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Social Work Assessing the Mental Health Needs of Older People
by
Nadira Sharif
  • LAST REVIEWED: 06 May 2015
  • LAST MODIFIED: 25 May 2011
  • DOI: 10.1093/obo/9780195389678-0064

Introduction

This bibliography identifies resources that provide a general introduction to the mental health of older people and assessment of mental health needs within social work settings. Reference is also made to various mental health conditions, including dementia and depression, the two major conditions affecting older people. This bibliography takes a holistic approach to mental health by not only focusing on mental illness but also encompassing well-being to reflect increasing international awareness of the significance of well-being as part of a comprehensive approach to improving mental health. Conceptual frameworks for mental health and well-being need to consider inherent cultural assumptions. The World Health Organization states in a universal definition that mental health is not just about the absence of mental illness, but “...a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community” (see Introductory Works). Mental well-being is related to good physical health and is fundamental to a person’s quality of life. Its benefits extend beyond the individual to include families and wider society. Social work assessments of older people should facilitate the early detection and management of mental health conditions so that eligible individuals, if they wish, can be referred to a range of services, from low-level preventive provision to more specialized intervention for severe cases of mental illness. However, in both health and social care settings, assessments often fail to recognize the mental health needs of older people, especially where these needs are less severe, hence the importance of encouraging user-led assessment.

Introductory Works

The tendency for research, policy, and practice has been to compartmentalize work on mental health and on older people or to focus only on specific illnesses such as dementia or depression, rather than adopting a more holistic approach that encompasses well-being. However, in recent years the importance of promoting well-being has gained increasing recognition in the international and national discourse about mental health (World Health Organization 2007) and Klausner and Alexopoulos 1999 predicted that psychosocial interventions would acquire a progressively more important role alongside traditional medical interventions. Cattan and Tilford 2006 and Cattan 2009 examine the meaning of mental health, mental illness, and mental health promotion and the challenges in using chronological age in debates about mental health. McInnis-Dittrich 2005 provides an invaluable introduction to the biopsychosocial changes related to ageing, the role of social work with older people, assessment, and problem solving interventions. Berkman and D’Ambruoso 2006 highlights that social work, health care and ageing are often treated as separate entities, but in fact social workers deal with the latter two areas as part of their day-to-day practice.

  • Berkman, Barbara, and Sarah D’Ambruoso, eds. 2006. Handbook of social work in health and aging. New York: Oxford Univ. Press.

    DOI: 10.1093/acprof:oso/9780195173727.001.0001Save Citation »Export Citation »E-mail Citation »

    Drawing on international examples, this invaluable reference is the first to integrate the fields of health care and aging. It includes separate chapters on assessment, the mental health of older people, and social work practice in different settings. The comprehensive nature of this book makes it a highly recommended text.

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  • Cattan, Mima, ed. 2009. Mental health and well-being in later life. Maidenhead, UK: Open Univ. Press.

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    This key text takes a holistic approach to the mental health and well-being issues that affect older people.

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  • Cattan, Mima, and Sylvia Tilford, eds. 2006. Mental health promotion: A lifespan approach. Berkshire, UK: Open Univ. Press.

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    This highly recommended textbook provides a clear and coherent overview of mental health promotion for all age groups, with a separate chapter dedicated to older people.

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  • Finch, Jenny. 2004. Evaluating Mental Health Services for Older People. Oxford: Radcliffe Publishing.

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    Drawing on international examples from the United States, Canada, Australia, and Europe, this book comprehensively charts the developments in older people’s mental health services and highlights various models of evaluation.

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  • Herrman, Helen, Shekhar Saxena, and Rob Moodie. 2005. Promoting Mental Health: Concepts, Emerging Evidence, Practice. Geneva: World Health Organization.

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    This report explores the promotion of mental health and the available evidence on the effectiveness of interventions, while drawing implications for public health policy and practice.

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  • Klausner, Ellen J., and George S. Alexopoulos. 1999. “The Future of Psychosocial Treatments for Elderly Patients.” Psychiatric Services. 50.9: 1198-1204.

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    This paper reviews the evidence on the use of psychosocial interventions with older patients and proposes that these types of support will become an increasingly significant part of the practice of treating older people with psychiatric conditions.

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    • McInnis-Dittrich, Kathleen. 2005. Social Work with Elders: A Biopsychosocial Approach to Assessment and Intervention. Boston: Pearson.

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      This invaluable book includes material on biological changes and physical well-being; the impact of psychosocial approaches; assessment; and solution-focused interventions.

