Samaritans Awareness Day is on 24 July and the following day sees National Schizophrenia Awareness Day. These are two important days in the mental health and awareness calendar and come at a time when the issues of mental health and wellbeing are more prominent than ever.

Samaritans Awareness Day continues their focus on a campaign which has been running for 8 years. The ‘Talk To Us’ campaign aims to highlight the charity’s work and the help it can offer. With events being held throughout July by the Samaritans the aim is to highlight the organisation’s availability at any time of day or night to listen to anyone who is struggling to cope. According to Mind, one in every four people in the UK suffers from a mental health condition each year. Those who are experiencing challenges or discomfort have somewhere to turn in the Samaritans.

National Schizophrenia Awareness Day aims to shine a light on the everyday challenges the millions of people living with a diagnosis of schizophrenia face and how we can tackle the stigma and discrimination around it. It is estimated that one in 100 people will experience schizophrenia. Despite being so common, the stigma surrounding schizophrenia remains stubbornly high due to a lack of understanding.

‘Schizophrenia is a very complex condition that can affect how a person thinks, feels, and experiences the world around them. While the word is made up of schizo (to split) and phrene (the mind), schizophrenia does not mean split personality.

People with a diagnosis of schizophrenia can often experience very different symptoms, including audio hallucinations (hearing voices), delusions, disorganised thinking and changes in body language or emotions.’

I have written on a number of occasions about the challenges faced by individuals as they age with life enduring mental health conditions and the lack of support which is targeted at their particular needs. Far from the situation improving over the years I am afraid that the context today as we recognise these two significant mental health days is getting worse not better.

We are faced with some particular and escalating challenges, including increasing demand and resource constraints. It is a given though frequently comes as a shock to some that the population of Scotland is ageing. This means on a demographic level alone that this has led to a higher prevalence of mental health issues such as depression, anxiety, and dementia among older adults. Indeed, studies indicate that around 10-15% of older adults in Scotland experience depression, and a similar percentage suffer from anxiety. These conditions often go undiagnosed and untreated, as symptoms may be mistakenly attributed to aging or physical health problems. For regular readers you will see a resonance here with my last blog highlighting the rise of alcohol misuse amongst older Scots. Sadly we have also witnessed a concerning increase in the number of suicides among older men in particular. Although suicide rates are generally lower among older adults compared to younger age groups factors such as social isolation, chronic illness, and lack of support can contribute to this increased risk.

In addition, at the present time we are faced with not insignificant staffing shortages in mental health support organisations and amongst providers of social care and mental health support. This is all accentuated by the increasingly restricted resource many support services are working with because of underfunding or indeed because they have lost their funding.

And as if the demographic and practical support challenges were not hard enough, we still witness and have to live with enduring stigma. Regrettably mental health issues in older adults are frequently stigmatised, both within the community and among some healthcare providers. Older adults may feel ashamed or reluctant to seek help due to societal attitudes toward mental illness, particularly in older age groups.

As a result of the lack of specialist focus, lack of investment and stigma many of those working in the field who I speak to will argue that there is significant underdiagnosis. Symptoms of mental illness are still being mistaken for normal aging processes.

The mental health of older adults in Scotland is a complex and multifaceted issue that requires a coordinated and comprehensive holistic response involving all stakeholders including social care providers and families and those most impacted. These have to be approaches of care and support which meet the social, economic, housing and healthcare needs of older Scots.

Sadly, at the moment growing older with mental ill health in Scotland is an experience of isolation, despair and one where you feel you are simply not noticed, that your life does not matter. Just as I stated last week when I speak about alcohol harm, we urgently need all stakeholders to prioritise this harm and to do so in an inclusive prioritised manner.

There are many poets who have spoken about mental health struggles, but few have reflected on them as a lifelong experience into older and what ageing means for mental health. One who has is the late American poet Anne Sexton who wrote The Room of My Life:

Here,
in the room of my life
the objects keep changing.
Ashtrays to cry into,
the suffering brother of the wood walls,
the forty-eight keys of the typewriter
each an eyeball that is never shut,
the books, each a contestant in a beauty contest,
the black chair, a dog coffin made of Naugahyde,
the sockets on the wall
waiting like a cave of bees,
the gold rug
a conversation of heels and toes,
the fireplace
a knife waiting for someone to pick it up,
the sofa, exhausted with the exertion of a whore,
the phone
two flowers taking root in its crotch,
the doors
opening and closing like sea clams,
the lights
poking at me,
lighting up both the soil and the laugh.
The windows,
the starving windows
that drive the trees like nails into my heart.
Each day I feed the world out there
although birds explode
right and left.
I feed the world in here too,
offering the desk puppy biscuits.
However, nothing is just what it seems to be.
My objects dream and wear new costumes,
compelled to, it seems, by all the words in my hands
and the sea that bangs in my throat.

