A commentary on recent research and media reports by David Jolley, a member of the Christians on Ageing Executive Committee and, formerly, holding senior positions in the study of Old Age Psychiatry at Wolverhampton and Manchester Universities.
A response from Dr Susan M Benbow firstname.lastname@example.org
I have read David Jolley’s blog with interest and, whilst I agree with a lot of what he says, there are a few areas where I would respectfully disagree. But I should declare an interest – I am a UKCP registered family and systemic therapist.
David writes that “the implication within this systematic review that talking therapy alone is preferable to the prescription of antidepressants is worrying.”
Does he think that talking therapies don’t help older people with depression and anxiety disorders? Evidence shows that psychological therapies are as effective for older people as for people of working age. The recent Improving Access to Psychological Therapies (IAPT) manual says that “IAPT provides evidence-based psychological therapies for mild, moderate and severe depression and anxiety disorders where a uni-professional approach with or without concurrent medication management, usually by a GP, is appropriate.” So these aren’t people with the very severe depressive illnesses who are treated in secondary care services. And talking treatment is acknowledged to be compatible with anti-depressant drug treatment.
It’s good to remember that IAPT services were originally aimed at working aged adults with depression and anxiety disorders, with the main thrust being to try to get people back into work. Later the IAPT initiative extended to include treatment of older adults, but the proportion of older people (65 plus) referred to IAPT services is lower than the proportion of older people in the general population. Why should that be the case? Might therapeutic nihilism be operating here? There is data showing that more people aged over 65 referred to IAPT services complete treatment than working aged adults referred to IAPT (42% compared with 37% in figures from 2014-15) and the older adults are more likely to achieve “reliable recovery” than working aged adults (56% compared with 42%). (I can’t find any more up to date figures unfortunately.)
So yes, it is my view that older adults should be able to access IAPT and other talking therapies, just as they should be able to access treatment with anti-depressant drugs or the combination of the two when indicated. And I’ve seen the evidence – talking treatments work!
Susan M Benbow
AND a further response from David Jolley:
It is good to receive Professor Benbow’s comments. We are at one in believing that depression is an important and usually treatable condition when it occurs in older people. We are together in observing that both antidepressants and psychological approaches have benefits, sometimes in combination. In this we are at odds with Rachel Frost and colleagues who would deny the efficacy of antidepressants and favour only talking therapies provided by specialist (IAPT) services.
I would not deny that IAPTs can provide good therapy but I do believe that much good can be done, and is being done, by regular clinical staff who know their patients – The problem I have with specialist facilities in general is that they ‘can foster the belief that others can do nothing worthwhile.’ This erodes clinical confidence, deskills people, undermines trust between patient and their doctor or nurse, generates waiting lists and increases costs. This belief applies to the care and treatment of people of all ages. So we are together again in speaking to equality of access to appropriate services across the age bands.
A recent ‘long read’ contribution in The Guardian explores reflections on the availability of legal access to euthanasia in a growing number of countries. The subject is headlined: Death on Demand: Has euthanasia gone too far?
National attitudes to death
On our News page there is a report about an initiative earlier in 2018 by Co-op Funeralcare: the provision of low-cost funerals which involve no mourners and no ceremony. The Co-op announced that it would be conducting a nationwide survey of British attitudes towards death. The results of the survey have been published as ‘Making peace with death’ and can be read here. The Co-op says that over 30,000 responses were received although this figure is amended in the formal reference to the size of the sample (22664 adults 16+). The survey (which was conducted on-line) covered basic attitudes towards the death of others as well as the ways people thought about their own mortality. The main finding is that the majority of people find the whole subject of death very difficult and find themselves inadequate in the face of bereavement. Additionally, the lack of preparation for death is startling, including the making of a will (only 27% it is suggested). The word ‘taboo’ is used in the findings as a general description of the British attitude towards death. No one really likes talking about it and will go to great lengths to avoid having to deal with any aspect of it. The questions asked are not listed and, therefore, it is not possible to compare the enquiries with the answers.
One of the significant features of the survey results is the almost complete absence of any mention of religious faith or affiliation. There is a single reference, in a section about making funeral plans, to the influence religion might have had in prompting making a plan (9% said it did). Other than that, nothing. It is understandable that a commercial organisation with a very big interest in funerals should concentrate its effort on those matters which affect its own business planning, but to ignore the place that religious faith might have in people’s thinking and practice does raise a number of questions. Did the survey deliberately exclude any enquiry about the effect of faith on attitudes to death and bereavement, or was it just not remembered? If it was deliberate, why? If it was just forgotten, is this a reflection of the entirely secular purpose and approach of the survey, or symptomatic of a wider ignorance of the role of faith in people’s lives?
In the Press Release issued at the time of the announcement of this survey, Christians on Ageingsuggested that it was time for the Churches (as well as other faith communities) to confront the avoidance of death in our culture and bring discussion about dying and bereavement back into the land of the living. The results of this survey make that task more urgent. One of the main responses recorded in the survey was that people ‘didn’t know what to say or do’ when dealing with death and the care of those left grieving. The Church of Jesus Christ has got the words and knows what to do.
Christians on Ageing will continue to explore this issue. Our booklet on ‘Dying and Death’: what have Christians to say to secular society?’ is still available from our Bookstore.
You might like to read a recent review of ‘Terminal Illness’, by Drs Elizabeth Toy, Catherine O’Neill and Sarah Jackson, Redemptorist Publications.