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    • World Health Organization. 2007. Improving the mental health of the population: Can the European Union help?. 14th Report of Session 2006–2007. London: Stationery Office.

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      The 2005 WHO conference on mental health problems across Europe produced a declaration acknowledging the fundamental role of mental health and mental well-being to individuals, families, communities, and nations. This led to the publication of the European Commission Green Paper “Improving the mental health of the population: Towards a strategy on mental health for the European Union” in October 2005. This report synthesizes the evidence relating to the Green Paper.

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      Journals

      There is an increasing number of peer reviewed and professional journals featuring articles on mental health and well-being in later life. Most are published both in print and electronically. The Journal of Gerontological Social Work is the only journal with a focus on social work and older people. Some journals focus on specific conditions (see the Journal of Dementia Care) or specific fields (see the International Journal of Geriatric Psychiatry), while others, such as Ageing and Society and Quality in Ageing in Older Adults, have a broader remit. The majority of journal websites have search facilities enabling readers to search for all articles it has published on a particular theme or by a specific author. The list in this section is not exhaustive but also includes key UK and international journals such as Aging and Mental Health, which has a particular emphasis on the psychosocial aspects of ageing, and Health and Social Care in the Community and the Journal of Gerontology Series, which both include research, policy, and practice issues for a multi-disciplinary audience.

      • Journal of Dementia Care.

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        Aimed primarily at professionals who work with people with dementia, this multidisciplinary journal is focused on improving quality of care across a range of different settings, including hospitals and nursing homes. It is also a useful resource for students with an interest in dementia issues.

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        • Aging and Mental Health.

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          This internationally distinguished journal leads the field in knowledge on the association between aging and mental health. This includes coverage of the link between mental health and normal and pathological aging, as well as social, psychological, and psychiatric issues. The readership is multidisciplinary, with psychiatrists and psychologists making up the majority of its contributors.

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          • Ageing and Society.

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            This interdisciplinary and international journal concerns ageing in the context of the social and cultural backgrounds of older people. Popular with readers with a background in clinical medicine, humanities, and social sciences, the journal also publishes book reviews, occasional review articles, and special issues.

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            • Health & Social Care in the Community.

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              This international peer-reviewed journal addresses policy and practice issues for a health and social-care readership, including nurses, social workers, physiotherapists, general practitioners, primary health care workers, and social care researchers.

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              • International Journal of Geriatric Psychiatry

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                This journal disseminates research findings on the causes, treatment and care of mental health problems which affect older people and is aimed at a multi-disciplinary audience including psychiatrists, psychologists and social scientists.

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                • Journal of Gerontological Social Work.

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                  Primarily aimed at a US audience, this peer-reviewed journal is the only social work journal specifically devoted to social work with older people. It covers a diverse range of settings and issues, including social work in nursing homes and hospitals and mental health services for older people, as well as crisis intervention, and law and gerontological social work.

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                  • Journals of Gerontology Series.

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                    Among the first journals on aging to be published, the Journals of Gerontology started life in 1946 as the Journal of Gerontology. Today the journals are published as two separate publications, each consisting of two parts. The first publication, the Journals of Gerontology Series A consists of the Journal of Gerontology: Biological Sciences and the Journal of Gerontology: Medical Sciences. The second publication, the Journals of Gerontology Series B, consists of the Journal of Gerontology: Psychological Sciences and the Journal of Gerontology: Social Sciences. Both these journals are a valuable resource for a multidisciplinary audience including health and social care practitioners, researchers, and other academics.

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                    • Quality in Ageing and Older Adults.

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                      The focus of this highly recommended journal is on enhancing quality of life in older people. Targeted at a multidisciplinary audience including health and social care practitioners, researchers, academic institutions, service users, carers, and students, this journal aims to illustrate best practice through cutting-edge research results and reports.

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                      Reference Resources

                      The following websites provide links to useful material on mental health, well-being, and the assessment of older people’s mental health needs. Their audiences include health and social care professionals, older people, and their carers. The Mental Health Foundation, Alzheimer’s Society and Alzheimer’s Association websites include research specific to mental health and dementia. Joseph Rowntree Foundation’s website covers broad social care issues including mental health, while the Department of Health website also includes policy material relevant to England. From a US perspective, the Centers for Disease Control and Prevention website, which includes the Healthy Aging Program, also provides resources on mental health. Social Care Online, the United Kingdom’s most extensive database of social care information, includes material on older people, assessment, mental health and well-being. The Cochrane Collaboration and the Campbell Collaboration publishes systematic reviews in health care and social care interventions respectively.

