Are older people being denied access to mental health care?

All mental health services across the UK are under strain, with rising demand from all generations. But a couple of recent reports suggest that access to mental health care is even harder for older people, leading to accusations of ageism.

Depression affects 22% of men and 28% of women aged over 65 in England, but 85% of older people with depression are said to get no help at all, according to data from BACP, the leading professional body for counsellors and psychotherapists. BACP has now made it a strategic priority for the organisation to push for access to therapy for our ageing population.

Other evidence from a study at Plymouth University found that the percentage of patients referred to NHS therapy services reduced significantly reduced with age: from 23% of people aged 20-24 to a mere 6% for those between 70 and 74.

Yet the Plymouth study, led by Professor Richard Byng, shows that older people are actually more likely than younger ones to turn up for therapy sessions and then to benefit from them in terms of their recovery rates.

Maybe doctors need to check any tendency to assume that being miserable is part of getting old and be more alert to signs of real depression and anxiety in older people presenting in their surgeries.

My experience as a Hastings counsellor tends to support these findings. Many clients of all ages can find it difficult to engage with therapy to start with, but it does tend to be the older ones who stick with the process and then come to benefit from being able to talk openly and confidentially to an independent professional. And it tends to be the older clients who are able to work on the existential issues which can often underlie the more obvious issues of depression, anxiety or anger.

Are men more likely to experience work-related mental health problems?

Mind, the leading mental health charity, has just reported on survey indicating that men are twice as likely to have mental health problems due to their job, compared to problems outside of work.

One in three men (32%) attribute poor mental health to their job. That’s more than double the men (14%) who say it’s problems outside of work. Women, on the other hand, say that their job and problems outside of work are equal contributing factors; one in five women say that their job is the reason for their poor mental health, the same as those who say problems outside of work is to blame (19%)

These figures come from Mind’s survey research comes from a survey of 15,000 employees across 30 organisations.

The data also show that men are less prepared to seek help and take time off than women. While nearly two in five women feel the culture in their organisation makes it possible to speak openly about their mental health problems, fewer than one in three men say the same. More than two in five women have taken time off for poor mental health at some point in their career, but this is true for fewer than one in three men.

This suggests that although men are more likely to have mental health problems because of their job, women are more likely to open up and seek support from their line manager or employer. Previous Mind research suggests that men often try to find ways of dealing with their problems independently rather than reaching out and sharing their problems. Instead of talking about their problems, men prefer to watch TV, exercise or self-medicate, such as drink alcohol.

The findings show a difference in how men and women feel they’re being supported in the workplace. While nearly three in five women feel their manager regularly checks in on how they are feeling, only half of men feel the same.

 Emma Mamo, Head of Workplace Wellbeing at Mind, said: “Our research shows that work is the main factor causing men poor mental health, above problems outside work. Many men work in industries where a macho culture prevails or where a competitive environment may exist which prevents them from feeling able to be open. It is concerning that so many men find themselves unable to speak to their bosses about the impact that work is having on their wellbeing and even more worrying that they are then not asking to take time off when they need it. Our research shows that the majority of managers feel confident in supporting employees with mental health problems, but they can only offer extra support if they’re aware there is a problem”.

“In the last few years, we’ve seen employers come on leaps and bounds when it comes to tackling stress and supporting the mental wellbeing of their staff, including those with a diagnosed mental health problem. However, there is more to do and employers do need to recognise the different approaches they may need to adopt in how they address mental health in the workplace”.

There is much in the data from Mind which I would recognise from my work as a therapist, counselling in Hastings in East Sussex. But I also have noticed in recent years that whatever the source of their emotional issues, men are increasingly likely to seek professional help. I hope that this marks a long-term trend in our society, so that men are less likely to view their problems through the bottom of a beer glass, to resort to uncontrolled anger to relieve their feelings, or to use other socially dysfunctional outlets.






Choosing treatment for depression and anxiety

Anti-depressants do have their place in treating depression. But my experience as a Hastings counsellor is that many people are reluctant to start taking medication if other choices are available.

However, the evidence suggests that anti-depressants are sometimes the only choice offered and that the increasing rate of prescribing them is faster than the increased rate of depression. These conclusions come in a report by the OECD, a research body for the leading developed countries.  ‘Health at a Glance’ indicates that the use of antidepressants has increased significantly in most countries surveyed since 2000.

The report points out that one explanation includes the extension of indicators of some anti-depressants to milder forms of depression, anxiety disorders and phobias. But other research suggests that worldwide rates of depression have not increased in step, although depression is being diagnosed more in certain countries.  It appears that anti-depressants are being prescribed more frequently, but for milder conditions which weren’t previously thought to need them.

