UK: Speak Up – Tackling The Stigma Around Mental Health In The Elderly And Those At The End-Of-Life

Last Updated: 25 May 2017
Article by Mark Steedman

Last week marked both Mental Health Awareness Week and Dying Matters Awareness Week. These two separate campaigns run annually and, respectively, promote good mental health and the importance of talking about dying, death and bereavement. For our blog this week, our Manager Mark Steedman explores the challenge of addressing mental health in the elderly, including the impact associated with the stigma involved in talking about the problem, linking it to his experiences and interests in mental health and end-of-life care research.

Tackling the stigma around mental health in the elderly and those at the end-of-life

In my previous role at Imperial College, I spent a lot of my time working on health policy research around end-of-life care. One of the first things I learned is that there is stigma in talking about death and dying. It's intimidating. Many people are afraid to talk about death, to the extent that people fail to plan for the future – nearly two thirds of adults in the UK do not have a will.1 Far fewer have an advance care plan, which can help ensure patients' wishes are known and respected at the end of life, even if the patients are unable to express their wishes or lose their ability to make decisions.2

Similarly, there is also stigma around mental health, which we illustrated in our recent report At a tipping point? Workplace mental health and wellbeing. One in four people experience a mental health problem at some point in their life, yet there are wide inequalities in access to mental health care. Many people's mental health problems are made worse by the stigma and discrimination they experience from society, but also from families, friends and employers.3 Although 70 per cent of people with a mental health problem eventually fully recover,4 many individuals are afraid to speak up about their mental health out of fear that they will be ostracised at work or face long-term negative repercussions in their career.

The parallels between the stigma around mental health and end-of-life care have resonated with me for some time, and when I realised that both Mental Health Awareness Week and Dying Matters Awareness Week were the same week, I was inspired to research the links between the two areas.

It's accepted wisdom that our population is getting older. As our report on Better care for frail older people: Working differently to improve care showed, the population of over 75s in the UK increased from 4.4 million in 2001 to 4.9 million in 2010 and is projected to double in size by 2040. Similarly, those over 85 are the fastest growing segment of the population.5

As we age, many people develop long-term conditions such as heart disease, diabetes, hearing loss and osteoarthritis that affect their daily lives, and often people suffer from multiple conditions simultaneously. Many older adults also lose their ability to live independently due to factors such as limited mobility, chronic pain and frailty. Older adults are more likely to experience bereavement, loss of socioeconomic status due to retirement and disability, which can result in isolation, loss of independence and loneliness. Older adults are also more vulnerable to physical, sexual, psychological, emotional, financial and material abuse, as well as abandonment, neglect, and serious losses of dignity and respect.6 There is no question that these types of physical ailments, stresses and changes in quality of life can also have serious psychological repercussions.

At the end-of-life, particularly for people diagnosed with a terminal illness, depression can manifest at any time. However, onset can often occur after initial diagnosis or as the disease advances, often coinciding with increases in pain, and resulting in a decrease in a person's independence. The anxiety caused by the fear of dying can also often lead to depression, which can make their condition worsen.7

Yet many mental health problems in the elderly and those at the end-of-life are overlooked or misdiagnosed, and the aforementioned stigma hasn't gone away – people affected are still afraid to speak up.8 In over 65s, about 22 per cent of men and 28 per cent of women are affected by depression,9 and yet it is estimated that 85 per cent of these individuals do not receive any support or care from the NHS.10

Where these numbers manifest most tragically is through suicide. In 2012, the overall suicide rate in the UK for those 70 and over was 6.3 per 100,000.11 While these numbers are low compared to many other countries – for example in the United States it was 16.5 and in South Korea it was a staggering 116.2 – suicide prevention among the elderly is a preventable tragedy and should be a priority in the UK as well as around the globe.

So how do we overcome the stigma around mental health in the elderly and combat these figures?

In 2014, the World Health Organisation (WHO) produced a report on Preventing suicide: A global imperative that laid out nine areas of strategic action for ministries of health: engage key stakeholders; reduce access to means; conduct surveillance and improve data quality; raise awareness; engage the media; mobilise the health system and train health workers; change attitudes and beliefs; conduct evaluation and research; and develop and implement a comprehensive national suicide prevention strategy.12

More recently, in 2016 the WHO provided guidance specifically for treatment and care, including four ways to meet the specific needs of older adults:

  • training for health professionals in care for older persons
  • preventing and managing age-associated chronic diseases including mental, neurological and substance use disorders
  • designing sustainable policies on long-term and palliative care
  • developing age-friendly services and settings.13

Promoting active and healthy ageing in ways that ensure older adults have their basic needs met were also presented, including: providing security and freedom

  • adequate housing through supportive housing policy
  • social support for older generations and their caregivers
  • health and social programmes targeted at vulnerable groups such as those who live alone and rural populations or who suffer from a chronic or relapsing mental or physical illness
  • programmes to prevent and deal with elder abuse
  • community development programmes.14