                      The UK Inquiry into Mental Health and Well-Being in Later Life

                      This initiative led by Age Concern (now Age UK) and the Mental Health Foundation was established in 2003 to raise awareness, develop an evidence base, and influence policy and practice on older people’s mental health and well-being. Godfrey et al. 2005 and Seymour and Gale 2004 describe the impact of mental health problems on older people and the promotion of mental health and well-being. UK Inquiry 2006 and UK Inquiry 2007 are significant in that they include the views of older people and their carers – an issue often overlooked in research, on how to promote mental health and well-being and services that are more responsive to the needs of older people.

                      ESRC-Funded Research

                      The Economic and Social Research Council (ESRC) has an international reputation for funding high quality research and training in social and economic issues. The Growing Older Research Programme, with its focus on quality of life, is one such area.

                      The Growing Older Research Programme

                      The Growing Older (GO) Programme was completed in 2004 and consists of twenty-four research projects aimed at examining how to extend quality of life in older age. Walker and Hennessey 2004 sets the context for the work of the programme which is focused on six research topics: defining and measuring quality of life; inequalities; health and productive ageing; technology and the built environment; family and support networks; and participation and activity in later life. Bowling 2005 examines quality of life in older age from a theoretical perspective, while Walker 2005b explores issues such as the environment, family and bereavement on quality of life. For a European perspective see Walker 2005a. The site contains a wealth of research and most of the publications have been recommended for advanced undergraduate and postgraduate courses in social gerontology, social work, sociology and social policy, and will also be invaluable to professionals with health and social care backgrounds.

                      Mental Health Conditions

                      Mental health problems in later life can be grouped into four main categories: depression and anxiety; dementia; other mental health problems; and drug and alcohol misuse. The literature on depression and dementia is most prolific though much of it is set in the context of the medical model, where precedence is given to identifying, diagnosing and treating the symptoms of mental illness. Furthermore, the methodological limitations with collecting empirical data on mental health can make cross comparison between studies problematic (Ferguson and Keady 2001). Key resources are grouped by subject area; however, it is not always possible to segment the literature so neatly because of the co-morbidity of mental health conditions. Richardson and Barusch 2006 provides a comprehensive overview of the main mental health conditions affecting older people and the different types of intervention related to these conditions.

                      • Ferguson, C. and Keady, J. 2001. The mental health needs of older people and their carers: exploring tensions and new directions. In Working With Older People and Their Families: Key Issues in Policy and Practice Edited by Mike Nolan, Sue Davies, and Gordon Grant. Buckingham: Open University Press.

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                        This chapter succinctly reviews the literature on various mental health conditions and illustrates how socio-economic conditions and physical illness can affect mental health.

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                      • Richardson, Virginia E., and Amanda Smith Barusch. 2006. Part Two: Psychological Problems and Interventions. In Gerontological Practice for the Twenty-First Century: A Social Work Perspective, 91-201. New York: Columbia University Press.

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                        This section comprehensively covers anxiety, depression, suicide, dementia and substance misuse and their associated interventions.

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                      Depression

                      Depression is the most common mental health problem in older people, very often triggered by events associated with aging, such as bereavement or a painful long-term health problem (Anderson 2001, Cole and Dendukuri 2003, Alexopoulos 2005). The most accessible writings are Godfrey and Denby 2004 and Manthorpe and Ilife 2005.

                      Anxiety

                      Anxiety is still relatively unexplored in the literature, compared to other mental health problems such as depression. In later life, anxiety can occur on its own or coexist with depression (Beekman, et al. 2000). There is significant disagreement about what happens to the risk of anxiety and depression disorders and symptoms in later life (Jorm 2000), and Dagmar, et al. 2008 explore the associated risk factors.

                      • Beekman, Aartjan T. F., E. de Beurs, A. J. L. M. van Balkom, D. J. H. Deeg, R. van Dyck, and W. van Tilburg. 2000. Anxiety and depression in later life: Cooccurrence and communality of risk factors. American Journal of Psychiatry 1577:89–95.

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                        In this article, discussion focuses on the possible coexistence of anxiety with depression.

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                        • Vink, Dagmar, Marja J. Aartsen, and Robert A. Schoevers. 2008. Risk factors for anxiety and depression in the elderly: A review. Journal of Affective Disorders 106:29–44.

