Memorandum by Age Concern
1. INTRODUCTION
1.1 Age Concern welcomes the opportunity
to submit evidence to the Select Committee Inquiry into policy
issues related to the European Commission Green Paper on Improving
the mental health of the population.
1.2 Age Concern England (the National Council
on Ageing) brings together Age Concern organisations working at
a local level and 100 national bodies, including charities, professional
bodies and representational groups with an interest in older people
and ageing issues. Through our national information line, which
receives 225,000 telephone and postal enquiries a year, and the
information services offered by local Age Concern organisations,
we are in day-to-day contact with older people and their concerns.
1.3 Age Concern England has set up an independent
Inquiry into Mental Health and Well-Being in Later Life, in partnership
with the Mental Health Foundation. The Inquiry is a UK-wide project
running until 2007. To date it has reviewed existing evidence
and gathered new information from over 1,000 older people and
200 organisations and professionals. The Inquiry will publish
two reports of recommendations—one on the promotion of mental
health and well-being in later life (due June 2006) and the other
on the provision of services and support to older people with
mental health problems and their carers (expected Spring 2007).
2. SUMMARY
2.1 Age Concern welcomes the European Commission
Green Paper and the proposal to establish a strategy on mental
health for the EU. We particularly welcome the Green Paper's emphasis
on promoting mental health and preventing mental illness.
2.2 An EU strategy on mental health would
be appropriate but it must include people of all ages. Mental
health in later life is a much neglected area in policy, practice
and research. In the UK, this neglect has resulted in the development
of an unfair system that disadvantages older people.[1]
Much more work is needed to ensure that older people's mental
health receives the attention it deserves.
3. WOULD AN
EU STRATEGY ON
MENTAL HEALTH
BE APPROPRIATE?
3.1 Age Concern supports the development
of an EU strategy on mental health. Mental health and well-being
are very relevant in achieving the common objectives of economic
prosperity, social justice and equality as set out in the Lisbon
Agenda. As noted in the Green Paper, mental health problems are
a growing challenge for the EU. In the UK, mental illness has
been called "our biggest social problem—bigger than
unemployment and bigger than poverty".[2]
Mental health problems are also a growing challenge for citizens
of all ages. Discrimination is a major barrier to social inclusion
and quality of life for people with mental health problems, and
even associated with shorter life expectancy.[3]
3.2 An EU strategy on mental health must
be considered in the context of demographic change and population
ageing, which are growing challenges for all Member States and
already regarded by the Commission as strategically important
for economic growth and social protection. In particular, a strategy
that includes actions to improve mental health in later life is
needed at this time.
3.3 Mental health problems in later life
pose a challenge for the EU and for citizens of all ages. Depression
is the most common mental health problem in later life, affecting
up to one in four people aged 65 and over,[4]
or 2.4 million people in the UK,[5]
at any one time. As the older population grows, this number will
rise to 3.1 million over the next 15 years[6]
if prevalence rates of depression stay the same; in fact they
are expected to rise.[7]
There are 5 million people with dementia in the EU and this number
is expected to double by 2040.[8]
The costs of care, including related pressures on the supply of
informal support from family and friends, will increase.
3.4 Mental health problems are not an inevitable
part of ageing. The majority of older people are in good mental
health and they make significant contributions to the economy
and to society. In the UK, workers aged 50 and over account for
a quarter of the nation's economic output.[9]
Older people add £24.2 billion in unpaid contributions as
volunteers, carers and grandparents.[10]
They boost the economy by a further £239 billion in consumer
spending.[11]
As the older population outgrows the younger population, society
will become increasingly reliant on older people's contributions.
Good mental health is crucial to enabling these contributions.
3.5 It is thus in the public interest to
promote good mental health and well-being in later life. The opportunity
to maximise older people's contributions and to minimise the costs
of care is one that no country in the EU can afford to ignore.
3.6 To date, mental health in later life
has been much neglected in policy, practice and research. In the
UK, it is recognised that the issue has fallen in the gaps between
mental health and ageing, with mental health policy tending to
focus on younger people and adults "of working age"
(meaning up to age 65), and ageing policy tending to focus on
physical health. More work is needed to ensure that older people's
mental health receives the attention it deserves, and to better
integrate the issue into existing national policies.
4. WHAT ELEMENTS
MIGHT AN
EU STRATEGY ON
MENTAL HEALTH
CONTAIN?
4.1 An EU strategy on mental health must
address the mental health needs of people of all ages, including
older people. It should incorporate a life course perspective
on ageing and mental health, and ensure that mental health promotion
and the prevention of mental illness are given priority.
4.2 The Strategy should incorporate the
findings of the UK Inquiry into Mental Health and Well-Being in
Later Life, which show that the following themes impact on mental
health for people of all ages, but particularly older people:
— Discrimination. Age discrimination
is the most common type of prejudice experienced by people aged
55 and over in the UK. Our evidence from older people has shown
that it has a very negative impact on mental health and must be
tackled as a matter of priority. Age discrimination within mental
health policy is a particular problem. The Strategy could help
to tackle this by ensuring that it does not discriminate against
older people, directly (eg by excluding them from consideration)
or indirectly (eg by presenting ageing negatively).
— Participation. Older people
want to make contributions to society and be recognised for them,
but they face barriers to participation in many areas of public
and private life.
— Relationships. Strengthening
positive relationships will help to promote mental health and
well-being for people of all ages. Isolation and loneliness are
a particular risk in later life and must be tackled. Intergenerational
contact should be encouraged.
— Physical health. Physical
health and mental health are inextricably linked. Improving physical
health will help to improve mental health as well. There is overwhelming
evidence for the mental health benefits of physical activity,
and older people also stress the importance of a healthy diet.
