he world is celebrating the World Mental Health Day on October 10. This year’s theme – mental health is a universal human right – intimates the importance of mental wellbeing of everyone, especially the vulnerable segments of the population like the elderly. Mental health is an inseparable component of health. Just as physical health is recognised as a fundamental human right, mental health is accorded the same importance. According to the holistic definition propagated by the World Health Organisation, health is a “state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity.” Mental health of the elderly encompasses a state of integrity and completeness rather than just freedom from mental illnesses. This year’s theme also reminds us that achieving this state of mental health is not a privilege but a basic right for all. Mental health is not just an isolated right, it is intricately linked to the enjoyment of other human rights. When the elderly experience mental health issues or illnesses, their ability to exercise their rights to work; participation in family life and society; and access to healthcare are compromised.

Pakistan, like many other developing countries, is witnessing a rapid increase in its elderly population. According to the Pakistan Bureau of Statistics, the percentage of people aged 60 and above is projected to reach 10.2 percent by 2050. This demographic shift is largely attributed to improved healthcare and living conditions, resulting in increased life expectancy. As the nation’s demography shifts towards an ageing society, understanding and addressing the mental health challenges faced by the elderly becomes paramount.

Resource constraints in Pakistan, resulting in inadequate mental health infrastructure and services, disproportionately affect marginalised and vulnerable populations including the elderly. This is because limited resources force mental health issues among the elderly to become overshadowed by broader health concerns. Specialist elderly mental health facilities are unavailable in Pakistan and there is a lack of trained psychiatrists for the elderly. This shortage poses a challenge as the mental health needs of the elderly are in some respects distinct from those of younger populations. Training and incentivising professionals to specialise in elderly mental health is essential. While development of these services is on the cards for the College of Physicians and Surgeons of Pakistan and the Pakistan Psychiatric Society, there is still a long way to go before this supra-specialty gains recognition in the major psychiatric institutes of the country. On the governmental level, while some steps have been taken recently to improve mental health services in the country, there is a noticeable lack of specific programmes or policies tailored to address the mental health needs of the elderly.

Physical health problems are often intertwined with mental health issues. This is especially true for the elderly, where chronic illnesses, pain and disabilities can contribute to depression and anxiety. Integrated care that addresses both physical and mental health is necessary. Likewise, a multidisciplinary approach with strong liaison between psychiatry, neurology and medicine is needed for the care of people with dementia.

Cultural factors play a significant role in shaping mental health perceptions and behaviours in Pakistan. Elders are often expected to maintain stoicism and resilience in the face of adversity. Discussing mental health problems openly is uncommon. This can hinder early intervention and support. Elderly individuals often hesitate to seek help due to societal taboos and the fear of being labelled as “crazy”. Another significant barrier to addressing the mental health of the elderly in Pakistan is the lack of awareness, with many elderly individuals and their families not recognising mental health symptoms and considering them a part of normal ageing. Breaking down these stigmas and raising awareness about the importance of mental health is therefore crucial.

Social isolation, too, is a growing concern among the elderly in Pakistan. Although, traditionally the East boasts of a strong social fabric with its joint family system, now with more young people moving abroad or to urban settings for work, the traditional family structure is changing. Many of the elderly are left behind in rural areas or ageing homes. Loneliness can lead to depression and other mental health problems. Encouraging the development of community-based support programmes can provide much-needed assistance for elderly individuals living alone or with limited social interaction. These programmes can include counselling, recreational activities and social gatherings.

The prevalence of elderly abuse and neglect is disturbingly high. A study in 2019 found that 54 percent of the participants in a major city in Pakistan reported various kinds of abuse. Physical, emotional and financial abuse of the elderly can have severe psychological consequences. Another factor exacerbating mental health issues in the elderly is economic pressure, especially if they are living on inadequate pensions or have no financial support from their families. Legislative measures are required to promote independence in the elderly and to protect them against abuse.

To improve the mental health of the elderly, a multifaceted approach is needed. This includes raising public awareness, providing specialised training for healthcare professionals, establishing elderly mental health inpatient facilities and day care centres implementing government policies that focus on the unique needs of this population. By taking these steps, Pakistan can better address the mental health challenges faced by its elderly citizens, ensuring they enjoy a better quality of life in their golden years.

“In the end, it’s not the years in your life that count. It’s the life in your years.”

– Abraham Lincoln

The writer is a professor and chairman of the Institute of Psychiatry at Rawalpindi Medical University and the dean of the Faculty of Psychiatry at College of Physicians and Surgeons, Pakistan