                          DOI: 10.1016/j.jad.2007.06.005Save Citation »Export Citation »E-mail Citation »

                          This paper provides a comprehensive overview and compares risk factors associated with depression and anxiety in older people. Available online with registration.

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                          • Jorm, A. F. 2000. Does old age reduce the risk of anxiety and depression? A review of epidemiological studies across the adult life span. Psychological Medicine 30:11–22.

                            DOI: 10.1017/S0033291799001452Save Citation »Export Citation »E-mail Citation »

                            This article reviews the evidence concerning aging and the risk of anxiety and depression. Available online for a fee.

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                            Dementia

                            The prevalence of dementia rises with age; and with longer life expectancies in advanced industrialized nations, the number of people suffering from dementia is projected to increase. Dementia is usually not detected until symptoms have progressed significantly (Bond, et al. 2005). In the United Kingdom it is estimated that there are seven hundred thousand cases of dementia and about one million people caring for people with dementia (NICE and SCIE 2006). The economic and social costs are significant, so it is an important policy concern for all governments. Dementia care is often criticized for its lack of sensitivity toward individuals. Baldwin and Capstick 2007 provides commentary on the views of a well-known advocate of person-centered approaches, Tom Kitwood. Cox 2007 provides a comprehensive overview of the important role that social work has regarding people with dementia and their carers in different settings.

                            • Albanese, Emiliano, Sube Banerjee, Sujith Dhanasiri, Jose-Luis Fernandez, Cleusa Ferri, Martin Knapp, Paul McCrone, Martin Prince, Tom Snell, and Robert Stewart. 2007. Dementia UK: The full report. London: Alzheimer’s Society.

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                              This major report provides details of current and projected numbers of dementia sufferers in the United Kingdom, as well as services and treatments and the economic implications.

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                              • Baldwin, Clive, and Andrea Capstick. 2007. Tom Kitwood on dementia: A reader and critical commentary. Bradford, UK: Open Univ. Press.

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                                Tom Kitwood was one of the most influential writers on dementia since 1990. This reader collects twenty of his original publications, which cover the entire period of his writing on dementia.

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                              • Bond, J., C. Stave, A. Sganga, O. Vincenzino, B. O’Connell, and R. L. Stanley. 2005. Inequalities in dementia care across Europe: Key Findings of the Facing Dementia Survey. International Journal of Clinical Practice 59:8–14.

                                DOI: 10.1111/j.1368-504X.2005.00480.xSave Citation »Export Citation »E-mail Citation »

                                This article discusses the problems of diagnosing dementia and the possible reasons for this situation.

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                                • Cox, Carole B., ed. 2007. Dementia and Social Work Practice: Research and Interventions. New York: Springer Pub.

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                                  This recommended book covers social work issues as diverse as assessment, supporting families, and social work within different settings. Also included are international case examples.

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                                • National Institute for Health and Clinical Excellence and the Social Care Institute for Excellence. 2006. Dementia: Supporting people with dementia and their carers in health and social care. London: NICE and SCIE.

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                                  Aimed at health and social care staff who work with people with dementia and their carers, and those who work with older people and people with learning disabilities, this is an informative and comprehensive resource.

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                                Other Mental Health Problems

                                There is limited information on prevalence rates for learning disabilities and longstanding mental health problems in older people. Increasing life expectancy in the developed nations brings with it a rise in the number of people with learning disabilities who survive into old age. The prevalence of dementia among people with learning disability is higher than within the general population. Regular assessment for people with learning disabilities is essential to monitor changes (Hatzidimitriadou and Milne 2005). In terms of schizophrenia in older people, again the literature is limited. The illness can have devastating effects on individuals (Rodriguez-Ferrera and Vassilas 1998). Howard, et al. 1999 provides a very useful overview.

                                • Hatzidimitriadou, Eleni, and Alisoun Milne. 2005. Planning ahead: Meeting the needs of older people with intellectual disabilities in the United Kingdom. Dementia: the International Journal of Social Research and Practice 4:341–359.

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                                  This study discusses the use of regular assessment to ensure that changes in cognitive, behavioral, and social functioning are detected.

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                                  • Howard, Robert, Peter V. Rabins, and David J. Castle, eds. 1999. Late onset schizophrenia. Petersfield, UK: Wrightson Biomedical.

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                                    This is an excellent overview of late onset schizophrenia.

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                                  • Rodriguez-Ferrera, Silvia, and Christopher A. Vassilas. 1998. Older people with schizophrenia: Providing services for a neglected group. British Medical Journal 317:293–294.

