Challenges of promoting global mental health and wellbeing across the lifespan

By Lic. Analia Henriquez Cross, MSc Global Mental Health

Today we are going to highlight the importance of promoting mental health by adopting a life course approach, and we are going to introduce some of the challenges we might face when promoting mental health in later stages of life.

Several authors have said that health at an older age is influenced by health behaviours and inequities people live throughout their lives. Promoting healthy behaviours early in life contributes to better mental health among older adults. Concerning inequities, for example, someone born in a marginalized group can have poorer health later in life.

Koenen's book presents the main influences across the life course that have an impact on mental health even way later, first, experiences such as suboptimal emotional or cognitive development in critical periods of life -like our childhood.

Second, cumulative influences are also somewhat determinant of our mental health in the future. For example when people engage in persistent unhealthy behaviours or when they are chronically exposed to poverty.

So, the key is, and what we are going to do today, is to determine the trajectory of the disease from the beginning, at key stages of life such as pregnancy, childhood and adolescence.

Third, pathway influences throughout life make us pay special attention to women in pregnancy and motherhood to ameliorate the snowball effect. For example, mental illness in women adds to the probability of postnatal depression, therefore, postnatal depression can hinder a child’s socio-emotional development, which leads to poor school performance, and then employment in their adulthood, which therefore can onset common mental disorders.

Promoting mental health among women is crucial because the mother’s emotional well-being has significant effects on the quality of caregiving and, consequently, on the baby’s development (Pritchett, 2013; Horwitz et al., 2009). For example, a mother with unpredictable behaviour can lead to disorganized attachments styles, and severe and chronic disrupted interactive styles can lead to those well-known Adverse Childhood Experiences (ACEs).

ACEs make us pay special attention to mental health promotion in childhood. Parental maladjustment and maltreatment are associated with mental disorders and having multiple ACEs can have a stronger impact on health later in life.

It is interestingly exposed how ACEs wave into the brain in our childhood and have powerful effects on neural structure and function throughout adulthood. For example, the stress that ACEs entail disrupts hippocampal function and activates the hypothalamic-pituitary-adrenal axis, which when extended, can cause brain damage. Also, when there is no experience at all, or when expected environmental conditions needed for brain development to occur, do not, the brain is negatively affected.

Also, the significant changes lived through adolescence make this stage critical, especially because risky behaviours are usually adopted, behaviours that normally lead to substance abuse. And, worryingly, the onset in the adolescence of certain mental disorders can predict their repeated appearance later in life.

One example of how the domino effect can go from a mother’s mental health until adolescence, Bureau and colleagues found that early exposure to mother depressive symptoms can predict later depressive symptoms in adolescence.

As we can see, the major challenge to promoting mental health among the elderly is to pay attention to pregnancy, early intervention in childhood and preventing adolescence. But, once the person ages, and becomes an older person, there are several challenges to promoting mental health at this stage that can be identified:

1. Challenge 1 – is that to really meet the needs of older populations, we must understand that not every older adult might have the same needs. Making policies with this in mind is difficult, because of the diversity of needs. For example, some older adults might want to participate in social activities while some do not want to or just cannot due to health issues. (POLITICAL)

2. Challenge 2 - older populations are often excluded from research which leads to a lack of adaptation of assessment tools and medication for them. For example, medication efficacy could be wrongfully interpreted when prescribing for older people who -most of them- have several prescriptions and conditions. (RESEARCH)

3. Challenge 3 – about the unpreparedness of health systems to deliver comprehensive care. older people often have multiple health conditions simultaneously that should be assessed comprehensively and be focused on functionality. The World Health Organization last year indeed published guidance called the ICOPE approach about increasing functionality by building a personalized and holistic care plan through primary care for older people. (CLINICAL/POLITICAL)

4. Challenge 4 – ‘’ageism’’ can be considered a challenge to promote active and healthy ageing. it is suggested that ageism should be reversed and ideas of older adults as disabled and unable to be productive should be challenged. promoting participation is crucial when promoting mental health in older ages, and ageism prevents their participation in society.

As we said, one of the challenges of promoting mental health in later life is the exclusion of the elderly from research. Gaining informed consent from an older person with cognitive impairment for example can have ethical implications because they normally lack decision-making capacity, and surrogate consent is often questioned by studies that found disagreements between the surrogate and the patient.

There are also challenges in conducting research with disadvantaged, vulnerable and marginalized adolescents and studies stress the problem of excluding these populations from research due to ethical issues because they will not then benefit from the research. They invite researchers to include vulnerable adolescents in their studies while protecting them by using consultation when needed and collaborating with community members to modify the research according to local feedback.

In summary, promoting mental health in later life is about promoting mental health in the earlier stages of life. If this is not appropriately done, we have fewer chances to be successful when Intervening for good mental health in later life, especially because there are several challenges to mental health promotion with the elderly. Mental disorders should be understood as the consequence of a domino effect when convincing policymakers and researchers to invest and focus on early life prevention and intervention, to reduce the probability of mental illness appearing later in life.