Thursday coming is Time to Talk Day which offers an opportunity for people, organisations and communities to take time out to discuss mental health and to support each other.

The event takes place annually and is organised by a range of mental health organisations and charities across the United Kingdom making it one of the biggest mental health conversations.

Despite all the progress we have made as a society there is still a very real sense of stigma for some around mental health and so a day like Time to Talk carries a huge significance. You can find out more about the day and access resources via the Time to Talk website.

We all know that being encouraged to be open about how you are feeling, to talk about your health and well-being as it relates to your thoughts, feelings and emotions is extremely important. Therefore, creating spaces and places where folks can do so, facilitating an atmosphere where people will be valued and heard when they open up and share, fostering an attentiveness and appreciation amongst family, friends and community is essential.

Yet there are some for whom there are additional challenges who I think we need to increase our collective efforts to support. I’m thinking today of one group of people in particular- older people.

If there remains a societal taboo or discomfort around mental health in general, I think that is accentuated for older people. It is certainly the case that older people talk less openly about their mental health and well-being. Indeed, when I reflect on people of my parents’ generation, brought up as they were in a Hebridean and island culture, the very idea of talking about -even demonstrating – emotions, feelings and mental health seems anathema. They were a generation in large part – and I think this is evidenced in years of research – who were denied the emotional vocabulary and skills to both understand their mental health and to be able to communicate around thoughts and feelings. In no small part my own generation are the inheritors of attitudes and behaviours to mental health which have been hugely damaging and crippling of our own mental well-being.

Someone in their eighties who uses social care services and who is immensely articulate and astute on many issues of politics and on policy affecting social care was in touch with me over the last month or so about the state of social care. As we chatted and conversed not least about their own financial struggles in dealing with soaring energy costs as someone living on a fixed pension income – he began to share more of his own story with me. It became clear to me that here was an individual who was struggling with depression, very low moods and at times suicidal thoughts. But he was starting to talk and open up for the first time in a long time. It has taken immense courage and will on his part to do something about it and to seek professional support – but it all started with him talking and with a conversation however tangential to the issues which were really hurting him. But shamefully one of the very real challenges for his listener was to be able to signpost him too or direct him to someone or a group who were able to help him. Had he been under 25 I would not have had the same challenge even if waiting times might have been obscene.

Perhaps because of the pressures of the time I missed an excellent short report which came out a couple of months ago in November 2022. It is entitled ‘Older adults’ mental health before and during the COVID-19 pandemic: Evidence paper.’ Whilst the title might not grab it is a very insightful description of older person mental health challenges – which also serves to illustrate the paucity of similar exploration in this field. I’m less concerned with the focus on Covid though that is not unimportant but what struck me most was some of the analysis and key findings. Its conclusions are very similar to a report written in 2017 long before Covid. In it countless frontline carers were interviewed and told both myself and other researchers about the hidden hurt of unaddressed mental health issues amongst those older people receiving social care in the community and in care homes. That report was called ‘Fragile Foundations: Exploring the mental health of the social care workforce and the people they support.’

Five years later in 2022 the latest report articulating as it does so many of the same messages highlights not only the shameful absence of research and studies on this population group but also the lack of any tangible progress or ability to learn lessons. It’s almost as if older age mental health matters less than the mental health struggles of others. As it states:

‘There is currently a lack of evidence relating to older adults’ mental health, particularly relating to LGBTI identities, ethnic and religious backgrounds, caring responsibilities and finances and deprivation. There is also little evidence specifically concerning non-statutory mental health services.’

There is a glaring gap in the mental health provision for older Scots and this is wholly unacceptable and damaging. We need to be much more proactive as a society in not only encouraging people regardless of age to talk openly about their mental health but to have avenues and supports to take those conversations should it be necessary.

For too long we have I think deluded ourselves – in part because of a lack of transparent evidence to the contrary in assuming that there are not significant mental health challenges amongst older people. As the latest report states:

‘Older adults appear to report better mental health outcomes than younger adults; however, this might reflect that they are less likely to report poor mental health, particularly due to more stigmatising views of mental health amongst older people and reliance on self-reported data. Findings also indicate that age-related stigma affects older adults in various ways, such as how they are treated in mental health services and how they engage with these services (e.g., not accessing services due to not wanting to be a burden).’

There is also a joint articulation in the report five years ago and the latest one when it warns us that we should avoid viewing older adults as a homogenous group and that there are very real differences in mental well-being between older adults of different ages (e.g., 65-69 and 75+) as well as in gender and whether they lived alone or not. It also underlined the critical importance of avoiding the pitfall of assuming that all older age mental health was about dementia or delirium:

‘A clear distinction should be made between dementia and mental health, particularly in older adulthood. Evidence indicates that an older adults’ mental health issues might be neglected if they are diagnosed with dementia. Mixed wards (i.e., patients with dementia, mental health issues or both) are viewed as detrimental for older adults with mental health issues. Without making a clear distinction between these, a clearer understanding of each is impeded.’

To put it mildly it is disappointing in the extreme that so little has changed in older person mental health provision in Scotland in this period of time including as the latest report states ‘including the varied approach to older adults transitioning from adult to older adult services and the low availability and quality of services.’

