The Older People’s Commissioner for Wales, Sarah Rochira, is an independent voice and champion for older people across Wales, standing up and speaking out on their behalf. She works to ensure that those who are vulnerable and at risk are kept safe and ensures that all older people have a voice that is heard. Here we talk to the Commissioner about her priorities for older people’s mental health, and how we should tackle specific issues such as loneliness and ‘falling between cracks’ in services…
In what ways is your role focused on the mental health of older people, and what do you see as your priorities in this area?
When setting my priorities after I took up post as Commissioner, I was clear that our public services needed a much greater focus on older people’s mental wellbeing, moving beyond the focus on their physical health, and I welcome the fact that this is starting to come through more in policy making. There is, however, a long way to go to ensure that mental health services and policies have parity with other areas.
My specific priorities linked to mental health currently include work looking at access to advocacy services, which is due to commence early next year, and work to ensure that the services that older people rely upon to keep them connected with their communities and support networks are not lost due to cuts.
As part of my Review into the quality of life of older people living in care homes, one of my Requirements for Action was focused on ensuring that residents had access to in-reach, multidisciplinary specialist mental health and wellbeing support, while another Requirement called for an end to the inappropriate use of anti-psychotic medication, something that I have been working on closely with the Royal Pharmaceutical Society.
Over the course of your career you have worked within a wide range of NHS organisations across Wales, including in mental health services. How has this personal experience influenced your approach to promoting older people’s mental health in the role of Commissioner?
My work within the NHS has allowed me to understand the systems and structures in place within our health services, and the ways in which these may prevent people from getting the help and support they need – too often services are designed to fit the system and not the individual.
My NHS experience has also helped me to understand the pressures that are faced by our health services and NHS staff, the impact that these pressures can have on services and the care that people receive, and how these pressures could be alleviated most effectively. It’s important to remember that no-one sets out to deliver bad care or poor services and that we have many dedicated staff at all levels within our health service working to make a positive difference to people’s lives. But we need to get better at focusing on outcomes and listening to people’s voices – those who use services are often ‘experts by experience’ with a range of useful knowledge that could be drawn upon to deliver improvements.
Finally, my work within the NHS highlighted the importance of ensuring a holistic approach across our health and social care services – focusing too much on one particular aspect at the expense of other services, services that may be a lifeline for an individual or a particular group, often results in the need for more costly interventions in the longer term.
Much attention has recently been given to dementia, but Hafal is working with its friends Bipolar UK, Diverse Cymru and Crossroads Care Mid & West Wales to draw attention to the challenges faced by people with a serious mental illness such as schizophrenia and bipolar disorder when they enter old age. Is this something that you welcome, and can you suggest how they might ensure that this group of clients is given more attention?
I very much welcome this as there is often a perception that serious mental illness only affects younger people. In order to challenge this perception, it is essential to not only raise awareness amongst those who work with and for older people about the scale and impact of mental illness among older age groups, but to also work with the media to ensure that the language and imagery used around mental illness reflects the fact it affects people of all ages, something that will help to challenge perceptions more widely across society.
It is also essential that policy and decision makers hear and respond to the voices and experiences of older people living with mental illness so they are not overlooked as initiatives and potential sources of support are developed.
In your response to the Together for Mental Health Delivery Plan (April 2016) you note that there are a number of transitions that older people may experience where additional support may be beneficial. What kinds of support should be provided, and how can we prevent people ‘falling between cracks’?
The additional support needs to focus on ensuring that services are accessible, relevant and effective for older people, whose needs are often not fully considered as services are developed due to the kinds of perceptions described above.
In order to ensure that fewer people ‘fall between the cracks’, there must be a better coordinated and more joined-up approach across our public services, as well as strong partnership working between the Welsh Government, Local Authorities, Local Health Boards and other key stakeholders. This should be supported by Well-being of Future Generations (Wales) Act, which will encourage public services to work together with a greater focus on outcomes for an individual.
I recently issued Guidance to Public Services Boards in Wales who are required, under the Act, to publish local well-being plans. In this Guidance, I was clear that the Boards need to address the main critiques of public services by older people, which include ‘Why didn’t anyone tell me?’, ‘Why don’t people talk to one another?’, and ‘Why does it take a crisis for things to change?’. Addressing these will also play a role in ensuring that older people can get the help they need, when they need it, and that they are less likely to ‘fall between the cracks’ between services.
