Jill Manthorpe is professor of social work at Kings College London and director of the Social Care Workforce Research Unit. She is the co-author of the bestselling book, Depression in Later Life, with Professor Steve Iliffe (Jessica Kingsley Publishers, 2006), which was a runner up for the British Medical Association Book of the Year Award. Here, Jill discusses depression in older people, and how the current emphasis on developing dementia services might improve other mental health services for older people, too. 

Everyone who works with older people in social services or social care will encounter people with depression. The impact of depression among older people and those supporting them can be profound. This may be particularly so because depression is under-recognised and there are pessimistic views of the potential for response.

However, the social work response to older people with depression is three-fold: to uphold the social model of disability in order to improve or maintain the quality of life of those affected by depression; to ensure timely and tailor-made support is available for people with depression and their carers; and to work collaboratively with other practitioners at difficult times, crises or transitions. These aims reflect a social model of depression, greatly espoused in social work training and practice wisdom. This underscores social workers’ responsibility to respect people’s rights to self-determination, to promote participation, to treat each person as an individual, and to identify and develop strengths among individuals and communities.

For people with depression of all ages, and particularly older people, social workers see the principles of social justice as equally important, because they often work in environments where the quality of care and quantity of support are poor. Many social workers will see it as their role to challenge negative discrimination, to recognise and to respond to diversity, to be culturally sensitive, to distribute resources equitably and to work towards an inclusive society. That is no small task and one that cannot be undertaken alone; it may also conflict with a narrowly constructed medical model of depression.

This is a time when there is great emphasis on developing dementia services. Some people fear that this will further devalue other mental health services for older people. There are three arguments that can be used to challenge this. First, many older people with dementia are at risk of depression and so too are their carers – so artificial separations often don’t work in practice. Secondly, skills developed in working with people who are apathetic, low in mood, or even suicidal are very relevant to the skills needed to provide person-centred care for people with dementia. There is much to share and much to learn. Lastly, social workers can bring their knowledge of community development and work across agencies to ensure that prevention of loneliness and despair is built up and thrives at local level.

Copyright © Jessica Kingsley Publishers 2010.

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