Finally, the following interventions were recommended:

  • early diagnosis, in order to promote early and optimal management
  • optimising physical and psychological health and well-being
  • identifying and treating accompanying physical illness
  • detecting and managing challenging behavioural and psychological symptoms
  • providing information and long-term support to caregivers.15 

As an individual, I decided I also needed to do my part. I took a course on mental health first aid through Mental Health First Aid England. Although this course mainly focused on mental health in the workplace, the lessons were applicable to numerous situations, including any interactions I may have with older adults. I learned to spot the early signs of a mental health issue; gained more confidence helping someone experiencing a mental health issue; learned how to provide help on a first aid basis; learned how to help prevent someone from hurting themselves or others; learned to help stop a mental health issue from getting worse; learned how to help someone recover faster; and I learned how to guide someone towards the right support. Applying these techniques all work toward overcoming the stigma of mental health problems. In addition to all of this, I'm engaging in my own mental health. I'm speaking up about mental health. And I'm prepared to support my colleagues, friends and relatives if needed. I hope they will all do the same.

Footnotes

1 http://www.bbc.co.uk/news/uk-36325871

2 https://www.nursingtimes.net/clinical-archive/end-of-life-and-palliative-care/the-benefits-and-barriers-of-ensuring-patients-have-advance-care-planning/7014419.article

3 https://www.mentalhealth.org.uk/a-to-z/s/stigma-and-discrimination

4 http://citymha.org.uk/about-us/

5 Later Life in the United Kingdom, Age UK Fact sheet, February 2014.

6 http://www.who.int/mediacentre/factsheets/fs381/en/

7 https://www.mariecurie.org.uk/globalassets/media/documents/policy/policy-publications/october-2016/marie-curie-briefing-mental-health.pdf

8 http://www.who.int/mediacentre/factsheets/fs381/en/

9 http://content.digital.nhs.uk/pubs/hse05olderpeople

10 https://www.thetimes.co.uk/article/depression-in-old-age-is-the-next-big-health-crisis-vkb835j05f8

11 http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/

12 Ibid

13 http://www.who.int/mediacentre/factsheets/fs381/en/

14 Ibid

15 Ibid

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Authors
 
In association with
Up-coming Events Search
Tools
Print
Font Size:
Translation
Channels
Mondaq on Twitter
 
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
 
Email Address
Company Name
Password
Confirm Password
Position
Mondaq Topics -- Select your Interests
 Accounting
 Anti-trust
 Commercial
 Compliance
 Consumer
 Criminal
 Employment
 Energy
 Environment
 Family
 Finance
 Government
 Healthcare
 Immigration
 Insolvency
 Insurance
 International
 IP
 Law Performance
 Law Practice
 Litigation
 Media & IT
 Privacy
 Real Estate
 Strategy
 Tax
 Technology
 Transport
 Wealth Mgt
Regions
Africa
Asia
Asia Pacific
Australasia
Canada
Caribbean
Europe
European Union
Latin America
Middle East
U.K.
United States
Worldwide Updates
Check to state you have read and
agree to our Terms and Conditions

Terms & Conditions and Privacy Statement

Mondaq.com (the Website) is owned and managed by Mondaq Ltd and as a user you are granted a non-exclusive, revocable license to access the Website under its terms and conditions of use. Your use of the Website constitutes your agreement to the following terms and conditions of use. Mondaq Ltd may terminate your use of the Website if you are in breach of these terms and conditions or if Mondaq Ltd decides to terminate your license of use for whatever reason.

Use of www.mondaq.com

You may use the Website but are required to register as a user if you wish to read the full text of the content and articles available (the Content). You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these terms & conditions or with the prior written consent of Mondaq Ltd. You may not use electronic or other means to extract details or information about Mondaq.com’s content, users or contributors in order to offer them any services or products which compete directly or indirectly with Mondaq Ltd’s services and products.

Disclaimer

Mondaq Ltd and/or its respective suppliers make no representations about the suitability of the information contained in the documents and related graphics published on this server for any purpose. All such documents and related graphics are provided "as is" without warranty of any kind. Mondaq Ltd and/or its respective suppliers hereby disclaim all warranties and conditions with regard to this information, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Mondaq Ltd and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use or performance of information available from this server.

The documents and related graphics published on this server could include technical inaccuracies or typographical errors. Changes are periodically added to the information herein. Mondaq Ltd and/or its respective suppliers may make improvements and/or changes in the product(s) and/or the program(s) described herein at any time.

Registration

Mondaq Ltd requires you to register and provide information that personally identifies you, including what sort of information you are interested in, for three primary purposes:

  • To allow you to personalize the Mondaq websites you are visiting.
  • To enable features such as password reminder, newsletter alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our information providers who provide information free for your use.