Improved planning, for example in the development of communities
with good local facilities which promote safe walking and cycling,
would fall within the remit of Regional Policy.
— Poverty. Poverty is a risk
factor for poor mental health. Nearly 2 million older people in
the UK live in poverty. Money is important for the things it can
provide to make people feel included in society. Confidence about
future financial security is important for mental health and well-being.
5. HOW MIGHT
AN EU STRATEGY
ON MENTAL
HEALTH COMPLEMENT
AND ADD
VALUE TO
OTHER STRATEGIES
AND ACTIVITIES?
5.1 A strategy that pays particular attention
to mental health promotion and the prevention of mental illness
will complement and add value to strategies and activities being
undertaken by Member States and other international bodies. The
promotion of good mental health and well-being for people of all
ages requires co-ordinated action across many different areas
of public policy, such as health, social inclusion, income support,
housing, transport, employment and education. An EU strategy will
provide a platform for sharing examples of good practice within
the UK and create opportunities for learning from others.
5.2 A strategy that pays equal attention
to older people will complement and add value to strategies that
are being developed for ageing populations across the EU. The
UK strategy for an ageing population, Opportunity Age,
aims to promote well-being in later life and enhance older people's
contributions to society. Improving the mental health of older
people can play an important role in realising these aims.
5.3 Other policy developments in the UK
that would be enhanced by the development of a strategy on mental
health include:
— Strategies to promote equality and
human rights, for example in the establishment of the Commission
for Equality and Human Rights, which will tackle discrimination,
including age discrimination and stigma experienced by people
with mental health problems.
— Strategies to tackle physical health
inequalities, which are often experienced by people with mental
health problems.[12]
— Strategies to tackle mental health
inequalities, which are often experienced by older people.[13]
— Strategies to tackle social exclusion,
which is experienced both by people with mental health problems[14]
and by older people.[15]
6. RECOMMENDATIONS
Age Concern recommends that the European Commission
should:
6.1 Prioritise the mental health needs of older
people, as they have been much neglected across the spectrum of
mental health services, including promotion, prevention, treatment
and care.[16]
6.2 Use the findings of the UK Inquiry into
Mental Health and Well-Being in Later Life to develop a strategy
on mental health promotion in later life.
6.3 Ensure that the strategy is "age
proofed" to take older people's needs into account. Specifically,
the Commission should further develop the following parts of the
Green Paper:
— Pages 4-5: By acknowledging the costs
to society of mental ill health in later life.
— Page 8: By identifying a setting
for action for older people, similar to the settings that have
been identified for children (schools) and working adults (workplaces).
— Page 10: By recognising that suicide
is an important issue for older people, as suicide rates tend
to increase with age; globally the highest rates are among men
aged 75 and over[17].
— Page 16: By ensuring that all statistics
and figures include adults aged 65 and over.
6.4 Eliminate the use of age discriminatory
language such as the distinction between "the working population"
and "older people". Many older people still work. With
the EU employment directive on Age Discrimination coming into
effect in the UK in October 2006, the term "working age"
will become outdated and meaningless.
1 Healthcare Commission, Audit Commission and Commission
for Social Care Inspection, Living well in later life: A review
of progress against the National Service Framework for Older People,
Commission for Healthcare Audit and Inspection, 2006. Back
2
Layard, R, Therapy for all on the NHS, Sainsbury Centre Lecture
6 September 2005, Sainsbury Centre for Mental Health, 2005. Back
3
Social Exclusion Unit, Mental health and social exclusion,
Office of the Deputy Prime Minister, 2004. Life expectancies for
people with schizophrenia are 10 years less than the average. Back
4
Godfrey, M et al, Literature and policy review on prevention
and services, UK Inquiry into Mental Health and Well-Being
in Later Life, 2005. Godfrey et al estimate that one in seven
people aged 65 and over have "major" depression which
is severe and persistent and disrupts day-to-day functioning.
The proportion rises to one in four if we include all depressions
which are severe enough to impair quality of life. Back
5
Based on Government Actuary's Department estimates, there are
currently 9.7 million people aged 65 and over in the UK. Back
6
Based on Government Actuary's Department projections, the number
of people aged 65 and over in the UK will increase by nearly 30
per cent to 12.5 million in 2020. Back
7
Sainsbury Centre for Mental Health, The economic and social
costs of mental illness, 2003. Back
8
Ferri, CP, et al "Global prevalence of dementia: a Delphi
consensus study", The Lancet 2005 Dec 17;366(9503):2112-7. Back
9
Age Concern England, The ageing workforce, forthcoming. Back
10
Meadows, P, The economic contribution of older people, Age
Concern England, 2004. Back
11
Office of National Statistics, Household expenditure by age of
household reference person 2004-05, Family Spending Survey,
2005. Back
12
Disability Rights Commission, Equal treatment: Closing the
gap, Interim report of a formal investigation into health inequalities,
2005. Back
13
Healthcare Commission, Audit Commission and Commission for Social
Care Inspection, Living well in later life: A review of progress
against the National Service Framework for Older People, Commission
for Healthcare Audit and Inspection, 2006. Back
14
Social Exclusion Unit, Mental health and social exclusion,
Office of Deputy Prime Minister, 2004. Back
15
Social Exclusion Unit, A sure start to later life: Ending
inequalities for older people, Office of the Deputy Prime
Minister, 2006. Back
16
National Institute for Mental Health in England, Making it
possible: Improving mental health and well-being in England, Care
Services Improvement Partnership and the National Institute for
Mental Health in England, 2005. Back
17
Bertolote, JM and Fleischmann, A, "A global perspective
in the epidemiology of suicide", Suicidologi 2002;7(2):6-8. Back
| 
