‘What is my why?’

'I want to change people's attitudes to older people and how we meet the needs of people in later life.' Natasha cites a number of influences that informed her interest. One was 'a conversation with my supervisor during my training. I was working on a continuing care ward. I found the culture very difficult because it was so task-oriented and seemed to treat older people as commodities. 

My supervisor commented that in her day, older people in a ward like this didn't get their own clothes or even their own dentures. She talked about the work that she and others had done to change this. This opened my eyes about what was in my control. I could try and be the change that I wanted to see. This is something that I have tried to work on ever since.'

Natasha also stresses two principles that inform how and where she trained and then worked to achieve her present position. 'First, my family are important to me so, since starting in the NHS, I've worked either in the Black Country or the Herefordshire and Worcestershire Trust. I will shortly be moving to Midlands Partnership University Foundation Trust Second – and I'd stress this to anyone thinking of studying psychology – is to broaden your horizons.

Don't get forced too quickly into making a decision about what you want to study and your career. Psychology can be a terribly silod profession and you can easily become siloed without realising it. For example, I heard very little about organisational psychology when studying and, in turn,  people can be quick to write off the older adult clinical speciality.'

Natasha tells me she studied psychology at A-Level as she'd always been interested in it. 'My best friend seemed to always ask the question "How" in any situation; by contrast I'd ask "Why". I had an abnormal smear in my first year at university. That and people's reactions to it had made me think about studying health psychology. Clinical psychology was always described at university as "only the best of the best can do it", and I definitely didn't fit into that group. It also isn't true and closes down other equally rewarding and valued avenues such as counselling psychology.'

Natasha's brother had a road accident when she was at university so she returned home and wasn't sure where to go at this point. 'I became a nursing assistant in an in-patient ward. I was fortunate to be involved in a number of things even though I was an assistant: I even went on a leadership course. During that time I met an Assistant Psychologist who suggested I try clinical psychology which led me to assistant psychology posts. I had two posts; one in forensic inpatient services for women; the other working with adults and older adults in a community mental health team.'

Life stories

Natasha's way of responding to questions reflects her training, the areas she works in and her own strong philosophy. First, she regularly checks that she is talking on-subject and that the other person understands and is happy with what she is saying.

The second is that although she talks about theory and technique, she illustrates what she says using stories and examples. 'The first older person I worked with had a fear of enclosed spaces, and due to physical health changes could no longer use the stairs. 

We worked on graded exposure and at the end, as we were saying goodbye to each other for the final time, she gave me a thumbs up from the car. The car window was closed and this was the first time that was the case in many many years. She gave me a pair of very ornate earrings to say thank you and I still have them today.'

Natasha did her Clinical Psychology Doctorate training in Birmingham, authoring a thesis on children with a father who had young onset dementia and the impact of their transition into adulthood. She gained her first job as a clinical psychologist at the Black Country Partnership NHS Trust working in an older adult community mental health team then, after maternity leave, also working into an older adult inpatient ward. 

After three years, Natasha moved to Herefordshire and Worcestershire Health and Care NHS Trust, first as an Older Adult Clinical Psychologist, then as the Lead Older Adult Clinical Psychologist for the mental health needs pathway. She is plainly proud of two particular initiatives she pioneered there.

'The first is John's Campaign. John Gerrard was a 70-year-old doctor who was diagnosed with dementia. He went into a general hospital in 2014 and within five weeks had declined dramatically and died in November of that year. There was a distinct lack of knowledge about dementia at the time, particularly the importance of having your family and people you love around you to support your health and wellbeing. I read an article by his daughter Nicci Gerrard and  Julia Jones. I took it immediately to the older adult mental health inpatient leadership team. I recalled my own experiences of being in hospital and the team shared theirs. We realised that there was no reason why a mental health ward couldn't take up the ideas, not least of open visiting, but also of valuing family, friends, and others as integral to the support of older people with dementia and other mental health difficulties. We pioneered John's Campaign, speaking at their national conference, writing papers and supporting other trusts to take up the pledge. Within Worcestershire, all our Older Adult wards became open visiting and we looked into  chair beds for carers who may need to stay over. Our community hospitals also signed up.'

The other achievement Natasha talks about is Worcester Life Stories project. 'I worked on this project with my friend Sheena Payne-Lynn, Historic Environment Records Officer at Worcester City Council. The project was funded by the trust, the council, National Lottery funding and volunteer time contributions. We've developed two websites in collaboration with the public and organisations such as the Association of Dementia Studies and Platform Housing Group. 

The NHS site allows all residents of Herefordshire and Worcestershire to be able to create their own digital life story through uploading videos, photos, and writing or speaking their history. They can share it with whoever the person decides should have access. Using the platform promotes connecting with others:  coming together to share their memories. Sharing and telling stories are important and we are meaning-making beings. Life story can also support care for people with dementia by better understanding the person behind the distress.'

Dispelling myths

According to Natasha, these initiatives are a part of her drive to improve how we think, work and be about older people; to continue to change the narrative we have around aging and older people.

'The NHS talks about parity of esteem, to ensure that all people regardless of age have access, but this can come with consequences if we do not think about it. We are not the same person at 30, or 50, or 70… offering the same intervention to all of these groups is potentially unhelpful without thinking about the different transitions and needs we have at those times. 

One example is trauma-informed care. There is more recognition now about people's experiences and we have more of a language to be able to describe it. However, an older person who has experienced something that we now recognise as trauma may reject that term, as it will not have been thought or talked about in the same way. 

Continuing ageist attitudes assume that because something happened a long time ago, it is no longer relevant. This is not true and stops older people from being able to access interventions which are effective. Research has also shown that older people who do access therapy, have good outcomes.'

With colleagues in the Faculty of the Psychology of Older People (FPOP), Natasha is suggesting older adult adaptations to the NHS England recommended therapies for people with severe and enduring mental health difficulties. 'We've also worked with NHS England to dispel myths about aging as well as to introduce better understanding of older people's needs. Most recently we have been working with The Anna Freud Centre, a training provider for Structured Clinical Management, to produce a bespoke older adult training course.'

Natasha is very proud of FPOP and the work that they do to increase the understanding and experience for older people accessing services. 'We have 600 members, hold a conference every year, produce a quarterly bulletin and last year we ran 12 webinars on community transformation and recommended therapies and how they pertain to older people. We run workstreams aiming to address some of the more current areas such as autistic older people, behaviours that challenge in dementia, and competencies for working with older people. A key aspect of the faculty that it's open to anyone working in the area or has an interest, not just psychologists.'

After a fascinating conversation, Natasha's enthusiasm shone through. 'If you're studying psychology don't write off this area – there's so much in it. But above all stay open to different ideas and, as I did, ask yourself "What is my why?"'

Might you have an interesting story to tell about your career path, the highs and lows of your current role or the professional challenges you are facing? If you would like to be considered for a 'Careers' interview in The Psychologist, get in touch with the editor Dr Jon Sutton ([email protected]). Of course there are many other ways to contribute to The Psychologist, but this is one that many find to be particularly quick, easy and enjoyable.