In this article, ILC’s Senior Health Policy Lead, Esther McNamara, reflects on the impact of ageism on understanding and treating mental health. 

Are ‘Boomers’ as unsympathetic and dismissive of mental health and its impacts, and are ‘Gen Z’ as self-indulgent and fragile, as we might be led to believe? 

If you’re interested in mental health and follow the public discourse around it, you would have noticed age and intergenerational conflict is often at its centre. In some media circles where engagement is paramount (and simplified provocations drive engagement), you’d be forgiven for thinking that different age groups are working with an entirely different understanding of what mental health is, and differing opinions on what needs to happen next following symptoms or a diagnosis. 

Ageist assumptions and intergenerational conflicts and misunderstandings have permeated the public conversation about mental health, and addressing both will be key to reducing the burden of mental health diseases, and the stigma that surrounds them. 

Last week was Mental Health Awareness week, and as part of ILC’s ongoing programme of work ‘Mental Health Matters’, it is important to interrogate the age-related stereotypes that can seem built-in to our public discourse, and identify where the burden of disease actually falls. By acknowledging the limitations of these age-based distinctions and focusing on the psychosocial needs of underserved groups we can more effectively respond to the rising burden on mental ill health in the UK and around the world. 

What we have seen throughout this project is that mental health across the UK is characterised by inequalities, particularly by age and socioeconomic background. We need to challenge the orthodoxies that delineate us by age group, which leaves both younger and older people feeling sidelined and disconnected. For a more cohesive society, we must prioritise equitable access to mental healthcare, and to the communities and activities that make our lives more meaningful. Failing to do so can result in huge collective losses for our families, communities, workplaces, and the economy.  

In 2022-23, 17.1 million working days were lost due to work-related stress, depression, and anxiety in the UK alone. Mental ill health or distress was the most cited reason for absence. The average number of days off per person suffering was 19.6(1) – almost a month of working days lost. The increasing number of young workers impacted is concerning, with evidence showing younger workers are more likely to be absent from work due to mental ill health than older colleagues.(2)   

Previous ILC research on the lifelong impact of poor mental health during our younger years showed it had a significant impact on an individual’s employment trajectories in later life. Our research advocated for a life course approach to mental health, and outlined the cost-effectiveness it has for economies when people are mentally well and productive. It is important younger people participate in the workforce and in activities that matter to them, and providing appropriate mental health support is key to ensuring symptoms do not preclude them. However, we also wish to avoid an undue focus on younger people for economic reasons: even if retired people are not contributing to the economy through paid work, there is still a moral and economic imperative to make sure they are not left behind with regards to mental healthcare. 

A key observation raised by experts interviewed as part of our research for the ILC’s ‘Mental Health Matters’ project is that younger people are spending more time educating themselves about mental health ill health: the signs and symptoms, the impact, and their similarities and differences to physical ill health. Several interviewees pointed out people of all ages can draw upon less reputable sources with regards to mental health information, but younger people are perhaps more likely to access and act on this. Concerns about increasing self-diagnosis(3) amongst the young adults are well-founded and rooted in the evidence. However, there are a range of factors that affect each individual’s mental wellbeing and causation is extremely difficult to establish for huge cohorts. 

For both more and less acute mental health conditions, the socioeconomic context in which people are living, working, and making decisions can be a significant determinative of their mental health outcomes. In 2023, nearly a quarter of 17- to 19-year-olds (23.3%) and one in five 20- to 25-year-olds (21.7%) in England had a probable mental health disorder. This same study found young adults with a probable mental disorder were three times more likely to have insufficient disposable income to take part in activities such as sports, days out, or socialising with friends, compared with those unlikely to have a mental disorder (26.1% compared with 8.3%). Put another way: having enough disposable income to participate in sport and activities regularly is a protective factor for positive mental health outcomes. 

Older people also face a range of barriers to getting support. Older groups are less likely to have constructive discussions about mild to moderate anxiety and depression with GPs and healthcare practitioners which result in a referral or a suggestion that the patient self-refer for talking therapy.  

This is even though older adults have similarly positive outcomes and better adherence to other groups when accessing talking therapy. Yet despite the positive results, the evidence we have gathered suggests clinicians can unconsciously hold ageist assumptions about their older patients: assuming older people are less receptive to mental health referrals, less likely to engage and complete the treatment. People over 65 with symptoms of depression and anxiety are often considered by referring GPs to be less treatable, particularly through online treatment services. (4) In many cases, other physical health issues are likely to take up the limited time they have for a consultation.  

A range of other factors can affect our mental wellbeing: poor housing(5), loneliness(6), pressure to attain and achieve in schools and workplaces.(7) Such factors have been exacerbated by the uncertainty of living through a pandemic and the cost-of-living crisis that followed. Social and economic barriers to participation in ordinary leisure activities seem to be a key part of the prevalence of mild-moderate anxiety and depression: austerity measures in the UK may have had far-reaching consequences for people in the UK living in poverty, and people with mental health issues are “overrepresented in this group”.(8)  

Tackling ageism and ensuring that all age groups have equitable access to mental healthcare are two key steps to equitably reducing the burden of mental health issues in the UK. We must begin by focusing on meeting the basic psychosocial needs of underserved groups, who are disproportionately underserved by the current system. If we are to live longer lives that are happier, healthier, and more productive, some significant changes are needed. Investing in and prioritising mental health across age groups, and focusing on unmet need, is crucial to keep our economy sustainable and our societies fulfilled and productive. Without action being taken now, our economy and society will pay a higher cost in the long run. 

ILC UK have received unconditional grant funding from Boehringer Ingelheim to conduct this programme of work. All editorial decisions, and all views expressed, are those of ILC UK. 

Citations:

(1)https://www.hse.gov.uk/statistics/dayslost.htm#:~:text=Stress%2C%20depression%20or%20anxiety%20and,around%2015.8%20days%20off%20work.

(2) https://www.resolutionfoundation.org/app/uploads/2023/06/Left-behind.pdf

(3) https://www.hopkinsmedicine.org/news/articles/2023/08/social-media-and-self-diagnosis

(4) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6048732/

(5) https://www.mind.org.uk/information-support/guides-to-support-and-services/housing/housing-and-mental-health/

(6) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9765084/pdf/igac059.614.pdf

(7) https://www.sciencedirect.com/science/article/pii/S0165032723008510

(8) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6025145/