|POLICY STATEMENT OF IAGMH
|Year : 2019 | Volume
| Issue : 1 | Page : 4-6
Mental health policy for elderly
|Date of Web Publication||16-Aug-2019|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Mental health policy for elderly. J Geriatr Ment Health 2019;6:4-6
| Introduction|| |
The population of elderly has been increasing globally with a more rapid increase in the developing countries like India. The increase in life expectancy has contributed to the increase in elderly population, particularly the older old (above 80 years' age). Unlike some of the developed countries, the change in demography in developing countries has started even before the adequate improvement in the health-care system to manage the challenges in health care of elderly. The burden due to noncommunicable diseases (NCD) is high in elderly as they have a high prevalence of comorbid general medical and mental health problems. The health system in India is less prepared for the management of NCD in elderly that requires an approach of chronic care. The facilities for the treatment of mental health problems even in young adults in India are not adequate, and Mental Health Care Act, 2017 highlights this issue, and there is a need for prompt action to improve this situation. Elderly being a vulnerable population have more risk factors and also have more barriers in access to treatment. The National Programme For Health Care of the Elderly launched few years back to promote active and healthy aging in elderly has not yet been implemented actively. Therefore, there is an urgent need for policies and geriatric mental health services to focus toward this neglected population.
| Aging Population|| |
According to a 2016 report by the Ministry for Statistics and Programme Implementation, India has 103.9 million elderly, i.e., people above the age of 60 years, which constitutes for about 8.5% of the population. The elderly population has grown at about 3.5% per year, double the rate for the population as a whole. In addition, a 2014 report by the nonprofit organization, Help Age India shows that India will be the youngest country in the world by 2020, but by 2050, as many as 325 million people, or 20% of the population, will be “elderly.” Therefore, while the overall population of India will have grown by about 40% between 2006 and 2050, the report adds, the elderly population will have grown by 270%.
This, consequently, would also result in an increasing burden of geriatric health care, especially mental health. Older adults are considered a high-risk category for developing mental disorders and substance use problems. Combined with the scarcity of resources targeted for the elderly population, this could result in India approaching a silent epidemic.
| Burden of Mental Health Problems|| |
The mental health problems frequently encountered in the elderly include dementia and mood disorders, depression in particular. The average prevalence of mental health problems in the rural and urban communities indicate that 20.5% of the older adults are suffering from one or the other problems (urban 17.3% and rural 23.6%).
| Physical Comorbidity|| |
Elderly have a high risk for chronic medical illnesses such as diabetes mellitus, hypertension, and ischemic heart disease. Elderly with mental health problems commonly have coexistence of other medical problems as comorbidity. Persons who have a chronic medical illness are more susceptible for mental disorders such as depression and anxiety with a prevalence of between 20% and 40%.
People with severe mental disorders are less likely to be treated for physical conditions and less likely to receive preventive health care. There are many barriers to receiving health care for the severely mentally ill, including – lack of integration of mental and physical health care services, socioeconomic disadvantage, cognitive limitations, and lack of motivation.
| Impact of Mental Health on Outcome of Other Medical Illnesses|| |
The presence of comorbidity of general medical illnesses and mental health problems has an adverse impact on each of them. The presence of mental health problem increases the risk for poor outcome for coexisting medical illness both due to direct effect as well as possible due to poorer drug compliance.
| Mortality and Suicide|| |
Elderly with mental health problems have reduced life expectancy due to earlier mortality. The increase in mortality rate is due to early death due to both medical illnesses and due to suicide. The elderly is among the population with the highest risk for suicide and particularly high rate of completed suicide in those who attempt suicide.
| Caregiver Burden|| |
Elderly with mental health problems, particularly those with dementia, have severe disability and become dependent on caregivers for most of the complex and basic activities of daily living. The common presence of behavioral and psychological symptoms associated with dementia is another important contributing factor for significant caregiver burden.
| Economic Burden|| |
Many healthy elderly people contribute to the economy directly by being independent and engaging in gainful employment. When elderly develop mental health problems, very often they have to give up employment and are unable to contribute to the family income. The dependency of family caregiver is very high for most of the elderly with mental health problems like dementia as there is a lack of adequate support systems such as daycare and other rehabilitation services. Many of the caregivers have to give up their regular employment to fulfill the role of caregiver. These factors contribute to significant economic burden due to direct and indirect cost.
| Treatment Gap|| |
Elderly in general and particularly those from developing countries have poor awareness on mental health issues and hence do not seek treatment early when they develop mental health problems. The presence of bias due to ageism in the general population as well as in health professionals contributes to the view of mental health problems such as depression and cognitive impairment as normal for elderly. This contributes to the delay in appropriate intervention for mental health problems in elderly. In view of these factors, there is a significant treatment gap for elderly with mental health problems with only less than one third receiving treatment.
| Resources Workforce|| |
The health professionals in primary care as well as other general health-care facilities do not have adequate training in mental health issues. Primary care physicians often fail to identify or treat mental illness in older adults.
