Open Letter to encourage referrals to NHS Psychological Therapy Services

To: General Practitioners

One in five over-65s living in the community are affected by depression but, despite Improving Access to Psychological Therapies (IAPT) services being open to all adults, older people are underrepresented amongst those accessing services.

According to NHS figures only 6.4% of people referred to NHS psychological therapies were over 65 despite making up 18% of the population. Research also shows that older people were 6 times more likely to be on medication to treat their mental or emotional problem compared to other age groups.  

Older people with depression and anxiety usually experience more physical symptoms – such as tiredness, weight loss and problems sleeping, which is why treating mental illness is as important in older people as treating physical illness – and it can be treated just as successfully. Evidence shows that older people who are referred to IAPT are as likely to benefit from the service as younger age groups.    

Depression and anxiety in later life, especially over the age of 65, are often dismissed as a normal part of ageing. While there are often personal or even physical barriers which can prevent older people from accessing IAPT services, the figures above suggest that there are also inequalities in referrals to those services.

Although IAPT services are treating more older people for depression and anxiety than ever before, evidence suggests that their access to talking therapy is not progressing fast enough.

The Long Term Plan has committed the NHS to ensuring that by 2023/24, an additional 380,000 adults and older adults will be able to access IAPT services, taking the total to 1.9m per year. As part of a wider drive to address inequalities in access to mental health care, the NHS Long Term Plan will help local areas further improve older people’s access to IAPT services, including older carers, people living with dementia and frailty, and those living in care homes.

In support of these ambitions, Age UK is working with NHS England to raise awareness of mental health needs in older people and the services that could help them, including talking therapies.  

This is a great opportunity for GPs and primary care staff. The expansion and availability of IAPT services for adults and older adults can indeed help reduce the pressure on GP practices by ensuring that older people with common mental health problems – who are likely to present frequently to GP practices – get the mental health care they need.

As part of this, we are calling on health care professionals/GPs to:

• Start the conversation about depression and anxiety with the older people you see

• Think twice before offering medication to treat depression and anxiety in older people as a first-line treatment option,

• And, refer more older people to NHS psychological therapy services without age restrictions.

Yours sincerely,

Caroline Abrahams, Charity Director Age UK

Alistair Burns, National Clinical Director for Dementia and Older People's Mental Health at NHS England and NHS Improvement