Steve Davies
National 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?
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"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?
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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?
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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.”
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(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
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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
(Laidlaw et al, 2003)
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!