If anti-depressants always worked all the time, with no side effects, this wouldn’t be a problem. But they don’t work for everyone and some people are troubled by side-effects.

Anti-depressants are better regarded as part of an overall plan for dealing with the issues troubling us. The natural partner for medication can often to be talking therapies such as counselling.

This can give us the chance to really explore the underlying causes of depression – as well as anxiety, anger, and relationship problems. Once we understand why we feel or behave the way we do we have a better chance to make better choices for the future, freed of some of the burdens of the past.

As a fully qualified counsellor and an accredited member of BACP, I have substantial experience in working with clients who want to work through their depression or other issues in this way. I am able to offer a safe, accessible and personalized approach to client issues for people in the Hastings area.

Can bad relationships break hearts in Hastings? Counselling might help

People in unhappy marriages are at a much higher risk for heart disease than people in satisfactory relationships, according to recent research from the US.

A study reported in the Journal of Health and Social Behavior reported that married people seem healthier because marriage may promote health. But it’s not that every marriage is better than none; the research shows that the quality of marriage is really important.

The report, one of the first to take a fully representative sample of adults and examine the impact of marriage quality on heart health over time, showed that the negative effect on cardiovascular health was even more pronounced for women and older adults.

The researchers looked at five years of data taken from 1,200 adults in their late 50s to 80s, and examined their heart health, measured by factors such as heart attacks, strokes and cholesterol levels. They then compared heart health to how these adults said they felt about their marriages. Wives and husbands (who were not married to each other) answered questions about how close they felt to their spouses, how happy their marriages were, and how demanding and critical they felt their spouses were.

Both negative and positive marital qualities were taken into account because as the researchers said “Some people really love each other and have a lot of happiness, but at other times they may have a lot of arguments”. But the bad was more powerful than the good; they found that negative marital qualities hurt a spouse’s heart health more than positive qualities helped.

Being in an unhappy marriage can cause stress, which has a direct link with cardiovascular health. And those effects accumulate over time, which might explain why it’s stronger for older people, as the body “remembers” the effect. Such marriages can also push people toward unhealthy and harmful habits, like drinking a lot or smoking.

Speculating about why is it that women were hurt even more by unhappiness in a marriage, the researchers wondered whether women were more likely to internalize their feelings, feel depressed and be more sensitive than the men in their relationships. They also found that when women were sick with heart disease, it lowered the quality of a marriage, but not when men were sick. The report suggested that it might be because women are more likely to serve in a caregiver role for their sick husbands and be more sensitive to not exacerbating stress, but husbands may not be as sensitive about the relationship when their wives are sick.

As a therapist counselling in Hastings, I am able to offer counselling on relationship issues, either to individual clients or to couples. And I am always alert to the possibilities that the bodily problems which clients might describe actually have emotional roots.

Can too much Facebook bring on anxiety and depression?

Browsing Facebook has become a daily activity for hundreds of millions of people. Because so many people engage with the website daily, researchers are interested in how emotionally involved Facebook users can be with the social networking site and how regular use can affect their mental health.

Now, researchers at the University of Missouri have found that Facebook use can lead to symptoms of depression if the social networking site triggers feelings of envy among its users. Professor Margaret Duffy says that how Facebook users use the site makes a difference in how they respond to it.

“Facebook can be a fun and healthy activity if users take advantage of the site to stay connected with family and old friends and to share interesting and important aspects of their lives,” she said. “However, if Facebook is used to see how well an acquaintance is doing financially or how happy an old friend is in his relationship—things that cause envy among users—use of the site can lead to feelings of depression.”

In the study, the researchers surveyed young Facebook users and found that some of those who engage in “surveillance use” of Facebook also experience symptoms of depression, while those who use the site simply to stay connected do not suffer negative effects. Surveillance use of Facebook occurs when users browse the website to see how their friends are doing compared with their own lives. The researchers found that Facebook postings about things such as expensive holidays, new houses or cars, or happy relationships can evoke feelings of envy among surveillance users. They say that these feelings of envy can then lead to Facebook users experiencing symptoms of depression.

The researchers found that if Facebook users experience envy of the activities and lifestyles of their friends on Facebook, they are much more likely to report feelings of depression. The risk comes when Facebook is used as a way to compare up our own accomplishments against others; it can then have a negative effect.

The study found that, while Facebook can exert positive effects on well-being, but it can also trigger envy among users. Users need to realise that positive self-presentation is an important motivation in using social media, so it is to be expected that many users would only post positive things about themselves.

