doing so and they saw therapy as a modern concept. After the presentation they said they would recommend our service and access it themselves if necessary”

11. Work in progress

12. Similar to Stress Buster • Happiness • Resilience • Assertiveness • Problem-solving • Interaction & peer support • Course evaluation & development with course members

13. Young at Heart • Publicity e.g. PCT, posters, info to GPs, Age UK, Radio Cornwall interview, Pro-vision and bus adverts • 4 pilot courses; Attendance 13 • Feedback positive & helping course evolution

14. Feedback • “It has given me my zest for life and living again. I see a future now of purpose and happiness”. • “I think this course is about more than just stress. I’ve found it inspiring in moving on.”

16. How would you describe your level of knowledge about stress?

17. How would you describe your level of coping skills when dealing with stress?

18. How would you describe your level of confidence in controlling your stress?

20. 2011/12 Q4 Data • 6.5% referral rate • 2:1 female to male • 6 /70 practices made no OA referrals • Variability across practices continues 0%-28% • Higher referrals rates in less deprived areas

21. Where do we go from here? ? Commissioning? AQP? • More courses; revised measures? • Take the service to groups, organisations?,, health settings (e.g. LTC groups)? • Taking the service to the individual- home? • Targeted work with GPs? E.g. Assertive follow-up with GP report • Etc...............

22. Thank you