As Australia’s population ages, providing appropriate and effective mental health care for older adults will require an ongoing focus. Despite growing awareness of the harmful effects of mental illness on a person’s day-to-day functioning and relationships, adults aged 65 years and over continue to under-utilise mental health services compared to younger adults.

In Australia, results of the ABS 2007 National Survey of Mental Health and Wellbeing revealed that adults aged 75–85 years with mental health needs reported some of the lowest rates of mental health service use compared to other age groups (Slade, Johnson, Oakley Browne, Andrews, & Whiteford, 2009). Similar trends have been reported in the USA, Canada and Britain (Wuthrich & Frei, 2015).

Beyond the immediate impacts on wellbeing and quality of life, untreated mental ill health in older age can lead to a deterioration in overall health, increased hospital admissions and an earlier transition to residential aged care facilities (Muir-Cochrane, O’Kane, Barkway, Oster, & Fuller, 2014).

Why do older adults under-utilise mental health services?

Research has identified a range of factors that may act as barriers to appropriate mental health care for older adults. These barriers include:

• a lack of services specialising in mental health care for older adults (Muir-Cochrane et al., 2014)
• the prioritisation of physical health care above mental health care for older adults (McCabe, Davidson, Mellor, & George, 2009)
• older adults’ poor mental health literacy (Wuthrich & Frei, 2015)
• the stigma associated with mental illness (McCabe et al., 2009; Stargatt et al., 2016).

An under-researched barrier to mental health care for older adults is the assumption that mental illness is a normal part of the ageing process (Sarkisian, Lee-Henderson, & Mangione, 2003; Wuthrich & Frei, 2015).

Normalising mental illness in older age may act as a barrier to an older adult’s inclination to recognise a need for help, as well as a barrier to the identification, assessment and treatment of mental illness by professionals. Available research suggests that professionals in aged care services tend to view depression as a normal consequence of ageing, and pay less attention to the impact that depressive illness can have on older adults than other age groups (McCabe et al., 2009; Wuthrich & Frei 2015).

In an international study conducted by Sarkisian and colleagues (2003), it was found that older adults who believe depression is a normal part of ageing were four times more likely to believe it’s not important or necessary to seek help from a doctor or mental health professional. In more recent Australian research, a survey of 60 older adults with mental health disorders revealed that 50% of study participants believed their symptoms of anxiety and depression were normal given their age (Wuthrich & Frei, 2015).

What is ‘normal ageing’?

Schaie (2016) suggests that normal and healthy ageing involves:

• maintaining a consistent level of psychological functioning through your early 60s
• experiencing some declines in physical and cognitive functioning into your 80s  
  and
• experiencing increased deterioration after this.

Research into the barriers to mental health care for older adults has highlighted that increased mental illness is not included in the normal profile of ageing (Sarkisian et al., 2003; Schaie, 2016).

Cognitive decline, medical illness or normal expressions of grief and loss may be difficult to differentiate from signs of mental illness in older age. It can be challenging to identify mental illness in older age when these other factors are present. However, the challenges associated with identifying mental illness in older age are compounded when older people and professionals accept it as a normal or inevitable part of ageing. When mental illness in older age is normalised, then appropriate and targeted supports are less likely to be offered by services and are less likely to be sought by older adults.

Conclusion

Further research is needed to achieve a better understanding of the barriers to mental health care and access to mental health services for older adults. A greater focus on the harmful effects of normalising mental illness or not properly diagnosing mental illness in older age should inform the development of new strategies and policies to address the under-recognition and treatment of mental illness in older adults.

The under-utilisation of mental health services suggests that better diagnosis of mental illness in older age is needed, including the support that practitioners may need to help identify the signs of mental illness. Greater capacity in recognising signs of mental illness will help remove barriers that may currently prevent older people from receiving the treatment that would improve their mental health and wellbeing.

Related resources

• Fact or fiction? Stereotypes of older Australians Research Report 2013  
  This report, published by the Australian Human Rights Commission, examines the prevalence and depth of stereotypes and negative attitudes towards older Australians.
• Depression in older people (PDF)  
  This fact sheet, published by the Black Dog Institute, provides an overview of the signs, types, causes and treatment of depression in older people.
• Supporting recovery in families affected by parental mental illness  
  This CFCA practice paper outlines ways in which practitioners can support healing and recovery in families affected by parental mental illness.
• Placing family at the centre of mental health recovery  
  This CFCA webinar outlined ways in which practitioners can support healing and recovery in families affected by parental mental illness.

References

McCabe, M. P., Davidson, T., Mellor, D., & George, K. (2009). Barriers to care for depressed older people: Perceptions of aged care among medical professionals. International Journal of Aging and Human Development 68(1), 53–64.

Muir-Cochrane, E., O’Kane, D., Barkway, P., Oster, C., & Fuller, J. (2014). Service provision for older people with mental health problems in a rural area of Australia. Aging & Mental Health, 18(6), 756–766.

Sarkisian, C. A., Lee-Henderson, M. H., & Mangione, C. M. (2003). Do depressed older adults who attribute depression to “old age” believe it is important to seek care? Journal of General Internal Medicine, 18(12), 1001–1005.

Schaie, K. W. (2016). Theoretical perspectives for the psychology of aging in a lifespan context. In K. W. Schaie & S. L. Willis (Eds.), Handbook of the psychology aging­­ (8th ed., pp. 3–13). New York: Academic Press.

Slade, T., Johnson, A., Oakley Browne, M. A., Andrews, G., & Whiteford, H. (2009). 2007 National Survey of Mental Health and Wellbeing: Methods and key findings. Australasian Psychiatry, 43, 594–605.

Stargatt, J., Bhar, S. S., Davidson, T. E., Pachana, N. A., Mitchell, L., Koder, D., Hunter, C., Doyle, C., Wells, Y., & Helmes, E. (2016). The availability of psychological services for aged care residents in Australia: A survey of facility staff. Australian Psychologist, 5(4), 1–8.

Wuthrich, V. M., & Frei, J. (2015). Barriers to treatment for older adults seeking psychological therapy. International Psychogeriatrics, 27(7), 1227–1236.