Mental health and older people – time to make some noise
By Toby Williamson
As most of us know, 2018 marks the 70th anniversary of the founding of the NHS. There are many people living in the UK who were born the same year as the NHS was created, back in 1948. As we are often reminded the UK is an ageing society: there are more and more older people and they are living longer, partly thanks to the NHS. By 2040, it is projected that older people will make up 25% of the total population.
It is a myth that depression or dementia are inevitable parts of ageing. The majority of people aged over 70 experiences neither. Promoting mental health and preventing mental health conditions in later life is essential. Yet it’s estimated that 25% of people over 65 experience depression, and there are currently 850,000 people living with dementia in the UK. That means that well over 3 million older people aged 65+ are currently experiencing mental distress and/or cognitive impairment. It is estimated up to 50% of people with dementia also experience depression.
25% of people over 65 experience depression, and there are currently 850,000 people living with dementia in the UK
However, mainstream media’s scant coverage of mental health in later life would have us believe that it’s an issue of little significance. Earlier this year, during Mental Health Awareness Week, the majority of related stories concerned Government announcing plans to improve young people’s mental health, services for perinatal mental health, and the mental health of students. Older people’s mental health barely received a mention.
My point is not that mental health problems among children, or students, or mothers aren’t important. Nor am I suggesting that older people are ignored entirely; news items about social care never fail to mention older people (though usually in the context that they are the main cause of problems in the sector). My concern is that the imbalance in the coverage of mental health in later life, combined with a growing hostility in the public narrative about older people is unwarranted, unfair and can only result in poorer outcomes for older people and society as a whole.
I believe this is already manifesting itself in a variety of ways. For example, recent research from the Society for Public Health found that 25% of millennials believe it is normal for older people to be unhappy and depressed, while 40% believe there is no way to avoid dementia as you get older. These kinds of negative and incorrect beliefs, if unchallenged, can harden into ageist attitudes and aged-based discrimination, which in turn can lead to poorer mental health and cognitive functioning, and greater social exclusion among older people. And this can have wider societal outcomes.
The imbalance in the coverage of mental health in later life, combined with a growing hostility in the public narrative is unwarranted, unfair and can only result in poorer outcomes for older people and society as a whole
Increasingly mental health services for older people are incorporated into adult mental health in general. Yet with the exception of dementia, older people with mental health problems using ‘age inclusive’ services appear to get lost in adult services focused on younger people, working people and families. Older people’s mental health is the little Cinderella of what has always been described as a Cinderella service.
The life experience of older people, including retirement, bereavement, loss of status and income, increasing illness and disability, and ageism, can all be significant factors in their mental health. These factors need to be understood where they cause or exacerbate poor mental health. Dementia is an organic, progressive and terminal brain disease unlike any ‘functional’ mental health problems. Yet the experience of depression in later life may also have similarities to depression experienced by younger people, and appropriate responses may be similar. The different realities and beliefs that people with more severe dementia experience have similarities with people experiencing psychosis.
Ensuring services (including health, social care, housing and community organisations) are genuinely age inclusive, inter-generational where possible, and explicitly address the multiple needs and experiences of older people is essential. And it can work. A human rights-based approach to policy and service development can challenge ageism, discrimination and inequalities.
Older people’s mental health is the little Cinderella of what has always been described as a Cinderella service.
Giving the attention required to older people’s mental health requires a change of gear and focus in public narrative, policy and practice. Just over a decade ago Age Concern and Mental Health Foundation produced a report on older people’s mental health and concluded that:
"The levels of unmet mental health needs amongst older people are extremely high. The facts about mental health problems in later life should generate a sense of urgency and of anger about the lack of attention paid to them. Yet there is still a resounding silence." (Lee, 2007)
That report was published in 2007. The number of people aged 65 and over has increased by 20% in the last 10 years. Making some noise to break that resounding silence is long overdue.
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