Depression affects over 6.5 million of the 35 million Americans aged 65 and older, and yet only 10% of them are receiving treatment for the condition. This indicates a deep failure on the part of our healthcare system to recognize and treat mental health problems in older adults. While numerous problems contribute to this failure, underlying assumptions about elderly people cause social, self-, and institutionalized stigmas that complicate the ability of older people with mental illnesses to seek treatment for psychiatric diseases.
Let’s briefly discuss some of the different types of stigmas based around mental illness in the elderly:

Social Stigma
• Social stigma against mental illness in the elderly is closely related to ageism, or the idea that older people are not as able to contribute to society as younger people.
• Oftentimes, depression and related mental illnesses are seen as normal aspects of the aging process. Events such as retirement, the death of loved ones, medical problems, and increased isolation can evince feelings of sadness and grief, but do not directly cause depression. With strong support from one’s family or therapist, these distressing events may be successfully overcome. However, dismissing depression as an unavoidable side effect of aging drastically reduces the chances obtaining treatment for depression and related mental illnesses and can exacerbate the severity of the illness.
• The media commonly portrays elderly people with mental illnesses as childish, stubborn, and resistant to change. While this representation may stem from the self-stigma (discussed below), this portrayal only reinforces existing stereotypes of mental illnesses by imposing judgments on afflicted individuals rather than highlighting the need for change. In this sense, the media contributes to the problem.

Self-Stigma
• Self-stigma occurs for a variety of reasons, including fear of financial repercussions, embarrassment, isolation, and/or distrust of mental health services. At worst, elderly patients fear being institutionalized in psychiatric wards or old-age homes and where they will be cut off from their families and friends.
• The baby boomers’ emphasis on self-reliance in the face of difficulty also contributes to self-stigma. As such, self-stigma is directly caused by and contributes to social stigma.

Institutional Stigma
• Assumptions about older people based on the above stigmas can lead to misguided policy that in effect punishes the mentally ill. For example, Medicaid does not cover services for those suffering from mental illnesses, which means that patients are often forced to find more expensive healthcare plans. To complicate the issue further, many states are cutting funding for mental health services in an effort to balance the budget even while 1 in 6 Americans suffer from some sort of mental illness.

Each stigma is engendered by and reinforces the others.

Next week, we will discuss existing barriers to eliminating these stigmas and current efforts to bring awareness to the state of mental health services in America.

Sources

• Depression in Older Adults & the Elderly—http://www.helpguide.org/mental/depression_elderly.htm
• Goodell et al. “Health Policy Brief—Mental Health Parity.” Health Affairs, April 3, 2014. http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_112.pdf
• Mentally Healthy Aging: A Report on Overcoming Stigma for Older Americans. DHHS Pub. No. (SMA) 05-3988. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2005.
• Persky, T. “Overlooked and Underserved: Elders in Need of Mental Health Care.” http://www.mhaging.org/info/olus.html
• Tomasky, M. “The Great GOP Mental Health Hypocrisy.” The Daily Beast, Politics, 9/20/2013. http://www.thedailybeast.com/articles/2013/09/20/the-great-gop-mental-health-hypocrisy.html