Talking as an older person or indeed at any age finding the courage to talk about mental health is not easy the least society and our political leadership can do is to listen with sufficient depth so that we create supports and services that can respond to mental health issues regardless of age.

The young Punjab born Canadian poet Rupi Kaur puts the balance of commitment well in an unnamed poem. From her book The Sun and Her Flowers:

when the world comes crashing at your feet

it’s okay to let others

help pick up the pieces

if we’re present to take part in your happiness

when your circumstances are great

we are more than capable

of sharing your pain

Donald Macaskill

There are many reasons for the current pressures being faced by our NHS and I have rehearsed those at some length in the weeks and months that have passed. This week I want to acknowledge the truth that if we were as a whole society to focus more sharply upon dementia and our response to that most pernicious condition then we would go a long way to addressing some of our NHS and social care crisis. I’ve had three dementia ‘prompts’ this past week which highlight for me the criticality of dementia.

I am focussing on dementia today in part because it is the Race Against Dementia Day. Race Against Dementia is a charity founded by Sir Jackie Stewart in 2016 to raise awareness and funds to enhance research and the development of a cure or treatment for dementia. It was created by Sir Jackie after his wife Lady Helen developed frontotemporal dementia and utilises the spirit and strategic thinking of Formula One to focus on this goal. The charity aims on Race Against Dementia Day to raise £127,000 and reminds us that 1 in 3 people born today will die of dementia unless we find a cure or treatment. It points out that that is the equivalent of 127,000 babies born in the UK every day and the goal is to raise £1 for each of these babies.

I was reminded of this urgent need to raise funds to promote research and the search for a cure earlier this week when I watched Kate Lee CEO from Alzheimer Society on BBC Breakfast television. In her interview she argued that dementia research which is the UKs number one killer is being neglected. On the back of a letter signed by 36,000 people Ms Lee called on the UK Government to honour its election commitments. She called for “a massive reform of social care, a visionary 10-year plan for dementia, and the National Dementia Mission funding to unlock treatments for people now and in the future”. Now whilst things are different in Scotland the challenge of under-funded research, patchy access and post-diagnostic support, and a lack of consistent and coherent vision around dementia is still the case.

My third dementia prompt this week was the chance with colleagues to meet Sophie Fraser from Alzheimer Scotland’s Brain Scotland work and to hear about the amazing work they are undertaking to increase awareness of dementia amongst children and young people and to explore ways in which inter-generational work between the care sector and children and young people can advance this work. More to come on that but you should catch their amazing video which communicates the preventative message so well at – https://www.youtube.com/watch?v=FjDAggnowz8

All of the above dementia prompts link directly into what I have been spending so much time working on in the last few weeks. I know for a fact that a disproportionate number of those who are ending up in our accident and emergency departments are older people many of whom are living with dementia. If we were able to have an adequately resourced social care system which was able to be less reactive and more formative and preventative in its delivery, then many of those individuals would not require hospitalisation or would not require it as frequently. But the truth is that despite the Herculean efforts of professional frontline social care colleagues we are only playing lip service to the priority which dementia should be for our society. We could do so much more with a dementia strategy in action which enabled every frontline social carer to be trained and equipped to the highest possible level of confidence and skill in supporting someone with dementia. The social care sector both in care home and community is crying out for resource to enable frontline staff to build on the existing innovative tools and techniques which help someone remain independent, which slow the progression of the disease, and which maximise the potential and creativity of an individual.

Alongside this I’ve been having conversations this past week which have highlighted for me just how perilous our existing social care dementia response is – never mind what we might want or should be doing to enhance existing practice. The vast majority of people who are living today with dementia are supported primarily by family carers and friends. Unpaid carers in Scotland are on the margins of notice and public importance yet their criticality cannot be over-emphasised. But they are, many of them, on their knees with exhaustion, a lack of support and resource, and lack of opportunity to have respite and take a break. Tens of thousands of people have taken the really hard decision to end their employment in order to look after a loved one and the lack of focussed support for them in that decision, especially when the supported person has dementia, is truly shameful. Our failure to care and support unpaid carers has an immediate impact on our stretched NHS and social care. Attending to system and service delivery without an equal focus on unpaid carers is folly.

At the same time many of us are deeply concerned about the potential savage cuts which are facing community based, third-sector and charitable organisations in our local communities. Faced with really difficult decisions local authorities are withdrawing funding from many projects which keep older people independent. The experience of Food Train in Glasgow which faces the real risk of closure as a result of the loss of funding is illustrative of what the umbrella body the Scottish Council for Voluntary Services warns is facing many charities across the country. It should be obvious that the loss of support organisations for older people in the community will in the medium-term result in more burden on an already creaking health and social care system. Decisions made today will result in people unnecessarily requiring care and support tomorrow and I fear that there will be a disproportionate affect upon our older age population.

Dementia cure is one that we are all seeking to work towards, to fundraise for and to struggle in a race to achieve. But alongside this we need to fight for a re-conception of priorities perhaps especially at times of fiscal restriction. A public health approach to dealing with dementia requires a focus not solely on prevention and cure though these are critical but upon the adequacy of treatment and support in our community. Dementia remains a major killer in our society but does it really receive the prioritised focus that it requires?