1. A GP Perspective Isolation & Emotional Wellbeing Dr Fiona Butler

2. Isolation and Depression Depression is under diagnosed in primary care K&C prevalence high for London, and highest in older adults (>65 years) Changing age structure means more older adults with depression Local investment in primary care mental health services developed by practice based commissioners – Range of psychological therapies – Personalise care – Time Bank – Exchange of skills and reduction in isolation – Self help support groups

3. Physical Health and isolation Increasing numbers with long term conditions Complex symptoms – Poor mobility, low mood – Isolation Vulnerable Elderly enhanced service – Holistic review for > 85’s living alone Screening chronic disease for depression Deliver NICE guidance for those with physical health problems

4. Case Study 1 Eleanor, aged 86 years – Lives alone, no family around – Anxiety and panic attacks for many years – Complex cardiac history involving frequent hospital admissions with palpitations – Does not want to take anti-depressant or cardiac medicines – Cannot get out for psychological therapy as does not feel safe to go out on her own – Isolated, worrying about her health – Most successful intervention is a befriender who takes her to see local gardens

5. Case Study 2 Alice, aged 74 yrs – Ex GP practice receptionist – Lives alone – Brought in by daughter who is worried about her low weight and social withdrawal – Not meeting friends and stopped going to social club – Screened for depression and physical health investigated – Treated for depression and low vitamin D levels – Did not fully improve – Final picture was of a dementia – Unable to keep up with bridge – Forgetting to eat