Let’s Not Talk About Mental Illness

Then we won’t have to talk about late-life suicides, either.

Photo by British Library on Unsplash

We have no problem talking about our physical health. We’re happy to tell you about our new hip, our defibrillator implant, and our gym routine. Get any two older adults together and there’s a good chance of hearing what’s known as an organ recital.

Mental health is another matter.

We don’t like to talk about it with our friends. We don’t even like to talk about it with our doctors – we’re far more likely to discuss physical symptoms, a key reason the data on late-life depression and anxiety are underreported.  

Let’s not talk about it. It makes us uncomfortable. It’s embarrassing. It’s something we fear. You might say it’s the last major taboo.

And while we’re at it, let’s not talk about late-life suicide either. We don’t want to give people ideas.

As long we don’t talk about it, we don’t have to recognize that the highest rate of suicide in the U.S. is among men aged 85 and up. We can ignore the fact that older adults comprise 12% of the population but account for nearly 18% of suicides. And we can ignore the fact that older adults are far more likely to succeed in suicide attempts than any other group – an ironic example of the value of more life experience. Older adults plan more carefully and use deadlier methods.

And as long as we don’t talk about suicide, we can avoid the whole debate over whether older adults should have the right to terminate their own lives in the face of agonizing pain or unbearable loneliness – a term medical ethicists call “rational suicide.”

Why We Hate to Talk About It

We don’t like to talk about it because mental illness carries a stigma. Yes, in the 21^st century, in spite of celebrities opening up about their mental struggles and despite public awareness campaigns to bring mental illness into the light, the stigma remains strong. In a British survey several years ago, people said  it would be far easier for them to come out as gay than to admit publicly to mental illness. And with reason: In another study, more than 60% of employers felt they could not employ someone with a mental health problem. Admitting to mental health issues also dooms many romantic relationships.  

I know something about this, as I am no stranger to mental illness myself. I have been in treatment for depression for nearly 30 years. That hasn’t kept me from being a functioning, contributing member of society, but it has cost me thousands of dollars in additional life insurance premiums. I happen to think insurance companies, and the rest of us, should be able to make a distinction between treatable conditions like depression or anxiety and severe conditions that lead to erratic behavior or danger to others. But the insurers don’t, and most of us don’t. Our first impulse is to treat anything labeled mental illness with fear, loathing, and avoidance.

But If We Did Talk…

Imagine what might happen if we did decide to talk openly and compassionately about mental illness – and in particular, mental illness among older adults.

1.       We might combat the widespread belief that depression is a natural part of being old. It is not. According to The State of Mental Health and Aging in America, only 9% of adults 50 or older experience frequent mental distress, which can include depression, anxiety, or severe cognitive impairment. Depression is treatable in 80% of cases. But because of our reticence to talk about it, depression among older adults is widely under-recognized and undertreated.

2.       We might change the fact that fewer than half of older adults who need mental health care get it. Professionals are under-trained in treating older adults and therefore avoid treating them, says Regina Koepp, a clinical psychologist and founder of the Center for Mental Health and Aging. Insurance coverage is also spotty. Medicare does not reimburse all types of mental health providers, including counselors.

3.       We might weaken the stigma around mental illness. Stigma comes in three flavors: public stigma is negative attitudes that others have, institutional stigma the policies in government and private organizations that limit opportunities for people with mental illness, and self-stigma – the hardest of all to crack – is the negative attitudes and the internalized shame that people with mental illness have about their own condition. Our brains understand that mental illness is brain chemistry and no more the fault of the patient than a bad kidney. Our emotions, however, find mental illness dangerous and a mark of disfavor.

4.       We might counter the unfortunate ageist belief that the lives of older adults matter less than the lives of other adults and children. It’s that notion that undergirds the medical community’s lack of interest in geriatric medicine and its lack of curiosity about late-life mental illness and suicide. It’s that notion that dooms many older adults to live with untreated mental illnesses that become more debilitating over time.

5.       We might be more outraged at the high numbers of suicides in nursing homes, assisted living centers, and adult care homes. When frail older Americans manage to kill themselves in institutions designed to keep them safe, secure, and supervised, we could ask questions about whether those institutions are paying adequate attention to mental health risk factors.

6.       We might spread the word about the new national suicide prevention hotline (Dial 988 or https://988lifeline.org), launched a year ago, which links people in crisis or concerned friends, family, and caregivers to counselors providing free, unbiased, and confidential support 24/7.

7.       We might learn the five action steps we can take if we know an older adult considering suicide:

•        Ask if you can help, in a supportive and nonjudgmental way.

•        Be there, to ease feelings of isolation and provide a sense of connection.

•       Keep them safe. If they have a suicide plan in mind, try to remove the necessary tools.

•        Help them connect to support systems.

•       Follow up. Be sure to check in with them.

Or we can just not talk about it. Ever.