Response 70003172

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Age Scotland

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1. Our framework sets out 8 priorities for a new Mental Health Strategy that we think will transform mental health in Scotland over 10 years. Are these the most important priorities?

If no, what priorities do you think will deliver this transformation?
Age Scotland welcomes the opportunity to respond to the consultation on the Scottish Government’s new mental health strategy. Our aspiration is for all older people to love later life and to encourage healthy active ageing, including promoting good mental health. Age Scotland welcomes the government’s proposal for a 10-year plan. We believe that now is the time for bold and ambitious transformational change for Scotland’s mental health services. The strategy should be outcome and recovery driven with clear and deliverable year-on-year milestones. We believe that progress should be monitored through yearly reporting. A steering group comprising third sector organisations, the NHS, the Scottish Government and key stakeholders could be set up to monitor and review progress.

2. The table in Annex A sets out a number of early actions that we think will support improvements for mental health.

Are there any other actions that you think we need to take to improve mental health in Scotland?
Loneliness and isolation We support the 8 priorities which have been set out in the strategy and welcome the specific strand on Ageing Well. Mental health problems can affect people at any stage of their lives, perhaps for the first time in later life. Loneliness and isolation for example can lead to depression or anxiety. Life experiences such as retirement, physical impairment or bereavement can have a significant impact on a person’s mental wellbeing. The strategy would benefit from additional measures to address these issues as well as placing an emphasis on the needs to support carers. 100,000 older Scots feel lonely all or most of the time, and one in six people aged 75 and above haven’t spoken to their family, friends or neighbours in a week. Chronic loneliness affects mental, physical and emotional health – doubling your risk of developing dementia, and being as bad for you as a fifteen-a-day smoking habit. While Age Scotland would support the emphasis on self-maintenance and support from link workers, the Charity is conscious that while direct support in the home or with a link worker is important, support given in a group environment is also beneficial in tackling loneliness. Early Prevention and Intervention We agree with the Scottish Government’s emphasis on prevention and early intervention - though it must be stressed that this approach should be taken throughout a person’s life. We welcome the emphasis placed tackling inequalities outlined in the priorities for the strategy and believe this should be an important aspect of the ‘Age Well’ priority. We also believe embedding a human rights based approach will help address inequalities and aid the ambition of a transformative approach to services. It’s important that older people are aware, for example, of the advocacy services that are available to them, so that their voice is heard and they have greater control over their lives. The focus on assisting people to find or remain in employment is important, and is a goal Age Scotland is pursuing to raise awareness of dementia in the workplace and supporting people with a diagnosis to remain in employment. Age Scotland acknowledges the emphasis on employment given the devolution of employability powers: Work Choice and Work Programme and the need to design better services that work for people. The strategy must however recognise that (i) many people with mental health problems cannot work and (ii) many are in retirement, and link workers should be available to these people as well. With regard to people who are retired, volunteering can encourage people to make an important contribution to society. It can empower individuals and should not be underestimated. We welcome the Scottish Government’s pledge to recruit 250 link workers to be based in GP surgeries but note that this would only cover around a quarter of surgeries across Scotland. We seek clarity about the precise role that link workers will play and which services they will be able to direct people towards. For people in work, we believe that in addition to the crucial anti-stigma drive, a range of support packages should be encouraged at the workplace as people transition, for example, into retirement. Employers could provide pre-retirement training, and support for people in circumstances where they are made redundant. Employers also have a role more broadly in providing support to help employees have good mental health. Dementia Point 8 of Annex A in the strategy states that by April 2017 the Scottish Government will begin a review of learning disability, autism and dementia in the definition of “mental disorder”. We believe this raises broader questions of where the focus of policy development for dementia sits. Dementia has its own national strategy, and policy making in other areas of health services beyond those for mental health are crucial to supporting the specific needs of people with dementia. Age Scotland, through the work of its Early Stage Dementia Project supported by the Life Changes Trust, was pleased to submit to the consultation on the third National Dementia Strategy to be published at the end of the year. The interim publication on the new dementia strategy includes giving primary care a greater role in diagnosis and support for people with dementia. We believe it would be beneficial for new thinking around where the focus should be within health services for the delivery of support for people with dementia to be complemented by consideration of how Government approaches policy development for dementia as well. A specific issue regarding mental health and dementia is depression as a risk factor for dementia. One study among older people found depression nearly doubled the risk of developing dementia, and