Anne Sexton. “The Room Of My Life.” Family Friend Poems, https://www.familyfriendpoems.com/poem/the-room-of-my-life-by-anne-sexton

Photo by Kristina Tripkovic on Unsplash

Donald Macaskill

It was Alcohol Awareness Week at the start of the month and during it I was reading some of the latest research and data on alcohol and older age in Scotland. It was both disturbing and yet sadly predictable.

Across Scotland today one of the hidden harms of alcohol is its impact on the lives of older Scots and their families and the relative lack of specialist social care provision to address that crisis. This growing issue is not only a personal tragedy for those affected but fractures too many families and communities. It is also a harm which as I’ve reflected upon last year in this blog space we still remain poor at calling it out and resourcing the change that’s needed.

Alcoholism among older adults is often overshadowed by other public health concerns. However, the statistics tell a worrying story.

Research indicates that alcohol misuse among those over 65 in Scotland is on the rise, exacerbated by factors such as loneliness, bereavement, and physical health problems. Unlike younger drinkers, older adults often face more severe health consequences from alcohol misuse, making early intervention and support crucial.

Health data indicates that a significant proportion of older adults consume alcohol regularly, with a notable segment drinking more than the recommended guidelines.

The 2022 Scottish Health Survey indicated that 24% of men and 13% of women aged 65-74 drink more than the recommended weekly alcohol limit (14 units per week). For those aged 75 and over, these figures are 16% for men and 8% for women.

In addition, data from the Information Services Division (ISD) Scotland reveals an increasing trend in alcohol-related hospital admissions among older adults. In the past decade, there has been a marked rise in admissions for alcohol-related conditions such as liver disease, falls, and cognitive impairment. ISD Scotland reported that in 2021, there were approximately 2,300 alcohol-related hospital admissions per 100,000 population for those aged 65 and over, a significant increase from previous years.

And further National Records of Scotland recorded 467 alcohol-specific deaths in 2022 among individuals aged 65 and over, an increase of 15% compared to 2021. Statistics show that individuals over 65 have higher alcohol-specific mortality rates compared to younger age groups, reflecting the severe health impacts of prolonged alcohol misuse.

Older adults struggling with alcoholism face a unique set of challenges. Physiologically, the aging body is less capable of metabolising alcohol, increasing vulnerability to its effects. This can lead to a range of health issues, including liver disease, cardiovascular problems, and cognitive decline. Moreover, alcohol can interact dangerously with medications commonly prescribed to older adults, compounding health risks.

Socially, older adults may experience isolation and loneliness, which can drive them to use alcohol as a coping mechanism. I’ve known too many times where the loss of a spouse, or retirement, or relocation has led to folks turning to the drink in older age. All this can sever social ties, leaving individuals even more vulnerable and the stigma associated with alcoholism can further isolate them, making it difficult to seek help.

The rise of alcoholism among older adults has profound implications for social care in Scotland. More and more frontline workers especially in homecare are telling of noticing an increase in alcohol addiction. They are often the first to notice the signs of alcohol misuse, such as frequent falls, memory lapses, or neglect of personal hygiene. However, recognising these signs can be challenging, as they are often attributed to aging itself rather than alcohol use.

Care providers face the complex task of managing the immediate health needs of these individuals while also addressing the underlying issue of alcoholism. This dual challenge requires a nuanced approach that combines clinical care with psychological and social support. In other words, the response has to have social care at its heart.

The data underscores the growing need for targeted interventions to address alcohol misuse among older adults. The current system is stretched to a point that it struggles with the majority and is failing to pick up this growing demographic and their acute needs.

Social care providers must be equipped with the knowledge and resources to identify and manage alcohol-related issues effectively. Investment at this level will support preventative work and will thus reduce the growing pressures on hospitals and residential care settings.

However, social care workers require specialised training to effectively support older adults with alcoholism. This includes understanding the signs of alcohol misuse, managing withdrawal symptoms, and providing compassionate, non-judgmental care. Without adequate training and resources, care providers will struggle to meet the complex needs of this population.

Addressing alcoholism among older adults in Scotland I believe requires a multifaceted approach, including:

Awareness and Education: raising awareness about the issue is the first step. This includes educating the public, care providers, and policymakers about the signs of alcohol misuse in older adults and the unique challenges they face.

 Integrated Care Models: developing integrated care models that combine medical, psychological, and social care support is essential. This holistic approach can ensure that older adults receive comprehensive care tailored to their specific needs.

Community Support: strengthening community support networks can help reduce isolation and provide older adults with the social connections they need to combat loneliness. Yet sadly we are cutting back and defunding these programmes at a time of real need and acuity. Community programmes that offer social activities, peer support, and outreach can play a crucial role in prevention and early intervention.