The availability of mental health professionals is very inadequate in India, particularly in the semi-urban and rural settings. The availability of professionals with adequate expertise in geriatric mental health is even lacking. The trained workforce in the field of geriatric medicine and geriatric mental health is very inadequate, considering the population size of elderly, and prevalence of mental health problems. The specialty training in geriatric mental health is available only in very few centers in India.
| Vision of Iagmh for National Mental Health Policy for Elderly|| |
The vision of the National Mental Health Policy for the Elderly is to enable more people to grow old with good mental health and well-being, promote de-stigmatization, prevent possible mental health problems, and make provisions to guarantee access to high quality treatment and care for those suffering from a mental disorder, recovery from mental illness and to contribute to the progress of the society.
| Strategic Directions and Recommendations of Action|| |
- Recognition of geriatric mental health
- Mental health promotion and preventive interventions
- Community care/Primary care
- Improved availability of adequately trained geriatric mental health professionals and resources
- Support to caregivers
Recognition of geriatric mental health
- Mental health-care needs of the elderly must be recognized, and high priority has to be given
- Develop relevant policies, programs, laws, and regulations with implementation and monitoring systems
- Appropriate plans with adequate budget
- Increasing the government's attention to the preservation and promotion of the mental health of the elderly.
Mental health promotion and preventive interventions
- Promote the concept of “Ageing in Place” or “Ageing in own home,” housing, income security, old age pension, home care services, and access to health-care insurance schemes to facilitate and sustain dignity in old age
- Efforts should be made to strengthen the family system so that it continues to play the role of primary caregiver in old age. This would be done by sensitizing younger generations and by providing tax incentives for those taking care of the older generations
- From early age, citizens should be encouraged to contribute to a government-created health-care fund that will help in meeting the increased expenses on health care after retirement
- Support of promotion and establishment of senior citizens' associations, especially among women
- Legal support: Revocation of transfer of property by elderly people in case of negligence by caregivers. Extending legal support to elderly, through tribunals at the district level
- Facilities such as elder's helpline and improving access for free legal aid are required to facilitate the protection of rights of elderly with mental health problems
- Provisions of social security
- Legal provisions available to ensure the safety of elderly to protect their rights and protection from abuse and exploitation
- Establishment of old age homes at district level for indigent elderly people. Recreational facilities have to be established
- Developing residential, respite, and day care facilities at every district
- Ensuring that the residential homes that exist should have paid and trained staff with mental health-care facilities, with a well laid out guideline for practice
- Developing a positive attitude toward the elderly in the community, promoting social inclusion, and eliminating discrimination
- Increasing awareness about the fact that participation in meaningful activities contributes to mental well-being in old age
- Measures against social isolation can keep old people “engaged” with the community and reduce the risk of mental disorders
- Housing and outdoor environments are key factors for active lifestyles
- Employment of older adults promotes mental health and economic growth
- Provide public education and outreach to address the issues of stigma and ignorance of geriatric mental health
- Prevention of vascular risk factors; adequate nutrition; promotion of physical activity; and healthy lifestyle since adulthood
- Improving physical health and the management of chronic illness can prevent mental disorders
- Prevention of elder abuse
- Mental health promotion campaign
Community care/primary care
- Integration of mental health care with general health care by providing the necessary training for primary care physicians
- Need for special services in both outpatient and inpatient mental health services
- Home-based interventions: By health workers
- Training of medical and paramedical professionals
- Increase access to services through service expansion, increased mobile- and community-based services and increase affordability
- Enhance the quality of care and treatment in community; to decrease the barriers to treatment
- Address the cultural differences
- The development of a proper referral system
- With the improvement in technology, interventions based on the mobile technologies or telemedicine/telepsychiatry may be used to provide care of the elderly in remote places
- Involving community health workers, primary and secondary health-care providers as the first line care providers
- Responders to manage and prevent mental health disorders in early stages
- Guaranteeing general and special nursing home services and an adapted environment for elderly with mental and behavioral disorders, securing the accessibility of specialized services
- Increase funding and to develop models for service delivery
- Public–private partnership, involvement of NGOs.
Improved availability of adequately trained geriatric mental health professionals and resources
- Improvement of geriatric mental health care from the subcenter to the tertiary care center
- Initiating dedicated mental health services for elderly in all postgraduate centers
- Establishment of Geriatric Mental Health Units in higher tertiary centers
- Ensuring training in geriatric mental health for professionals of health care at various levels
- Every training program for any health-care practitioner needs to incorporate some level of competence in geriatrics.
- Recovery-oriented approach supports the caregivers and provides information to the public about the journey toward recovery
- Enable people with mental illness to remain in or return to the community and avoid institutionalization; offer home services.
Support to caregivers
- Provide support and education of family caregivers of older adults, for older family members caring for adult children with mental disabilities and grandparents raising their grandchildren.
- Increase research on geriatric mental health: epidemiological, biomedical, clinical, services, and systems research.
Following members of IAGMH contributed to the formulation of policy and the document: Abdul Maajid, Ajit Avasthi, Alka Subramanyam, Dalton N, G Prasad Rao, Gautam Saha, Indira Sharma, Jahnavi Kedare, K S Shaji, Mathews Varghese, Nishamani Pandey, O P Singh, P T Sivakumar, S C Tiwari, S P Gupta, Sandeep Grover, Shiv Gautam.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.