it is important this issue is addressed through the mental health strategy. Service Reform Reforms to primary care present opportunities for integrated and holistic approaches to healthcare tying in physical health and mental health. It is crucial that older people have the same access to mental health services as any other group in society. Older people have expressed fears that the mental health services they receive, such as access to community psychiatric nurses, might stop when they reach a certain age. It’s crucial that services are available throughout a person’s life and are based on need. The strategy should also recognise that while mental health problems affect people of all ages, genders and demographics, research shows that areas of multiple deprivation are particularly at risk. These geographical and socio-economic disparities should be addressed. Age Scotland wants to see further progress in giving older people choice over their care through Self Directed Support, and the Charity believes it would be beneficial to consider how this approach could better support people in terms of their mental health needs. Access to services It’s important that older people benefit from a wide range of services and that a choice of treatment is available to them. Social prescribing should be made available for people of all ages and GPs should have updated information about what services are available locally, with the ALISS system fully up-to-date, as called for by the previous mental health strategy (2012-15). Age Scotland believes that the Scottish Government should undertake an impact assessment on the benefits and cost-effectiveness of social prescribing. We believe that community services can have a significant impact on a person’s mental health and in some cases help tackle loneliness and isolation. We believe that peer support services must be available for older people with mental health problems and we would like to see further proposals for these services in the finalised strategy. Individuals with a personal experience who are trained to support others on their journey to recovery is an invaluable resource that can boost a person’s confidence and help them build relationships. It is also an important intervention in tackling loneliness, as are support networks and drop-in facilities, as well as encouragement and help to participate in community activities. Age Scotland has engaged with the Age in Mind project and we have been aware of concerns of older people who have lived with mental health conditions throughout their life. Increased health care and improved medication have led to people with long term mental health needs living longer. Often these people are also experiencing high levels of co-morbid health needs. In 2014, the Charity engaged in a consultation with a group of older mental health service users. For most of their mental health journey, people had experienced specialised support systems (such as SAMH and NHS Health and associated support services), building up supportive networks which had enhanced their well-being. Many discussed their fears or experiences that on transfer from adult to older peoples’ health, social care and welfare systems they lose these support systems, and may not have access to anything other than non-specialist home care that does not meet all their needs. Concerns were raised about lack of continuity, and uncertainties of services dependent on annual funding decisions. These uncertainties were widely perceived to impact on mental health and wellbeing. At the time of the 2014 consultation there appeared to be few specific services designed to meet the needs of older people with complex enduring mental and physical health care needs, with established “working age” mental health support services aware of the need to develop to meet older people’s needs but not appearing to be resourced to do this work. It is vital these services are provided. Minority Groups LGBTI people and BME groups are at increased risk of loneliness and isolation and often face additional barriers to services. Work should be undertaken to determine how minority groups can be reached, working in partnership with third sector organisations and community groups. The future of our mental health services for older people We welcome the results of the actions set out in Annex A particularly with reference to improved access by older people to support for mental health problems, including access to psychological therapies, and people with mental health challenges living longer with improved quality of life. We share the ambition for services which help people live longer and promote good mental health in later lifer, and the contribution healthy active ageing can make to that. We want to see mental health services which are delivered in a way which recognises the impact loneliness can have on mental health and addresses the isolation too many older people face, particularly those who have had faced challenges with their mental health over many years. Our aspiration is for mental health services in a society where stigma about accessing these services has been successfully addressed and which meet the needs of the people who need to access them whatever their age.

3. The table in Annex A sets out some of the results we expect to see.

What do you want mental health services in Scotland to look like in 10 years' time?
Age Scotland is a national charity which represents Scotland’s older people, and their rights and interests. We aim to help all of Scotland’s people love later life. We believe that everyone should have the opportunity to make the most of later life, whatever their circumstances, wants and needs. That’s why we work to make later life the best it can be. We think Scotland can and should inspire, engage, enable and support older people to change their later lives for the better and ensure there is support for those who are struggling as they live longer to achieve better, happier and healthier lives. We work in partnership with other charities within the Age Network – Age UK, Age Cymru and Age NI – to pursue these aims across the UK.