Policy and Funding: it’s perhaps stating the obvious but national and local government in Scotland must prioritise funding for programmes and models that address alcohol misuse among older adults. This includes investing in training for social care workers and expanding access to treatment and support services.

Alcoholism among older adults in Scotland is a pressing issue that demands our collective attention and action.

The data on alcohol misuse among those over 65 in Scotland paints a concerning picture of a hidden crisis that requires urgent attention. By acknowledging the prevalence and impact of this issue, we can better support our older population through targeted interventions, comprehensive care models, and robust community support. Addressing this challenge is not only a matter of health but also of dignity and quality of life for our older citizens.

It is a challenge that intersects with the very heart of social care, impacting both those who suffer from alcohol misuse and the professionals who support them.

Let us not turn a blind eye to this issue. Let us confront it with compassion, understanding, and a commitment to creating a social care system that supports every individual, at every stage of life.

Donald Macaskill

Photo by Thomas Picauly on Unsplash

Whether it’s Efcharisto, Danke, Gracias, Merci, Takk or simply thank you – wherever those who can and choose to travel or holiday this summer doubtless most of us will learn the basics of communication in the native language of the place we find ourselves in.

Saying thank you to show gratitude is an important part of etiquette in almost all cultures. Whilst manners might change and customs will divert there remains a truth that learning the vocabulary of gratitude is the first step to properly showing your appreciation in a new community.

I think the same can be said of the busy world of social care. Amidst the daily routines and pressing challenges, there lies a profound yet often overlooked practice: saying “thank you.” These two simple words carry immense weight, embodying gratitude and recognition, fostering a culture of appreciation that is vital for both care and support workers and those they support.

Saying thank you might sometimes feel like an afterthought, a perfunctory nod to social etiquette. Yet, these words carry an astonishing power. In my years of working in social care and beyond, I’ve seen firsthand the profound impact that genuine gratitude can have on individuals, relationships, and communities.

At its core, social care is about human connection. It’s about seeing the person behind the condition, label or stigma; it’s about understanding their stories, their struggles, and their triumphs. In such an environment, gratitude is more than just a courtesy; it is a cornerstone of human dignity and respect.

For social care workers, the role they play is both physically demanding and emotionally taxing. They provide support, comfort, and companionship to individuals who often face significant challenges.

This work can be deeply rewarding, yet it can also lead to burnout if not balanced with adequate support and recognition. The central focus of that recognition has to be the continued struggle to give people adequate terms and conditions – and I hope all governments and organisations will heed the criticality of improved pay for the social care workforce as the primary mark of saying thank you!

However wider acknowledgment of the work of a carer is crucial for individual mental health and job satisfaction.

The act of expressing thanks does not just benefit the recipient; it also positively affects the giver. Research shows that practicing gratitude can enhance well-being, reduce stress, and increase overall happiness. In a field as challenging as social care, where the emotional demands are high, cultivating gratitude can serve as a buffer against burnout and compassion fatigue. This is true at all levels of organisations and communities.

For gratitude is not just a social nicety; it is a fundamental human need. Philosophers, psychologists, and spiritual leaders have long extolled the virtues of gratitude, recognising it as a cornerstone of human well-being. Saying “thank you” acknowledges the efforts of others, affirming their value and fostering a sense of connection and mutual regard.

In social care, where the heart of the work lies in human connection, saying “thank you” is more than good manners—it’s a vital practice that sustains the spirit and dedication of caregivers. It strengthens relationships, builds trust, and fosters a culture of mutual respect and appreciation.

In our increasingly disconnected society, where digital interactions often replace face-to-face encounters, expressing thanks has never been more crucial. It bridges the gap between us, reminding us of our shared humanity and interdependence.

So I’m pleased that Thank You Day is returning tomorrow.

Thank You Day began with a handful of organisations looking for a way to enable us all to say a huge ‘thank you’ to everyone and everything that helped us through the COVID-19 pandemic.

Since then the campaign has grown to include hundreds of partners and over 20 million people have taken part in Thank You Day celebrations. Last year 74% of those who took part in a Thank You Day event said they felt a stronger sense of belonging to their local community as a result.

The celebrations this year are focusing on giving thanks to our local communities.

At their heart is the act of gratitude which creates and nurtures the wellbeing both of individuals and communities and not least those who require care and support.

Two simple words – thank you – a powerful act that can transform our interactions and relationships. It is a small gesture with a huge impact, fostering a culture of appreciation and respect.

I hope you have a summer where you are able to both receive and give thanks.

Donald Macaskill

I first knew Jane when we were both in our early twenties. She and her husband had just suffered a bereavement. Their little girl had contracted meningitis and had died within hours of reaching hospital. They were both devastated, searching for sense through the darkness of their despair; looking for any answer to the thousands of questions they had, all of their conversation tumbling out from their tears and sobs. I was there to listen and be present and to help them as much as I could.

