Mo Ray

Challenges and Opportunities

We have attempted to highlight, in this book, the significant improvement in the provision of mental health services for older people which has been achieved through changes in legislation, policy and practice. Despite many drivers for change, there is still evidence that older people feel that mental health problems are stigmatising and they experience discrimination when attempting to access care. We discuss the recent policy directives which highlight these inequalities and make suggestions for improving care, including offering more acceptable interventions to older people with mental health problems, and working more closely with the third sector to provide such services. We mention the specific needs of older people in care homes. We highlight the need to promote good mental health across the life course and emphasise the importance of mental health promotion.

Person-centred care and dementia

Person-centred approaches in dementia, based on the concept of personhood, have undoubtedly provided a fulcrum to challenging and changing traditional approaches to dementia care. Over the past two decades, there has been a significant growth in awareness of dementia and a developing discourse on the potential to fundamentally change the experience of living with dementia. The growing visibility and voice of people living with dementia has offered an important challenge to the systematic marginalisation and invisibility that has long been a characteristic experience. There have been some real achievements in changing awareness, attitude and approaches to the care and support of people living with dementia, and arguably, a more positive view of dementia has been achieved. The message that it is possible to ‘live well’ with dementia is included at least in its general message, in the national dementia strategy for England. Yet, it is evident that structural, social and interpersonal factors continue to negatively impact on and shape the lived experience of people with dementia. This chapter argues that despite the fundamentally important role that person-centred approaches have played, and will doubtlessly continue to play, it is inevitably limited in addressing structural and social processes which influence the experience of living with dementia.

Mum and Me, a Journey with Dementia: A Personal Reflection

This chapter is a personal reflection of a daughter’s experience of supporting and caring for her mother, who was diagnosed with vascular dementia and Alzheimer’s disease in 2008. As well as reflecting on the past 8 years, this chapter aims to increase awareness of the experience of living with and caring for someone with dementia. This chapter also highlights the importance of dementia care being integrated and coordinated throughout a person’s journey in dementia.

Policy Context for Mental Health and Older People

The ‘problem’ of old age dominated post-war old age policy and practice, and for years after its abolition in 1948, the Poor Law continued to exert a considerable influence on progress in policy and practice. Expectations about the care of older people were low, fuelled by assumptions of inevitable decline, and institutional care continued to be the assumed means by which formal care was provided. Mental health services continued to be dogged by low expectations and the marginalisation both of older people with mental health problems and gerontological mental health services. Since the 1980’s there has been a significant growth in the development of policy which has in turn led to improvement in services. This chapter reviews key mental health and ageing policy and argues that while there is evidence of positive change and improvement, significant areas of development remain.

Creativity and the Arts for Older People Living with Depression

The right to participate in cultural life and enjoy the arts is enshrined in Article 27 of the 1948, Universal Declaration of Human Rights. In a contemporary context, there is an appreciation that the arts and creative activities can support the development and maintenance of good mental health across the life course. Policies in each of the devolved nations recognise the positive role of culture and the arts in the lives of its citizens and the part that it plays in supporting vibrant and creative communities. More recently, arts and creativity as non-pharmacological interventions in the treatment and management of mental health conditions has received considerable attention. The Department of Health and Arts Council England, for example, has highlighted that the arts have an important role to play in the delivery of health care, in promoting social wellbeing and in delivering demonstrable benefits across the life course against a wide range of health priorities. Arguably, older people have been at the vanguard of community arts and crafts through their leadership and participation in the many voluntary organisations, such as the Women’s Institute (WI), which exist at least in part, to support and encourage such activities. However, the involvement of older people in participatory arts in the form of community projects or as interventions in the support, management and treatment of mental or physical health needs has traditionally been less visible.

Ageing in Urban Environments: Challenges and Opportunities for a Critical Social Work Practice

Ageing and urbanisation are now identified as significant social trends affecting life in the twenty-first century (Buffel et al. Journal of Aging and Social Policy, 26, 52–72, 2012). By 2030, at least one quarter of urban populations will be aged 60 and over, with significant implications for urban planning and development. Increasingly, cities will need to balance their role as drivers of economic development with responsibilities for improving the quality of life of their older residents. Urban environments produce particular stressors and constraints on older people. At the same time, older people bring advantages to urban areas. There are hazards and risks as well as benefits and opportunities for them (see Buffel et al. Journal of Aging and Social Policy, 26, 52–72, 2012). After contextualising the issues and considering major initiatives such as Age Friendly Cities, this chapter considers the role and contribution of social work in developments such as age friendly cities. It makes comparison with other such initiatives cross-nationally in demonstrating the notion of active citizenship, participation and involvement for older people. It considers how social work responses will need to change to respond to the phenomenon of ageing cities.