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                                    This study explores the impact of schizophrenia on the older person, and the need for services to respond appropriately and sensitively.

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                                    Drug and Alcohol Misuse

                                    Comparatively little attention has been given to alcohol misuse in later life (Hajat, et al. 2004), despite the fact that older people are vulnerable to its social and health consequences (Johnson 2000). Alcohol use can be associated with many factors, including anxiety and depression. Social workers have an important role to play in recognizing alcohol misuse in older people (Simpson, et al. 1994). There is even less information on the misuse of prescribed and unprescribed substances by older people. Inconsistency exists in the identification of this problem between younger and older age groups (Derry 2000).

                                    The Assessment Process

                                    Social work assessments take a holistic approach by investigating difficulties that the individual may be facing, such as poor health and declining mental capability. Older people who are eligible for services may receive support in areas such as personal care, social care, housing, transport, and activities of daily living (see Victor 1997; Health and Watson 2005; and Orrell and Hancock 2004). Social work assessment is also concerned with preventing decline in an individual’s physical and mental condition, recognizing his or her strengths and maximizing what he or she can do, with the intention of improving well-being, self-esteem, independence, and quality of life. Compared with medical contexts, the literature on the assessment of mental health conditions in older people in social work settings is proportionally much smaller, but nevertheless it presents the reader with a daunting variety of tools. See Reynolds and Orrell 2001;Kerr, et al. 2005; and Kane and Kane 2004. Kane (in Berkman and D’Ambruoso 2006) explores standardized measures which extend beyond the actual assessment process itself and rate the attributes of an older person and the issues that are of concern for him or her. Geron (in Berkman and D’Ambruoso 2006) discusses comprehensive and multi-dimensional assessment for older people, while Lubben (in Berkman and D’Ambruoso 2006) examines abbreviated and targeted geriatric assessment. Griffiths, et al. 2005 reviews the evidence on self-assessment of health and social care needs.

                                    Psychosocial Interventions

                                    Much of the literature on older people and mental health is rooted in the medical model of mental health, which is concerned with identifying symptoms, making diagnoses, and treating illness. However, there is growing recognition of the benefits of adopting the psychosocial model (Ramon and Williams 2005) which gives precedence to understanding the interrelationship between psychological and social factors and their influence on mental health. Though a discrete approach, psychosocial interventions are not intended to conflict with medical approaches, so for instance, where mental health problems are complex, a combination of psychosocial and pharmacological interventions may be necessary for an older person. Norman and Redfern 1997 very helpfully introduces the non-medical professional to medical or pharmacological treatments and electro-convulsive therapy (ECT) for older people with mental health problems. Common psychosocial interventions used by social workers include goal setting, case management (see Naleppa 2003), psychoeducation, and brief psychotherapies such as cognitive behavior therapy and solution-focused therapy. Hepple, et al. 2002 provides a very useful overview of examples of brief psychotherapies while Laidlaw, et al. 2003 focuses on cognitive behaviour therapy and Chapin, et al. 2006 examines solution-focused therapy. Other psychosocial interventions may include stress management techniques and reminiscence therapy, the latter which is the subject of a meta-analysis in Bohlmeijer, et al. 2007. Evidence-based practice for psychosocial interventions is limited and Moniz-Cook and Manthorpe 2009 help to fill this void in the area of dementia.

                                    • Bohlmeijer, Ernst, Marte Roemer, Pim Cuijpers, and Filip Smit. 2007. The effects of reminiscence on psychological well-being in older adults: A meta-analysis. Aging and Mental Health 11:291–300.

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                                      This meta-analysis assesses the positive benefits of reminiscence on psychological well-being across different target groups and individuals.

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                                      • Chapin, Rosemary, Holly Nelson-Becker, and Kelley Macmillan. 2006. Strengths-Based and Solutions-Focused Approaches to Practice. In Handbook of Social Work in Health and Aging. Edited by Barbara Berkman. New York: Oxford University Press.

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                                        This chapter succinctly examines the role of solutions-focused approaches in social work with older people.

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                                      • Hepple, Jason, Mary-Jane Pearce, and Philip Wilkinson. 2002. Psychological Therapies with Older People: Developing Treatments for Effective Practice. Hove, England: Brunner-Routledge.

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                                        This recommended book provides a useful overview of five forms of brief psychological therapy: brief psychodynamic, cognitive-analytic, cognitive-behavioral, interpersonal, and systemic. Also illustrated with case studies.

