steve davies national clinical advisor for older people going for a walk later: older people,...
TRANSCRIPT
Steve DaviesNational Clinical Advisor for Older People
Going for a walk later: Older People, Ageism, CBT and the real language of
IAPT access
Access: The Holy Grail?
• "Old man!"• "I'm 37, I'm not old."• "well, I can't just call you man, can I?"• "You could call me Dennis"• "I didn't know you were called Dennis."• "Well, you didn't bother to find out, did
you?"
What is the psychological IMPACT of ageing?
• Losses and gains or just losses?• A time for universal marble loss?• A time for realistic depression?• Daytime TV, bowels and tepid tea?• Ill, in a home, alone, poor support
What other impacts are there?
• Retirement• Grandparenthood• Money • Friends, Family and remembering• Culture and Country• Illness• Dementia
Freud puts his foot in it at 48
• “The age of patients has this much importance in determining their fitness for psycho-analytic treatment, on the one hand, near or above the age of 50 the elasticity of the mental processes, on which the treatment depends, is as a rule lacking – old people are no longer educable – and, on the other hand, the mass of material to be dealt with would prolong the duration of treatment indefinitely.”
• (Knight in Woods, 1999).
A More Helpful Psychological Model?
• KNIGHT’S MATURITY-SPECIFIC CHALLENGE MODEL
• Some things have come with us across the lifespan - Maturity Issues (e.g. abuse)
• Some issues represent the Specific Challenges of being older (e.g. illness)
• Successful psychological ageing involves the balancing of both of the above
So What is our Problem?
• Age-related Access Inequality
• “Realistic” Depression
• Therapeutic nihilism
• Self-stigmatisation
AGEISM, what Ageism?
• Ageism is still overt despite the Act
• Age is stigmatised in Society
• Older people are heterogeneous
• INSTITUTIONAL AGEISM is the problem
Institutional Racism
• “Institutional racism has been defined as those established laws, customs and practices which systemically reflect and produce racial inequalities in society. If racist consequences accrue to institutional laws, customs or practices, the institution is racist whether or not the individuals maintaining those practices have racial intentions”. (Stephen Lawrence
Enquiry report, 6.30, para 2)).
Some Insights from Institutional Racism (Ridley, 1995)
• INTENTIONS are not an accurate gauge for measuring the impact of discrimination
• It is in the eye of the BEHOLDER
• Mistaken GOOD WILL can exacerbate discrimination
COMMON FACTORS IN DISCRIMINATION (Oakley, 2000)
• Identity is constructed and changes • People don’t define themselves willingly as
part of a powerless group• Collective, unthinking prejudice is as
problematic as overt discrimination• Self-stigmatisation is common
Changing Ageist Outcomes
• Making Ageism unthinkable as well as illegal
• Reducing self-stigmatisation
• Raising Consciousness in older people
• Follow the Social Gerontologist
Late Life Psychological vulnerabilities (Specific Challenges)
• Physical Disability
• Loneliness
• Bereavement
• Cognitive Impairment
CBT for Older People (Laidlaw et al, 2003)
• Rates of recovery are GOOD • Better outcomes related to: • (a) Interdisciplinary working • (b) cognitive assessment • (c) age differences • (d) effective socialisation• (e) resistance • (f) working alliance
IAPT, CBT and Older People
• Most Older People use Primary Care
• BUT access is low
• Particularly difficult to reach in low income areas
• Access tools to find out
IAPT OLDER PEOPLE POSITIVE PRACTICE GUIDE (DH 2009)
Understand the need
Remove the barriers
Engage the Client group
Train the Workforce
Remove the Barriers
• Social Isolation
• Self-Stigmatisation
• Institutional Ageism in health
Train the Workforce
• Anti-Discriminatory Training
• Lifespan Development Training
• Develop a SIG base
What about Access?
• There is a Access Tool?!?
• The work of Steve Boddington
• And there is a Score?!?!?!
• Accessing the National and the Local
The Access Tool Project
• A Three IAPT site pilot of Tool usage
• Liverpool City, Wirral and South Essex
• Two Stage Assessment
• Qualitative view on Tool acceptability
Two Stage Assessment
• Brief User satisfaction questionnaire of Workers in all three services using Survey Monkey
• Focus groups in each service to develop themes of Survey and identify qualitative experience of this form of improving access
Conclusions
• What is being older nowadays?
• The problem of Ageism
• The radical call to action of CBT
• The difference that accessible IAPT could make
Stuff the walk! Let's go for a run, Forrest!
