What is a mental health problem?

From Chapter 1: Introduction in Improving our Response to Older Adults with Substance Use, Mental Health and Gambling Problems: A Guide for Supervisors, Managers and Clinical Staff

Feeling sad or worried, having unusual thoughts or forgetful moments is most often normal. Everyone has these feelings and experiences at times. The distinction between normal emotions and thinking and a mental health problem is that a person with a mental health problem has:

• several symptoms

• symptoms that continue for a long time

• symptoms that cause distress and interfere with his or her ability to function in terms of self-care, work, leisure or relationships.

For example, symptoms of depression may include loss of interest or pleasure in daily activities, irritability, loss of energy and change in appetite. For depression to be diagnosed, the symptoms must persist for at least two weeks, most of the day, almost every day (American Psychiatric Association, 2000). An older person with depression may not eat well and may lack proper nutrition, lose interest in hobbies and become isolated.

Mental illness impairs a person’s thoughts, mood and behaviour. It is caused by unregulated brain chemistry, sometimes complicated by life circumstances, such as trauma or abuse, which may trigger the illness. Research points to a genetic factor in disorders such as schizophrenia, bipolar disorder and major depression.

Mental illnesses tend to be episodic or cyclical; a person may have episodes of acute illness, but also long periods of wellness. The exception is dementia with a continuing decline of function. The presence and course of mental health problems in older persons vary considerably in terms of their general health, diet, care setting, access to social supports and other life factors.

A strong support network that offers security and a sense of control over circumstances may help a person with mental illness to cope with his or her symptoms. Older persons with dementia or other late-life problems are more likely to have a strong social support network than people with long-term chronic mental health issues, such as early-onset schizophrenia or bipolar disorder. By the time people with long-term severe mental illness reach old age, they often have little or no contact and support from family. This can result in poverty, isolation and hospitalization.

Mental health problems in older adults

Mental health problems seen in late life include anxiety disorders, depression, personality disorders, psychotic disorders, dementia and delirium.

Anxiety disorders and depression can hit people in their later years, even when they have not experienced these problems as younger adults. The physical, social and economic losses associated with normal aging can overload people’s emotions, making them more vulnerable to these mental health problems.

Personality disorders or psychotic disorders, such as schizophrenia, that were present early in life often persist into old age. Symptoms or behaviours may either increase or decrease over time. Schizophrenia may also develop later in life, after age 40 or even after age 60.

Dementia is the most frequent cause of behavioural problems in older adults. The longer a person lives, the greater the chance of developing a dementia.

Delirium in older persons is often misdiagnosed or under-recognized. Symptoms such as confusion, disorientation and a clouding of consciousness can all be found in other types of mental health problems. However, with delirium, the symptoms usually begin abruptly, for example, after surgery, and may last only a few days. If left untreated, delirium can become a more permanent cognitive problem. Delirium is considered a medical emergency.

Each of these problems is discussed in greater detail in Chapter 3 of this book.