As a counsellor in Hastings, I often find that social media are now complicating the personal relationships of clients. The instant availability of Facebook, texting and tweeting means that people give themselves little time to process what someone might have said to them electronically, leading to automatic negative thoughts.


Counselling for work-related stress in Hastings

Employees are experiencing high levels of stress, yet many still feel unable to tell their bosses that this is the reason for taking sick leave.

A survey commissioned by the charity Mind, show that staff are experiencing high levels of stress. Over half of those surveyed (56 per cent) said they found work very or fairly stressful, more so than debt or financial problems (38 per cent), health (29 per cent), or relationships (20 per cent). These findings tie in with my own practical experience when working with stressed clients as a counsellor in Hastings.

The survey found that workplace stress is impacting on other areas of people’s lives. One in five said it had put a strain on their marriage or relationship with significant other, while 11% had missed important events such as birthdays or weddings. Stress was also having a physical impact, with 53% agreeing that it affected their sleep, 22% their appetite, and more than a quarter their physical health.   The poll also highlighted some common sources of stress at work. Frequently cited factors deemed very or fairly stressful included excessive workload (52 per cent), frustration with poor management (54 per cent), not enough support from managers (47 per cent), threat of redundancy (27 per cent) and unrealistic targets (45 per cent). In times of stress, many people are resorting to unhealthy coping strategies, such as drink and smoking.

The research also revealed that mental health at work is still a taboo. Nearly a third of respondents said they wouldn’t be able to talk openly with their line manager if they were stressed. Of the 14% of respondents who had a diagnosed mental health problem, only 45% had told their current employer.

Despite the high prevalence of stress at work, staff still don’t feel comfortable telling their employer if stress has caused them to take time off work. Of those who said they’d taken time off sick with stress, just 5% said the main reason they gave their employer was that they were too stressed to work.

As a practising therapist in Hastings, I am concerned not just about the scale of stress at work, but also that people don’t feel supported to help cope with that stress. Some employers are starting to take the issue more seriously, but where people are concerned about talking to their managers, the safety of the counselling room might offer the best place to start to deal with the problems of stress.

Could a counsellor help me?

Would seeing a counsellor help me? Probably, yes. And almost certainly at some point in your life.

Counselling is about change, and there are always things in our lives, feelings and relationships which we would like to be different for us. Seeing a counsellor can provide us with the space, time and security to talk about the stuff which might be affecting us. And talking in this way can help to facilitate the change which we want to make.

In that sense, counselling, as a talking therapy, can be a liberating experience, enabling us to be freer of the past. By helping us to understand how our past experiences have shaped our current behaviour and feelings, counselling can put us in a better place to choose how we want to live our lives differently for the future.

Most often, clients start to see a therapist because a particular problem has occurred in the past. Talking to family and friends might not be doing the trick. They may be well-meaning, but they won’t be independent and impartial in the way a counsellor will be.

That problem is often about loss in some form or another: for example, divorce, redundancy, failing health, empty nest syndrome, or of course actual bereavement. A weekly session with a counsellor gives us a safe place and an opportunity to look at the whole mix of feelings that losses of this sort can throw up for us before they tip us over into depression or anxiety.

Other clients can come to counselling with specific issues which they want to address. They might want to look at a pattern of failed relationships.  They might be worried that , for some reason, their low self-confidence is holding them back from what they want to achieve in life.  Or the stress of work is getting too much to handle on their own.

Others find that their anger is getting in the way of forming happy relationships: exploring the pattern of anger in their lives by therapy with a counsellor can help to give them a better chance to handle angry feelings in a less destructive way.

It can take courage to start counselling, to talk about difficult feelings to someone who starts off as a complete stranger. The early stages of counselling can throw up strong emotions, ones which we have consciously or unconsciously hidden behind our defences: drink or other addictions, repetitive patterns of behaviour, eating disorders, or just a stiff upper lip.

Counselling can’t offer a magic wand to wave away the issues which might be troubling us. But it can offer a chance to make changes in our lives, based on a better awareness of where we have come from and where we might go in the future.

As a fully qualified counsellor working in the Hastings area of East Sussex, I have substantial experience in helping clients who want to talk about the issues mentioned above.  If you feel that I might be able to help you to get past the problems which stand between you and a better life, please contact me for a free introductory session.


From the savannah to Sussex: dealing with anxiety

There is no long-term future on the African savannah for the complacent impala. As the take-away meal of choice for a wide range of hungry predators, the impala has much to be anxious about. If it is not alert to its dangerous environment it won’t survive the night.