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                                      • Laidlaw, Ken, Larry W. Thompson, Dolores Gallagher-Thompson, and Leah Dick-Siskin. 2003. Cognitive Behaviour Therapy with Older People. Chichester: Wiley.

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                                        This book provides a comprehensive guide to applying cognitive behaviour therapy (CBT) with older people. Primarily aimed at psychotherapists, this book will be useful to a wider audience too.

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                                      • Moniz-Cook, Esme, and Jill Manthorpe, eds. 2009. Psychosocial Interventions in Early Dementia: Evidence-based Practice. London: Jessica Kingsley Publishers.

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                                        This book examines the evidence from the UK and Europe on various psychosocial interventions that are known to be beneficial to people with dementia. Interventions are arranged into four key areas: diagnosis support; cognitive and memory support; psychological, emotional, and social support; and developing evidence-based psychosocial support services.

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                                      • Naleppa, Matthias J. 2003. Gerontological Social Work and Case Management. In Social Work and Health Care in an Aging Society: Education, Policy, Practice, and Research. Edited by Barbara Berkman and Linda K. Harootyan. New York: Springer.

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                                        This chapter comprehensively describes the development of case management in social work with older people, with detailed discussion of the processes involved.

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                                      • Norman, Ian J., and Sally J. Redfern. 1997. Mental health care for elderly people. New York: Churchill Livingstone.

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                                        This text provides an excellent overview of different types of mental health problems in older people, assessment, and a range of psychosocial and pharmacological treatment, with emphasis on a user-centered approach.

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                                      • Ramon, Shulamit, and Janet E. Williams, eds. 2005. Mental health at the crossroads: The promise of the psychosocial approach. Aldershot, UK: Ashgate.

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                                        In this book the contributors, mostly social scientists, mental health practitioners, and some psychiatrists, advocate the replacement of the dominant biomedical approach with the psychosocial approach.

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                                      Black and Minority Ethnic Older People

                                      Black and other minority ethnic older people with mental health conditions experience similar problems to majority older peoples, such as failure by professionals to recognise mental health problems; but in addition they face barriers including culturally inappropriate assessments and interventions (Bhui 2001; Sharif, et al. 2008; Shah, et al. 2009; Sorkin, et al. 2009). Sometimes older persons or their families may fail to detect the symptoms of mental illness; for example, there is limited knowledge and experience of dementia in South Asian communities in the United Kingdom, despite the work of the voluntary sector and National Health Service special projects (Bowes 2003). Culture, language, and educational differences are factors that can hinder the study of the mental health needs of black and other minority ethnic older people (Livingston and Sembhi 2003). It is useful to compare the literature from other countries (Padgett 1995; Cooper, et al. 2008).

                                      Carers

                                      Carers can experience hardship because of the duties of their caring role and therefore, assessment of carers’ needs is essential in order to identify their support requirements. However, carers express that health and social care professionals fail to recognize their needs, and that they have difficulty in accessing services (Seddon and Robinson 2001; Bruce, et al. 2002). Victor 2009 discusses the different types of services that are designed to support carers, including those that help them to access services, those targeted at carers’ physical health, interventions focused upon emotional and social support, education and training for carers, employment-related interventions, and carer breaks. The conclusion of a review (Arksey 2003) of mainly US literature, which focuses on carers of people with Alzheimer’s disease or other forms of dementia, is that in terms of the effectiveness and cost-effectiveness of interventions for carers of people with mental health problems, there is generally a lack of conclusive evidence to support any specific interventions; however, most of the studies were able to identify some positive outcomes of services provided.

                                      Public Policy and Mental Health

                                      In recent years Europe has experienced a significant policy shift toward prevention of mental illness and the promotion of mental health and well-being in later life (see World Health Organization, et al. 2007). However, there is still further progress to be made in various areas, such as assessment, ending discrimination in services, and providing effective support and person-centred care. The promotion of psychosocial interventions has gained increasing acceptance with professionals (see Ramon and Williams 2005). The publication of the United Kingdom’s first dementia strategy (Department of Health 2009a) is a key milestone, and the commitment to keep well-being on the agenda has gained momentum in recent years (Department of Health 2009b). In the United States mental health has risen up the agenda as part of wider health care reform. Community mental health programs in the United States include a broader range of issues such as housing, medication, education and psychosocial skills training; but the most important change in mental health services overall has been that of medicalization (see Mechanic 2008).

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