When You Are Older, Your Mental Health is Not a Priority

Ageism is referred to as the last socially-acceptable prejudice by some experts. It’s bad enough in its day-to-day manifestations. It’s worse when it’s practiced by mental health professionals.

My experience with health care in general and mental health care in particular bears this out. I have suffered from depression my entire life. A number of attempts to deal with it went nowhere. Nevertheless, a few years ago as a newly minted senior, I decided to give therapy one last try, especially since it was among the services offered at the local senior center and Medicare was going to carry the cost.

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I will be the guest on a show hosted by my friend, Neil Parekh and his co-host, Dawn Helmrich Neuburg. It's Ep. 31 of “Shining Light on Shadows: A Candid Conversation About Mental Health,” Thursday, June 12 at 6pm CT / 7pm ET. Our topic, "Ageism in Mental Health Services for Seniors." You can watch the live show or recording on Facebook, Twitter*, LinkedIn, YouTube or Instagram*.

*We won't know the exact urls for Twitter or Instagram until we go live on Thursday. For now, these links go to Neil's Twitter and Instagram.

You can watch here or click on the social media links above. That way, if you comment, we can put it on screen.

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The pre-screening did not go as expected. Among the questions I was asked was whether I had any weapons at home. This is a reasonable question given the correlation between depression and suicide. I explained that as an ex-fencer, I did have a number of swords, knives, and other edged weapons. (This is normal within the sub-culture, however odd it may sound to the mainstream.) The interviewer dismissed the collection because “a sword is not a weapon.”

The second round of screening wasn’t much better. The psychiatrist was more interested in figuring out what medications to prescribe as opposed to responding to my specific concerns about the possibility of becoming a prescription drug addict. Instead of investigating why I have such strong feelings, the psychiatrist postponed discussion of the issue by saying it would be revisited later. In fact, they were not shy about “revisiting” the topic. 

Every few weeks the social worker “discussed” prescribing something. Ultimately, I felt I wasn’t getting any help from the therapist and was scheduling fewer and fewer appointments, while thinking about stopping the sessions altogether, which eventually did come to an end. I felt everyone was more interested in giving me pills and less interested in helping me address my problems or issues, in part because of my age.

The World Health Organization (WHO) estimates that roughly half the population is ageist. WHO cites the consequences of ageism on individuals as a decreased quality of life, from poorer physical and mental health to greater social isolation and loneliness. The organization goes as far as to credit ageism with causing premature deaths among seniors.

WebMD notes on its website that “too many doctors mistake acute medical conditions for normal aging,” adding that “[o]thers ignore pain, anxiety, and depression as unavoidable as we get older or unconsciously view older people as less worthy or less important than their younger counterparts.”

Baylor University Online lists examples of ageism in health care: oversimplified explanations; interrupting the patient; directing questions and decision making to caregivers; and discouraging the use of technology, among other things. Baylor also notes the exclusion of seniors from a large percentage of clinical trials, much like the Adult ADHD test I reference below.

According to the website, “undertreatment is when healthcare providers dismiss treatable concerns, such as joint pain, as ‘normal’ parts of aging. Without treatment, the joint pain could worsen over time and lessen mobility. Overtreatment is providing interventions that aren’t beneficial to the patient, like aggressive chemotherapy for an older patient who communicates their preference for palliative care.”

But there is more than just refusing certain treatments due to age or discussing preventive care, as one pundit put it, there is also the condescending tone or inappropriate use of endearments. And the issues don’t just end there. NPR cites a 2020 study that ageism “cost[s] the health care system $63 billion a year.”

I wrote off pursuing therapy for my depression. As a senior, I don’t have that many years left before I die. Do I want to spend it pursuing something that hasn’t gone anywhere in the past when there are so many new things to pursue? For me, the answer is no.

But Neil Parekh related his discovery that his depression was actually adult ADHD. That caught my attention. What if the reason why therapy for my depression never worked because what I was suffering from wasn’t depression?

Following in Neil’s footsteps, I took a free online test, and managed to score in the high end of the grey area. I decided to invest in the real test—despite the fee—but found the system wouldn’t let me take the test because I had entered an “invalid” birth date. When I told the very able and very nice staff this, they moved fast and fixed the problem by changing my birthday by about a dozen years. The software just wasn’t set to accept anyone my actual age. I would later learn that the FDA had not approved the test for anyone older than 65 years old. By lying about my age, making me ten to fifteen years younger, I was able to take the test and complete the assessment.

The follow-up consultation was live online. The doctor assured me that I didn’t have adult ADHD. He mentioned in passing that he had dealt with only a few patients in my age group. While that does raise the question whether there’s enough of a random sample for my age group to make such a determination, the question for me was why so few?

The doctor added that an email would be sent to me with some local recommendations of places that might be able to help with my depression. None of the recommendations seemed to take health insurance in general or Medicare in particular.

The experience echoed something I learned in an Introduction to Psychology course I took at university in the 1970s. I no longer remember the instructor’s name, but I remember what he said, that the older the patient, the less likely the patient could be helped. The patient was too set in his, her, or its ways. I would later learn that somehow it is always the patient who is at fault if therapy doesn’t work. The patient didn’t really want it or some similar concept.

Oddly enough, that attitude still exists today. In the production meeting for this show last week, Dawn Helmrich Neuburg noted that in her research she has read people's concerns about the way mental health professionals treat older adults differently. If that’s not the definition of ageism, I don’t know what is.