I remember so many of those conversations with folks who had suffered the death of a child or baby – even if I’ve forgotten the names involved – or in truth I remember the feelings I was left with rather than the words. Feelings of utter uselessness in the presence of another’s brokenness.

I met Jane again years later and maybe understandably I didn’t recognise her at first. We had both changed, and we were not the people we were once. One thing she said though has stayed with me ever since. We talked about that first time we had met and about her little girl. Jane said to me “I’ve held her inside every step of the way.”

She told me of how it was really hard to go back home, the emptiness she felt and her desperation not to let go of anything belonging to her daughter – almost she said as if throwing anything away would be an act of betrayal. She told me how she’d visited the grave every day – how she just wanted to continue being a mum; she shared very openly about her attempts to hurt and harm herself because she simply wanted to be with her daughter.

All of this led to the breakdown of her marriage as her partner in her own words gave her ultimatum upon ultimatum as he tried ‘to drag her back into living.’

Then over time she said things started to change. Slowly at first – small steps but important ones. She started working again after 3 years; she began to go out and reconnect with friends; she reduced the time she spent at the grave and on some days chose not to go. She then after a while started dating and met someone.

As she told me of her marriage, of the birth of a son, of his first day at school, of his growing into a man and his graduation, after every story of her growing family and ageing self she said that at every moment of memory that she had held her wee girl inside her every step of the way.

I thought of Jane and her life of unforgetting love when I discovered that next Wednesday 3rd July that it is to be National Bereaved Parents Day.

The day was set up four years ago by the charity A Child of Mine, after they realised that there wasn’t a specific day that honoured bereaved parents from all walks of life. In their words:

‘National Bereaved Parents Day brings together anyone affected by the death of a child to show bereaved parents that they are not alone. This year’s theme is “Love Lives On”.

And how true that statement was and is for Jane.

Over the years I have been privileged to have spent time with people who have been bereaved and each and every encounter has been special. But I have found that the impact of the death of a child on parents has been one of the hardest of all experiences. It is a loss that lives with the parents throughout their time. It doesn’t diminish it just changes.

But what especially saddens me are the countless folks I have talked to in late and older age who are still mourning for a lost child or baby. It saddens me not because they are mourning or grieving but because in years gone by their loss was never validated, often ignored and rarely understood. Thankfully things have improved but I’m not wholly convinced that society doesn’t still expect us to speedily ‘ get over it.’ I’m not convinced that we are not still in a situation where it’s assumed that in your eighties or nineties that the grief for a child dead for decades should now be passed and forgotten. I’ve met too many in care home and community who have never had the chance to grieve and mourn, who have never been enabled to say a proper goodbye.

The death of a child remains with parents for ever – the love does not diminish. We all of us need to be much more aware and sensitive to the particular impacts of such bereavement. In fact in older age, it is often the case that parents may experience a resurgence of grief, particularly during milestones such as anniversaries or what would have been significant birthdays. As others see their children grow into adulthood and milestones like marriage or grandchildren arrive the painful longevity of grief touches ever sharper.

Older adults have often talked to me not least of the child who has died was an only child of how alone they feel as they age. Many older people as they age often face a shrinking social circle due to the deaths of peers or reduced mobility. But the absence of their child can amplify feelings of loneliness and isolation. Without their child to share memories with or support them, parents may struggle with a profound sense of emptiness.

I’d also want to highlight that parents can lose their child at any age and all that I’ve said about grief is as valid for the loss of an adult child as much as for a younger child. But added to the grieving is the possibility that if the deceased child had their own children, grandparents may take on the dual role of supporting their grandchildren while navigating their own grief. This responsibility can be emotionally and physically taxing, especially as they age, impacting their ability to cope and their overall well-being.

Every step of the way, every moment we age, every occasion and memento moment Jane and others will carry their child deep inside their heart. They will never be forgotten; the fracture will never truly heal. Love lives on even if its rhythm alters.

As a society I think we must do more to understand and acknowledge the particular aspects of losing a child at any age both for the parents and for others. We too need to find ways in which collectively and as communities we learn to carry the memory of those who are departed as we age together.

I leave you with a beautiful poem for all ages by the American animator and songwriter Rebecca Sugar called Time Adventure.

‘Time is an illusion that helps things make sense

So we are always living in the present tense

It seems unforgiving when a good thing ends

But you and I will always be back then

You and I will always be back then

If there was some amazing force outside of time

To take us back to where we were

And hang each moment up like pictures on the wall

Inside a billion tiny frames so that we could see it all, all, all

It would look like: will happen, happening, happened

Will happen, happening, happened

And there we are again and again

Cause you and I will always be back then

You and I will always be back then’

Donald Macaskill

Photo by Nick Fewings on Unsplash