Some anxiety is a natural part of our lives as well. It is part of being human. Anxiety helps us to survive too: we live in an uncertain world, even if it isn’t normally as dangerous as that of the impala. We cannot control all the events in our lives, or the actions of other people. So, we shouldn’t expect to be able to abolish anxiety entirely.

But as a counsellor and therapist in Hastings, Sussex, I often meet clients where anxiety has reached levels which get in the way of their lives.

High levels of anxiety can be prompted by the sense of loss which we all experience in our lives: bereavement, divorce, redundancy, ill-health, loss of youth and so on. Or extreme anxiety might be induced by the trauma of abuse, accidents or other searing life experiences as we grow up.

Anxiety at this level can be very distressing. So the temptation, often unconsciously, is to create defences against that anxiety – to take the edge off it so that we can try to continue to function. The defences then can give us the feeling of some control in our lives. Alcohol and drugs might provide some defence by anaesthetising the pain of anxiety.

For other people, phobias, eating disorders, avoidance and obsessive behaviour become their defences because they give an illusion of control. Even depression, dreadful though it is, can be seen for some people as a defence against experiencing the full pain of anxiety.

But what starts unconsciously as a defence risks becoming a bigger problem. Alcohol and drugs can become addictive. Phobias, eating disorders, and obsessions aimed at controlling events get in the way of normal living, jobs and relationships.

Counsellors have the experience to help clients explore what their defences really mean. Ultimately, most of the anxieties we all experience come from only a few existential sources: death, freedom, isolation and meaninglessness. If clients can be helped to understand and reframe their anxieties in these terms through counselling, they should have a chance to survive for longer and more happily than the average impala.


The truth about eating disorders for older women

Mention anorexia or bulimia and most people will immediately think of teenagers, and probably of teenage girls.

But new research shows eating disorders such as these are secretly blighting the lives of a large number of older women, perhaps 3% of them. That apparently small percentage translates into hundreds, if not thousands, of women across East Sussex.

The research study, led by Radha Kothari of University College London, suggest that many cases of eating disorder have their origins in childhood problems.

Of these older women, less than a third had asked a doctor for help. Indeed, many told the researchers that the study was the first time they had spoken about their troubles.

“Individuals with eating disorders can be unlikely to seek help, often due to feelings of shame and fear of being stigmatised,” Dr Kothari, said. “Therefore their prevalence at all ages may be higher than we think.

“This may be more the case for older adults than children and adolescents, whose parents and teachers may encourage them to seek help.

These findings led the scientists to suggest that doctors and psychiatrists needed to be on the lookout for mid-life eating problems.

According to the study, it was striking that so many cases appeared to have been heavily influenced by the women’s early lives, with many reporting that they had had unhappy childhoods or seen their parents split up while they were young. Those who had suffered sexual abuse as children were also disproportionately likely to struggle with binge-eating, bulimia and other difficulties with food much later.

The data which Dr Kothari and his team examined on women in the west of England suggested that some15% had faced an eating disorder at some point in their lives, and 3.6% had had one in the previous 12 months. Detailed interviews with 1,000 of the women suggested that the most common condition was binge-eating. Although most of the recent eating disorder cases had long histories, two out of five had begun in later adulthood.

Women who were strongly attuned to the feelings of others seemed to be particularly at risk, with their odds of having an eating disorder rising by 19 per cent for every extra point on their “interpersonal sensitivity” scores.

The scientists said that neglectful or “over-protective” parenting seemed to have inculcated body image problems and perhaps low self-esteem in many women. Adversities in early life seemed to lie behind psychological problems several decades later. Anorexia, bulimia, binge-eating and purging disorder were all associated with childhood unhappiness Parental separation or divorce during childhood seemed to increase the risk of bulimia, binge-eating disorder and atypical anorexia. The death of a carer could increase the likelihood of purging disorder, and sexual abuse during childhood, or a fear of social rejection, was associated with all eating disorders.

Christopher Fairburn, a professor of psychiatry at Oxford University, who was not involved in the research, said “We knew this for teenagers, but this is the first data we’ve seen across this wide age group,” he said. “These women should know that a large proportion of them can be helped and that they are not alone or unusual.

“Forty to 50 per cent of women with anorexia can be cured completely, and the cure rate is as high as 60 to 70 per cent in women with bulimia nervosa or binge-eating disorder.”

Many counsellors in the Hastings area have experience in working with eating disorders and would be able to use this experience to help sufferers from these disorders to overcome them.