Management of depression and referral of older people to psychological therapies

Co-chair: Nadia Llanwarne (@NadiaLlanwarne)

Nadia is a First5 GP in Birmingham. She works as a ‘GeriGP’ in a community hospital, and also works as a retainer GP. In her role as RCGP older adult mental health fellow, she is working to raise awareness and improve identification and treatment of mental health problems in older adults. She trained in Manchester, London and Cambridge. She was awarded NIHR fellowships in Cambridge, which centred on studying patients’ experience of healthcare encounters. Her interests include community geriatrics, mental health, diagnosis, and social science in/of medicine.

Article

Please read the following article (which, thanks to the BJGP, will be free to access during the whole of September) before the tweet chat:

Management of depression and referral of older people to psychological therapies: a systematic review of qualitative studies

Discussion questions:

1. Referral rates to psychological therapy of older adults with mental health problems are significantly lower compared to younger adults. What do you think is driving these low referral rates?

2. Despite high prevalence of depression, older people are more reluctant to seek help for mental health problems. Fewer than one in six older patients with depression will ever discuss their symptoms with the GP. How can GPs facilitate these conversations?

3. Frailty and multimorbidity are significant risk factors for depression in later life. But physical health is routinely prioritised. At the expense of mental health. What can we do about this?

4. Do you recognise some of the assumptions and attitudes surrounding older adult mental health that this paper refers to? eg medicalising adverse social circumstances, normalising depression, therapeutic pessimism. How can we challenge these?

5. The paper discusses the wide difference in service provision across regions. Social prescribing is touched on as one management strategy. What is your experience of social prescribing in the context of older adult mental health?