‘Older people live in a society that doesn’t value them’

Tell me about your journey.

From a young age, I have always been a curious person and have always had curious conversations with people. In fact, my stepfather would often joke about me being able to get stories from new neighbours. I think communication is really important, and I have always had an interest in it. When I was thinking about going to university, and about what I wanted to do, I was initially drawn to speech therapy. I decided to pursue psychology instead, as I believed it would afford me more choices. I did Psychology and Linguistics.

Later on, I also had the opportunity of doing postgraduate research in France, where I was studying dementia and cross-cultural care. My mentor, a woman called Marie Jo Guisset, was really passionate about older people, ageing and the cross-cultural aspect – the way the French viewed ageing was quite different to how the English did. I'm an American by birth, and so I have other models of ageing that I've been exposed to, and I was just really intrigued by how ageing differed so much across different cultures and how it is viewed and conceptualised. That was largely my inspiration for working with older people.

Aside from this, my journey into the world of psychology was in part influenced by my some of my own earlier traumatic experiences of parental divorce and coming to the UK as a four-year-old. And, although I'm not from a Black or minority ethnic group, I was a migrant and I experienced a lot of 'othering'. That's one of the reasons why I am so drawn to working with people from marginalised groups. I've done a great deal of work with South Asian elders and I'm working on a research project with African Caribbean elders as well.

That's my journey in a nutshell, although I'm still on it – psychology really is a lifelong journey, it doesn't end when you've done your degree, or with therapy.

What else drew you to work with older adults?

I love stories – I did History and English at A-level. I like the experience of the past and listening to people's life stories. Working with older people has given me that kind of social cultural history that I can learn from them, their experiences and their cohort and time. My mentor was very passionate about older people, and their rights, which inspired me to look further into this. When I was doing my postgraduate research, I was reading a lot by people like Doris Lessing about ageing, and Vita Sackville West about ageism, and I was also very aware of how older people, particularly older women's voices, were not being heard. There's something really important about having a voice and I wanted to support being heard.

What has your experience of working with older adults been like?

Absolutely fantastic. I would recommend it to everyone, because it gives you a variety. As a psychologist, you can work one-to-one, with families, groups, staff and care homes. You can also do research, and teaching – there really is a vast array of work you can do within the field. Yet if you choose an area like self-harm and older people, there is still so much to be done. You can write and create new things within the field, because it's still an innovative area.

Over the years, I have had many trainees come in with their own ageist assumptions, and challenging these ageist assumptions has been helpful. However, working in the area of older adults can be frustrating at times because of the lack of resources, which is why I have campaigned all my working life at different levels to try and get access to more resources. I've previously worked for the Department of Health as an age equality lead, which was a huge privilege. I've always thought about where in the system I need to work to make a difference, so working therapeutically, but also working within the Trust on service development. For instance, I was involved in a project called 'making connections not assumptions', where I co-produced some information with South Asian elders, with the view to encourage older South Asian people to access services… so I've co-produced different campaign materials over time with people. It's really frustrating because I find that people don't listen because of ageism, and I think it's actually our internal ageism – people are scared of getting older. They are scared of dying, and so they 'other' it, and I sometimes don't understand this because we're all going to get older, hopefully. We've all got parents and grandparents, so why aren't we more motivated to act in this area? I get that areas like child mental health are really important, but it's not the only area that is important.

In terms of the specific challenges for older people, I think number one, ageism and internalised ageism. I was recently diagnosed with Deep Vein Thrombosis, and I could feel myself diminish into a 'little old woman', who felt vulnerable and anxious and didn't want to disturb the doctor. I had to really give myself a good talking to and use my knowledge and skills, and tell myself 'Come on, you're not that person'. It's actually really easy to slip into how society expects you to behave as an older woman. Some of it is what they feel they ought to behave like and ought to be. 'Oh I don't want to disturb the doctor, so I won't ring the crisis line', and so they don't get the resources. There's internalised ageism, and also cohort issues. I recently had an article published on trauma and older people, where we highlight that older people have ACES, but they didn't grow up in an era where any of that was acknowledged or they had a language for that. This doesn't mean to say their amygdalas are not firing or they didn't experience trauma. So, if they had separation issues because they were evacuated in the war, and then they need to go into a care home, some of that might very well be reactivated.

Older people live in a society that doesn't value them, to think they're worth having therapy. In fact, the number of times I've had patients tell me that they don't want to take up my time and that I must have more important people to see… so there's their own challenge of internalised ageism. There are also therapeutic challenges and challenges around language, and how you build collaboration with people in a non-patronising way. I underestimated, as a psychologist, the physical impacts of ageing and how the mind and body works together. Identity is also another factor, particularly for men. From the self-harm campaign that I am involved with, we're seeing older men self-harming a lot more and coming through because they don't have a language and the networks to share their problems with, so they are trying to communicate their distress through self-harm. There's also challenges due to a lack of investment into older adult services.

You were part of the BPS Covid Bereavement and Care group… tell me about that?

Yes, and that was an amazing experience – I felt very honoured and privileged to be part of it. The group really knew their stuff, and I was experiencing some imposter syndrome! But we all really valued each other's knowledge and contributions. We worked intensely at the beginning to produce what we thought were helpful materials for people. It was also a time when my husband got Covid, so in parallel to writing this stuff about end of life and bereavement, my husband was in the bedroom with symptoms, and we were all self-isolating… it was quite challenging emotionally as well. I remember speaking that out in the group, and it really helped the dynamics in the group. We came together able to share our stories as people, not just in an academic way. I learnt so much from everyone but especially from Professor Nicola Rooney and Dr Angel Chater about grief and that idea of re-grief, which I was able to share with others to explain their grief.