The Together for Mental Health strategy explicitly marks an end to age-specific policy on mental health. How do we ensure it is properly implemented?
Older people, like any other age groups, are not a homogenous group and are diverse in terms of their backgrounds, needs, circumstances and aspirations.
In order to ensure that the assumptions that are often made on the basis of a person’s age do not restrict their access to mental health services, it is essential that services become truly person-centred, focusing on the needs of each individual and working with them to develop a personalised care, treatment and support plan.
Many of Hafal’s clients feel that they have tended to drift away from mental health services as they have become older, often because it is assumed that older people’s services will provide them with what they need. How can we prevent this disengagement?
Once again, it’s about challenging people’s assumptions. For example, those providing mental health services must ensure that they engage with those providing services for older people and provide information and resources so it’s clear that an individual’s age will not preclude them from a service they are referred to.
Similarly, those providing services for older people must ensure that they understand the support available for their clients with mental health problems so they are able to signpost or refer them to the most appropriate service that will deliver the best outcomes for an individual.
As I mentioned above, the information and resources published about mental health services should also ensure that they do not use language and/or imagery that may exclude older people or give older people the impression that a service is not relevant or available to them.
How do we deal with the lower expectations for recovery from mental illness which many services have for older people – and which older people sometimes have themselves?
Last year, as part of my ‘Say No to Ageism’ campaign, I highlighted the ways in which older people are often treated differently because of their age and the impact of stereotypes around ageing, which can lower people’s expectations and the expectations of those providing treatment and support, particularly in a health context. Many of the older people I’ve met with have told me that medical professionals are still comfortable saying to patients things along the lines of ‘What do you expect at your age?’.
If you look at cancer treatment, there has been a significant and welcome shift in attitudes, with a greater focus on patient outcomes rather than arbitrary barriers such as an individual’s age, which means that more older people than ever before are now receiving effective treatments.
This kind of shift is needed across a wide range of other services, including mental health services, and a positive step forward would be to see more older people represented in campaigns, training materials and other resources to make clear the fact that recovery is possible at all stages of the life course.
You have highlighted how loneliness and isolation is an issue for older people; our own research has shown that for older people with a mental illness and their carers, it is an area of particular concern. How should services and society tackle this?
Loneliness and isolation has been exacerbated in recent years due to the closure or reduced provision of key services – such as day centres, public transport, libraries and public toilets – that allow them to remain connected to their communities and the support networks that have a positive impact upon their health and wellbeing.
Whilst the strong emphasis on loneliness in the new Together for Mental Health Delivery Plan is welcomed, along with the Welsh Government commitment to develop a national strategy to address loneliness, loneliness must be recognised as a key public health issue so that it can be properly addressed. This will be difficult, however – due to the fact you can’t catch loneliness, it doesn’t get the recognition it deserves.
Due to the importance of tackling loneliness and isolation, it is one of the priorities of the Ageing Well in Wales programme, the national partnership programme, to improve the health and wellbeing of people aged 50+ in Wales. Ageing Well brings together key partners in this area, including the British Red Cross, Age Cymru, Royal Voluntary Service, the Centre for Ageing and Dementia Research and the Campaign to End Loneliness, to develop collaborative efforts to tackle loneliness and isolation across Wales.
How do we deal with the problem of older people with serious mental illnesses such as schizophrenia and bipolar disorder approaching old age and losing their elderly parents and carers when they have been the main or sole providers of support, advocacy and social contact for many years?
This is likely to be a growing problem in the years ahead so it is vital that individuals and their carers are aware of their rights under the Social Services and Well-being (Wales) Act so that they can engage with social services at an early stage to ensure that their care and support needs can be planned for both the short and longer term.
Ensuring that older people’s right to independent professional advocacy is upheld will also be more important than ever to ensure that those who need it have someone to represent their interests. As I mentioned above, I will be starting a piece of work in the New Year looking at access to and experiences of advocacy, which will include access to Independent Mental Health Advocates (IMHAs) and Independent Mental Capacity Advocates as the roles of these professionals are often misunderstood by our public services.
There is a need for wider understanding about the importance of advocacy in all its forms to address the shortcomings in this area, alongside a need to engage with individuals who may be affected by the loss of their parents and carers to ensure that their voice is heard and that they receive the support and guidance that they need at what will be a very difficult time.
For more information on the work of the Older People’s Commissioner for Wales visit: www.olderpeoplewales.com
Matthew Pearce, Head of Communications