Mondaq (and its affiliate sites) do not sell or provide your details to third parties other than information providers. The reason we provide our information providers with this information is so that they can measure the response their articles are receiving and provide you with information about their products and services.

If you do not want us to provide your name and email address you may opt out by clicking here .

If you do not wish to receive any future announcements of products and services offered by Mondaq by clicking here .

Information Collection and Use

We require site users to register with Mondaq (and its affiliate sites) to view the free information on the site. We also collect information from our users at several different points on the websites: this is so that we can customise the sites according to individual usage, provide 'session-aware' functionality, and ensure that content is acquired and developed appropriately. This gives us an overall picture of our user profiles, which in turn shows to our Editorial Contributors the type of person they are reaching by posting articles on Mondaq (and its affiliate sites) – meaning more free content for registered users.

We are only able to provide the material on the Mondaq (and its affiliate sites) site free to site visitors because we can pass on information about the pages that users are viewing and the personal information users provide to us (e.g. email addresses) to reputable contributing firms such as law firms who author those pages. We do not sell or rent information to anyone else other than the authors of those pages, who may change from time to time. Should you wish us not to disclose your details to any of these parties, please tick the box above or tick the box marked "Opt out of Registration Information Disclosure" on the Your Profile page. We and our author organisations may only contact you via email or other means if you allow us to do so. Users can opt out of contact when they register on the site, or send an email to unsubscribe@mondaq.com with “no disclosure” in the subject heading

Mondaq News Alerts

In order to receive Mondaq News Alerts, users have to complete a separate registration form. This is a personalised service where users choose regions and topics of interest and we send it only to those users who have requested it. Users can stop receiving these Alerts by going to the Mondaq News Alerts page and deselecting all interest areas. In the same way users can amend their personal preferences to add or remove subject areas.

Cookies

A cookie is a small text file written to a user’s hard drive that contains an identifying user number. The cookies do not contain any personal information about users. We use the cookie so users do not have to log in every time they use the service and the cookie will automatically expire if you do not visit the Mondaq website (or its affiliate sites) for 12 months. We also use the cookie to personalise a user's experience of the site (for example to show information specific to a user's region). As the Mondaq sites are fully personalised and cookies are essential to its core technology the site will function unpredictably with browsers that do not support cookies - or where cookies are disabled (in these circumstances we advise you to attempt to locate the information you require elsewhere on the web). However if you are concerned about the presence of a Mondaq cookie on your machine you can also choose to expire the cookie immediately (remove it) by selecting the 'Log Off' menu option as the last thing you do when you use the site.

Some of our business partners may use cookies on our site (for example, advertisers). However, we have no access to or control over these cookies and we are not aware of any at present that do so.

Log Files

We use IP addresses to analyse trends, administer the site, track movement, and gather broad demographic information for aggregate use. IP addresses are not linked to personally identifiable information.

Links

This web site contains links to other sites. Please be aware that Mondaq (or its affiliate sites) are not responsible for the privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of these third party sites. This privacy statement applies solely to information collected by this Web site.

Surveys & Contests

From time-to-time our site requests information from users via surveys or contests. Participation in these surveys or contests is completely voluntary and the user therefore has a choice whether or not to disclose any information requested. Information requested may include contact information (such as name and delivery address), and demographic information (such as postcode, age level). Contact information will be used to notify the winners and award prizes. Survey information will be used for purposes of monitoring or improving the functionality of the site.

Mail-A-Friend

If a user elects to use our referral service for informing a friend about our site, we ask them for the friend’s name and email address. Mondaq stores this information and may contact the friend to invite them to register with Mondaq, but they will not be contacted more than once. The friend may contact Mondaq to request the removal of this information from our database.

Security

This website takes every reasonable precaution to protect our users’ information. When users submit sensitive information via the website, your information is protected using firewalls and other security technology. If you have any questions about the security at our website, you can send an email to webmaster@mondaq.com.

Correcting/Updating Personal Information

If a user’s personally identifiable information changes (such as postcode), or if a user no longer desires our service, we will endeavour to provide a way to correct, update or remove that user’s personal data provided to us. This can usually be done at the “Your Profile” page or by sending an email to EditorialAdvisor@mondaq.com.

Notification of Changes

If we decide to change our Terms & Conditions or Privacy Policy, we will post those changes on our site so our users are always aware of what information we collect, how we use it, and under what circumstances, if any, we disclose it. If at any point we decide to use personally identifiable information in a manner different from that stated at the time it was collected, we will notify users by way of an email. Users will have a choice as to whether or not we use their information in this different manner. We will use information in accordance with the privacy policy under which the information was collected.

How to contact Mondaq

You can contact us with comments or queries at enquiries@mondaq.com.

If for some reason you believe Mondaq Ltd. has not adhered to these principles, please notify us by e-mail at problems@mondaq.com and we will use commercially reasonable efforts to determine and correct the problem promptly.