Moving Finger

Elders’ mental health: the neglected factor?

SRI LANKA was among the hundred or more member states of the World Health Organization who observed the World Mental Day last week. Under the theme 'Building Awareness', the UN health agency seized the opportunity to remind the international community of the suffering caused by mental disability.

According to the Director of Health Services, estimated two million people in Sri Lanka have some mental disorder and about 400,000 of them need treatment. She enumerated poverty, war, conflict, tsunami and other tragedies as main causes for mental disorders.

WHO has started funding a project for the compilation of the first national policy on mental health ahead of the formation of modern mental health legislation, as well as a national mental programme.

In the meantime, Sri Lanka Government has also laid down long-term plans, such as setting up wards in mental therapy at every district hospital and to appoint a psychiatrist to every MOH division. These are welcome concepts and need appreciation.

However, it is generally an accepted fact that in Sri Lanka, older people with mental illnesses face discrimination and poor services. One reason is people do tend to assume that being depressed is part of being old. This is not right.

In today's context, the issue of mental illness in the elderly should be regarded important, because our population is ageing and ageing fast.

At a time when the Government wants to make the most of older people's contributions to society, the neglect of their mental health needs represents a waste of human potential. We cannot afford that.

So, it's time we face reality. We should improve services and support for older people with mental health problems.

Our final vision should be a society where the needs of older people with mental health problems and the needs of their care givers are understood, taken seriously, and met in a way that enable them to lead meaningful and productive lives.

The range of mental health problems experienced in later life is very wide. It includes depression, anxiety, delirium, dementia, schizophrenia and other severe mental health problems, and alcohol misuse.

We will face daunting challenges in developing policies on older people's mental health but if we have a commitment to age-equality in policy and strong leadership, we could deliver the intended outcomes in practice.

I see three areas of action. First, we should accept that prevention is possible. It is proven that many mental health problems in later life can be prevented. The risk factors for depression, anxiety, suicide, delirium and some types of dementia are well known.

Social isolation is the common risk factor across this range of problems. The problems and solutions are diverse but all of them require preventative action at multiple levels, from the individual to the broader policy level.

What needs to be done? We should challenge the widespread idea which leads people to believe that mental health problems are an inevitable part of growing older and therefore nothing can be done. We should also reduce isolation and strengthen social support for older people.

Secondly, we should organise community development initiatives which would enable elders to help themselves and each other. Only a small percentage of older people with mental health problems receive help through formal services. The vast majority cope using their own resources, so support for self-help and peer support is necessary.

Ask any elder. He will tell you how he/she enjoys participation and relationships. They particularly value peer support from others who have had similar experiences.

Providing support for friends, family and other unpaid carers is crucial given the major role they play in caring for older people with mental health problems. Unpaid carers themselves are often older and also at risk of developing mental health problems.

Thirdly, we should improve our current services. Primary care is where many older people turn to for help and providers play a crucial role in the initial identification of mental health problems and the co-ordination of care. Social care helps older people to maintain independence and well-being.

However, State services are under pressure. There is considerable scope for improving these and newer services. The challenge is to provide services that older people want.

Finally, we should feel optimistic about change as there are many opportunities, with policy emphasis on age-equality and self-directed support. Improved education, training and support for those who work with older people will facilitate change. Stronger professional, managerial and political leadership is essential, as is the effective targeting of much-needed investment.

The older people with mental health problems need the best possible services. We need to shift our attention to them, to ensure that they are supported by loved ones and enabled to care for themselves - by design, not by accident or neglect.