By: Rochelle Amour MSc, Research Fellow, Caribbean Institute for Health Research

Mental health is a complex, connected issue, yet it is often excluded from conversations about ageing. Persons living with serious mental illness (*SMIs) pose both a challenge and opportunity for ageing landscapes, both in developing and developed societies. The challenge is that these persons tend to die 10 to 20 years earlier than their peers, an often preventable and unjustifiable phenomenon; while the opportunity lies in the fact that improving the health and longevity of persons living with SMIs has proven returns on a country’s productivity, wealth and resources.

Serious mental illness and ageing- an academic and moral challenge

Persons living with SMIs are 2 to 4 times more likely to die of unnatural causes. In order to tackle this incredibly pervasive and life-threatening state of affairs, the World Health Organisation launched its Guidelines on management of physical health conditions in adults with severe mental illness at the Healthier, Longer Lives Conference in New York in November 2018. The guidelines aim at ‘an integrated approach to health care for persons living with SMIs to decrease morbidity and premature mortality’. In other words, the goal is to give persons living with mental disorders an opportunity for a long, healthy life- something that all human beings are entitled to.

The challenge we face is therefore both academic and moral. We must advocate and act for persons living with SMIs to become part of our ageing society, and better accommodate those who already are. Persons living with SMIs are 4 times more likely to be unemployed or partly employed – but are they sufficiently and competently included in our conversations on poverty among older adults? Or are they mentioned as an unfortunate aside? When we talk about healthcare over the life course to improve longevity, are we actively including mental health care, or is it a vague afterthought? Are we inadvertently becoming part of the problem by excluding persons living with serious mental illness from conversations which have the power to change their lives?

These questions do not diminish the excellent, on-going mental health work which often takes place in pockets across our field. These questions simply highlight the need to better integrate mental health into our conversations, programmes and systems as we work to improve the lives of all older adults and improve the likelihood of longevity for all.

No wealth without mental health – an economic opportunity for ageing societies

At the Healthier Longer Lives Conference, Patricio Marquez, Lead Public Health Specialist at the World Bank, aptly demonstrated the economic opportunities of improving mental health and consequently the longevity of persons living with SMIs. Ideally, the idea of a long, healthy life for all should be motivation enough, but it is dangerous and naive to avoid the important role of money in our conversations about health and ageing. When we ask, How will we afford this?  instead of Who will pay for this? we come up with some tangible, viable answers. As economists, researchers and policymakers around the world have said time and time again, the answer may lie in investments. But what should we invest in? Human capital- the single most important economic asset. How do we secure human capital? By improving mental health.

To quote Patricio– ‘A growing body of evidence shows that the social and economic losses related to unattended mental conditions, including substance use disorders, are staggering. In the world’s most advanced economies…mental ill health affects an estimated 20 percent of the working-age population at any time…The high economic cost associated with mental health conditions is largely driven not by mental health care expenditure, but by lost productivity in the working-age population.’ The World Economic Forum and Harvard School of Public Health estimate that the direct and indirect costs of mental illness were 1.7 trillion in 2013. By 2030, that cost is expected to reach 6 trillion. This huge loss is reversible if we invest in the mental health of our people.

When investment into treatment and improvement of mental health was monetised and measured, it was found that for every dollar spent, there was a four dollar return. I’m no stock broker, but 3-1 is a solid investment, with promising implications. When persons have access to treatment and support, their productivity improves, and when less money is lost, more resources become available. In addition, when persons living with SMIs are supported and empowered to find and keep meaningful work, not only do they become active economic contributors (as they are at ‘clubhouses’ like Fountain House), but the demand on state support is reduced, while productivity is increased. This means, again, that more resources become available. 

As we consider how to prepare for and predict the challenges and opportunities of our ageing societies, let us work to ensure that all persons enjoy their right to live long, healthy lives. Let us ensure that persons living with mental disorders are integrated in a way that benefits families, societies and economies. As we discuss best practice going forward, let us acknowledge the power of mental health.

*‘Serious mental illness’ refers not only to schizophrenia, severe bipolar disorder and severe depression, but to any other mental illness which causes significant functional impairment and substantially limits major life activities