I was also then asked to do webinars for people with dementia around end of life because they were losing lots of their members, so the Dementia Engagement Empowerment Project (DEEP) commissioned me to do some webinars for them. And I've done lots of different webinars on grief and bereavement and re-revamped my own teaching on it, and re-evaluated that. It's had a huge impact and shift in some of my thinking, that I've also been able to share with others, and more recently the staff in the long Covid clinic in Pennine care.

The older adults' speciality seems to be an area that is often neglected, both in terms of government funding and in terms of research. Why do you think that is?

That internalised ageism, and it's not seen as 'sexy'. The Division of Clinical Psychology priorities are not ageing, and even within NHS England it is hard to get ageing on the agenda. This being said, there has been an increase in funding in dementia research and practice, because I think there are biochemical drug issues around that. There has been very little funding in therapy for older people and research into that. In terms of the Community Mental Health Transformation, although it mentions older people in it, locally, the implementation of it has just mainly focused on adults of working age, children and young people and crisis. The focus is on demand, which is understandable, but it doesn't focus on the need. If you look at the data, it's stringent needs assessment of the number of people you'd expect to have mental health issues in your area, and it doesn't address the demand or the needs of the population; it's addressing the people that pick up the crisis helpline. That doesn't tend to be older people.

You've been involved in an older adult self-harm awareness campaign.

That has been an absolutely fantastic collaboration between Adele Owen, who leads in the Greater Manchester self-harm suicide and bereavement work from the council side; myself from the health side as a psychologist; Gillian Stainthorpe , who is the chair of the Greater Manchester Older People's Network Health and Social Care subgroup; and Liz Jones from the Greater Manchester Older Peoples' Network. We worked with the Older People's Network, and we were able to bring in a cartoonist and illustrator called Tom Bailey from Leeds, to come to some focus groups and listen. We had input from LGBT, African Caribbean, and South Asian participants and we were able to have conversations about self-harm: what do we mean by self-harm? And how can we talk about it? Tom illustrated the whole array of conversations, which the participants really loved, because they could engage with it more readily.

We went away and played around with some of the ideas and brought it back to the focus group and co-produced it with them. We got good feedback about what they wanted, so it was really grassroots based. We also had support from the National Institute for Suicide and Self-harm, based at Manchester University. So, we launched it, and Gill, Adele and I have given a number of webinars as part of it, but there is a long way to go with it. I'm involved with a lived experience group, which I'm hoping can be a vehicle through which we can get the message out. The network that we're hoping to develop will build on that model with the illustrator; we're working on one for eating disorders, as well as a professional infographic. We want a more public facing one about disordered eating for older people. So it's about listening to the voice of older people.

You've written a book too, Life story work with people with dementia.

It goes back to co-production and what I said about voice and the importance of listening to stories. When I came to Oldham, I believed in life story work, and I met a man called Ken Holt. We worked together and he wrote a couple of pages for his wife when she went into a care home.

That was the beginning of a journey in Oldham, where we brought lots of people across to do life story work, such as Age UK etc., a colleague, Leslie Jones, did some workshops with us on life story at the beginning, and I videoed Ken and asked about his ambition, which was to create a national network. When I worked at the Department of Health as the age equality lead, there were funding cuts and so the older adult lead Ruth Ely (who is a co-editor of the book) and I set up, with others, a community interest company. Through that we were aware that a lot of people were talking about life story, but there was no one place that collated this information. Ken and his story take pride of place at the beginning, as does the voice of people living with dementia, through the Dementia Engagement Empowerment Project, as does the voice of carers. Bob Woods (king of old age psychology) also played a role in encouraging me to do the book. The book has been helpful to people in so many different ways; it's been used for a play by an artistic director, by carers and a colleague Natasha Lord has used it in Worcestershire to get life story work going on in her Trust and local online heritage too. Those are just a few examples of how it's been useful.

What needs to change to make provision for older adults more equitable?

There needs to be equitable investment, and we need older people themselves campaigning. We need investment in the primary care networks, for skilled staff who know about older people to be there at the front door. We need investment in psychiatry, psychology and in nursing. We need investment in training, and in awareness raising, so that even if you're not working with older people, you've got an awareness of some of the issues – almost like a tiered approach.

Everybody needs an awareness of ageing, but without investment this is going to be hard to achieve. I also think that we need investment in posts for mental health practitioners in both primary and secondary care, community development workers, peer mentors, nurses, psychiatrists, psychologists in old age because working in this area requires specialist knowledge. Anywhere where services have been configured for supposedly all age, we know older people don't get access to them. In fact, services like Leeds and Salford that went all age ended up reverting back to having old age specific services because otherwise they just didn't get a look in – you need that specialism retained.

We've spoken about your professional journey and work. Tell me about your life outside of psychology.

I love singing, and I was honoured to be part of an interfaith women's group in 2013 called 'sacred sounds' that had women of all faiths and none. We sang at the Manchester International Festival. I'm now part of a local singing group, which is joyful. I love swimming and water – my husband and I go once a week. I recently went for a taster sailing session, and I'm hoping to learn to sail next spring. I also love food (both cooking and eating it!). I also love my family, music – my husband is in a band and we go to festivals. Faith is also important to me. I've been part of an international interfaith network for nearly 30 years; that's helped root me in spiritual practices and interfaith dialogue. I like to go on retreats to prevent burning out… it's important to have that balance in life. In fact, my husband and I are working on a book around wellbeing too… we'd like to run some workshops in the future.