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
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.