More than a number

Malky was waiting in line in the bank when he experienced his first panic attack.

“Everything was going great. I ran my own successful landscape gardening firm and I said to the guys one day, ‘I’ll nip up the bank and get money for the materials and I’ll be back in half an hour.’ When I went into the bank there was an old lady in front of me who was taking her time. And then I started to feel unwell. By the time I got to the teller, I was really, really ill. The girl behind the till said, ‘Are you OK?’ I told her I didn’t feel well and she went and got me water and the next thing I knew two policemen walked in and asked me if I was OK. I said, ‘No’. They asked me, ‘What do you think is wrong?’ And I said, ‘It’s all in my head.’ I thought it was a brain tumour.”

Malky received treatment for anxiety and says a team of “first rate” doctors, psychologists, and Community Psychiatric Nurses (CPN) worked hard to help him gradually regain the confidence to go outside again after he initially shut himself away.

“Then one day I went into the Dunrowan (day hospital) and said, ‘Good morning. I’m the big 65 today!’ And the reply was, ‘Good morning and good bye. We can’t do anything more for you’.”

Malky’s transition from adult to older people’s mental health services was far from smooth and he says the support he was offered was “chalk and cheese” from the “10/10” adult services he had experienced. On one occasion a psychiatrist he had been referred to took out his badminton racket during their first appointment and started to restring it, telling Malky, with his eyes focused on his sporting task rather than his patient, that he had an important game that night and Malky should just carry on talking. Another time he was referred to a new self-help group where within a few minutes he realised that everyone there was not only significantly older than him, but also had dementia.

Disillusioned, Malky stopped pushing for services with his GP. Instead, he lent harder on his family and sought out his own ways of coping. The manager of the local Caledonia Clubhouse was a psychiatric nurse and whenever he called asking for five minutes, Malky says she gave him half an hour. However, when she retired he recognised he needed secure help and tentatively returned to his GP.

Now, he is happily settled with a new CPN and psychiatrist. However, he points out that he went six years without formal help and argues that those approaching their 65th birthday shouldn’t have to worry that they will find themselves cut off.

At 72, Malky is now one of the ambassadors for the recently formed Falkirk Seniors’ Group, which is open to older people from Falkirk who have functional mental health problems and those who care for them. Eddie Kelly, Service Users and Carers Development Worker, FDAMH, argues the group, which is financially supported by the Falkirk Change Fund Partnership Innovation Fund, couldn’t have come at a more crucial time.

“What’s happening at present is there is so much change going on with the new mental health strategy coming in and with the integration agenda, and we want the ambassadors to be placed at the heart of the redesigning of all of these. So older people can tell them the services they want, where they want them and when they want them.”

Eight months on, and the group has been making its voice heard by contributing to strategies, the Care Inspectorate Involving People Group, and Scottish Government consultations. And recently Kelly and other members of the group also presented their story to a meeting of the Scottish Parliament’s Cross- Party Group on Mental Health.

Its convener, Labour MSP Malcolm Chisholm, explains it is an issue the group felt deserved to have the spotlight turned on it.

“I think it is generally recognised that it is an area of services that has been underdeveloped, if not ignored. I think, quite rightly, there has been a lot of focus on dementia. But I think other aspects of mental health among older people have been ignored.”

However, when Chisholm and fellow CPG member Dr Richard Simpson raised the issue during the recent parliamentary debate on Scotland’s new mental health strategy, Public Health Minister Michael Matheson — who visited the Falkirk group as a local MSP earlier this year — praised Kelly as a “passionate advocate of the need to improve services for older people with mental health problems”. And added that with the group in his constituency, “there is no way that a strategy for which I am responsible would not recognise that issue”.

Indeed, specific commitments to older people were included in the final version of the strategy.

“The mental health of older people is a priority within the Mental Health Strategy. More than any other group, older people are less likely to have mental illness such as depression and anxiety diagnosed and less likely to receive treatment, although data shows that this is improving,” Matheson told Holyrood.

“As part of the work to support improved access to psychological therapies and delivery of the HEAT target for access to psychological therapies which covers all ages, the Scottish Government established a working group to focus on the needs of older people. The group reported in December 2011 making recommendations for service development for older adults. The report identified the need to make improvements across the system, from highly specialist therapeutic approaches to better community and self-help that support and maintain people’s wellbeing in later life.

“We are working with NHS boards and their statutory and voluntary sector partners to take forward the recommendations of the report as part of the integration agenda, and develop outcome measures related to older people’s mental health.”

Chisholm says he was pleased to see a specific section on older people included in the strategy:

“I think there is an obvious gap in terms of services for older people and, to be fair, the Government has recognised that in its strategy. So we were just keen to find out more about the problems that existed in order to feed that into the policy process.”

However, Charlie McMillan, director of operations, SAMH, argues there are also wider points around ageism and stigma that urgently need to be addressed.

“There is almost a mythology grown up around growing old that you are going to feel lonely and depressed and isolated and those are accepted norms of getting older.”

He worries that this in turn may leave older people suffering in silence as the stigma prevents them from asking for the help they desperately need.

“I think there is loads more that could be done in terms of mental health promotion aspects for people who are older because I do also think stigma among older people could be an even more significant issue — that whole generational issue about if you have a problem you don’t talk about it; particularly if it is a mental health problem. So, I think we probably,culturally, need to encourage older people to talk as freely as they can about their emotions and wellbeing and mental health.”

And while there has, rightly, been a strong focus on the transition between child and adult mental health services in recent years, McMillan argues that that transition is difficult at any age and so more support is required.

“I think at any point in your life where you may see services moving it is really critical that we make sure that it is seamless, because there is such a danger of people falling between the cracks and issues not being picked up on, or not translating forward into the new services.”

The seniors’ group would also like to see a greater emphasis on preparing older people for that transition. But Malky also questions why, when he had built up relationships with the professionals working with him, his age rather than his need determined that this should stop.

“I just wonder why I couldn’t see the same CPN. Why I couldn’t have seen the same psychiatrist as I did when I was under 65? Why, because I became a certain age, should all that stop? If I was diagnosed with cancer the day before I was 65, or had a heart attack, would that help have stopped? No. So why is it because it is a mental illness that that help stops?”

He continues: “Mental illness to a person like me, and many others, is just as important as having a heart attack. I was a very active person. I was in the army for four years. I worked all my life and all of a sudden you have this mental illness — panic attacks and anxiety and no one is helping you. And then you get a fool who has not got any time for you; his game of badminton was more important than me jumping in the canal. And that is how bad it got at one time.”

He expresses his gratitude to his family and the seniors’ group, which he credits for saving him.

“Imagine yourself in a light raft in the middle of the ocean and you see a boat coming towards you. That is what I took the seniors’ group to be: a boat coming to save me. Because I was bobbing about and no one was there to help.”

And he is hopeful that by uniting their voices the group can help others in the same situation to get the help they need.

“I think we are like a wee snowball on the top of the hill. We are getting bigger and bigger. So look out, here we come!"