Today celebrates World Mental Health Day, an initiative to raise awareness about mental health disorders worldwide, which was instigated by the World Federation for Mental Health and the World Health Organisation over two decades ago. The theme this year is ‘Mental Health and Older Adults’.
Worldwide, the ageing population is increasing, with the current population aged 60 years and over expected to expand to 2 billion by 2050, as lifetime expectancy continues to rise. As a recent report, published by the World Health Organisation “Mental Health of Older Adults: Addressing a Growing Concern” identified, mental health problems are often under-recognised in this age group. Depression is common, accounting for 9.17 million Disability Adjusted Life Years (DALYS). Dementia is recognized as a public health priority and by, 2050 it is estimated that 115 million people will be affected, of which over 50% will be in low and middle-income countries (Yasamy et al, 2013)
People living with mental disorders (PLWMD) face many challenges in accessing appropriate care worldwide, and this is exacerbated in low and middle income countries (LMIC), where it is estimated 90% of those individuals suffering from a mental disorder do not receive treatment (Patel et al ,2010).
Stigma, the negative attitudes and labelling that occur based on prejudices and misinformation about mental illness, has serious consequences. Older adults, whilst respected in some communities, in others face significant stigma. This is the case in some parts of Malawi, for example, where older adults may be perceived as witches, and subsequently ostracized and even victimized within their local communities. This is an area that some Governments are starting to recognize requires action (http://www.nyasatimes.com/2013/08/24/elderly-not-witches-says-malawi-pres-banda).
Elder maltreatment has been defined by the World Health Organisation as “a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust that causes harm or distress to an older person”. It is estimated to affect 4-6% of older adults in High Income Countries (World Health Organisation, 2011). In low and middle-income countries, the situation is less clear.
Dementia, is not just a problem that affects the older adult population, and particularly in sub-saharan Africa, the spectrum of HIV-associated neurocognitive disorders may affect up to 50% of people living with HIV/AIDS.
Perspectives from the mental healthcare field in a low income country:
How does the epidemic of mental disorders translate to experience in everyday psychiatric practice in a low-income context? In my work in a psychiatric institution in one of the poorest countries in the world, Malawi, we are faced with challenges in offering basic levels of care to individuals who have often gone for many years without treatment. The result is that they often arrive in a life-threatening condition, in some cases exacerbated by their neglect within general healthcare services, in part due to the stigma they face even within the healthcare profession. Whilst we are fortunate to have a reasonable supply of medication within our hospital, provision of other important aspects of care, such as intensive nursing, occupational and rehabilitation and social therapy are limited. On discharge from hospital the level of community care provision is sparse, often represented by a single monthly clinic that has no supplies or resources for providing psychological or social therapies. In this context, there is a need to improve training and education of primary healthcare professionals in basic interventions for mental disorders. Even within a specialist hospital, we have few nursing staff who have undergone specialist mental health training, and many have not chosen to be deployed to work in this area.
World Mental Health Day has an important role to play worldwide, by raising public and professional awareness of these issues, in the hope that we will move towards a brighter future in which individuals experiencing mental distress and mental illness, are able to access appropriate care and treatment in a non-judgemental and supportive way, that is tailored to their needs and respects their basic rights. We still have a long way to go, but I am hopeful that World Mental Health Day will continue to be one of the many small steps required to raise awareness of the needs of people living with mental illness, one of the most vulnerable groups in society, whether in low-, middle- or high- income countries.
Dr Selena Gleadow Ware is a Consultant Psychiatrist and Lecturer in Mental Health at the College of Medicine, University of Malawi and Visiting Honorary Lecturer at Edinburgh University where she facilitates the module on Global Mental Health.
Patel V, Maj M, Flisher AJ, De Silva MJ, Koschorke M, Prince M; WPA Zonal and Member Society Representatives. Reducing the treatment gap for mental disorders: a WPA survey. World Psychiatry. 2010 Oct; 9(3):169-76.
World Health Organisation (2011) Elder Maltreatment. Factsheet No. 357 http://www.who.int/mediacentre/factsheets/fs357/en/
World Health Organization. Dementia, A Public Health Priority, 2012, World Health Organisation. http://whqlibdoc.who.int/publications/2012/9789241564458_eng.pdf
Yasamy, WT., Dua, T., Harper, M., Saxena, S. Mental Health of Older Adults: Addressing A Growing Concern. 2013. World Health Organisation. http://www.who.int/mental_health/world-mental-health-day/WHO_paper_wmhd_2013.pdf
World Mental Health Day: Mental Health Foundation