Bridging the Void: Unraveling Mental Health Policies for the Older Adults in Pakistan's Tapestry- A Literature Review
Sadaf Murad and Salima Siraj*
Student at the University of Alberta, Faculty of Nursing, College of Health Sciences, Canada
*Corresponding author
Salima Siraj, Student at the University of Alberta, Faculty of Nursing, College of Health Sciences, Canada.
ABSTRACT
This literature review focuses on the significant difficulties in mental health policies for older individuals in Pakistan. As the world population ages and the old population in South Asian countries, particularly Pakistan, grows, there is a clear dearth of specialized care for the aging populace. The assessment of literature highlights major challenges such as limited government funding, the influence of the nuclear family trend, and a lack of mental health training. Despite the obvious need for focused strategies, Pakistan has made little progress. Existing policies must be restructured immediately to line with the World Health Organization's active aging framework and the United Nations MIPAA (Madrid International Plan of Action on Ageing). The review emphasizes the need for enhanced visibility, stakeholder collaboration, government financing for research, and policy restructuring about older adults mental health. There is major need to address the stereotypes and stigma related to aging which have negative impact on their quality of life and health. Establishing geriatric expertise in health care and creating policies for a quality aging process, is deemed necessary to enhance the mental health of older adults in Pakistan.
Keywords: Older Adults, Mental health, policies, challenges, Pakistan
Background
The world’s population is aging, and it is becoming a global concern. The number of older adults worldwide is expected to reach 2 billion by 2050, which will increase the rate of mental illness and other physical disabilities in this group [1]. Older adults need more specialized integrative care to address their unmet psychological needs, and this can have a direct impact on the quality of their aging. Many developing and developed nations are facing the challenges of aging. The elderly population in South Asian countries such as Pakistan is also dramatically increasing. WHO reported that 5.6% of the Pakistani population is over 60 years of age, and that number will more than double by 2050 to 15.1% [2]. However, the government in this region does not devote resources to care for older adults [3].
Increasing age results in many issues such as physical illness, stress, and financial insecurity, which lead to depression and other mental illnesses that often remain hidden in older adults. In Pakistan, the mental health of the elderly is the most neglected area of concern; no policy or program exists that targets this issue or focuses on the determinants of healthy aging [4]. The government, policy makers, health care professionals, and organizations can play a huge role in addressing the mental health needs of Pakistanielders. There is a lack of political willingness, knowledge, and evidence-based research on this crucial issue, which has a direct impact on the quality of later year of lifeyears [2]. WHO’s active aging framework has identified eight elements of aging that have an impact on the mental health of older adults: gender, culture, economics, health and social services, behavior, personal attributes, place, and social resources, which all need to be deeply incorporated into planning services and care for the elderly [5]. The government has failed to improve the quality of care for older adults in Pakistan [6].
In this literature review, we will discuss the mental health policies and programs for older adults in Pakistan. We will discuss the issues and challenges that older adults with mental illness face in Pakistan and the need for policies to address them. The government’s input into improving mental health, the barriers to implementing policy into practice, and the role of knowledge translation (KT) in improving the mental health of older adults.
Purpose
The purpose of this literature review is to examine mental health policies for older adults in Pakistan, evaluate existing challenges and advocate for enhanced governmental commitment and strategic planning to address their unique needs.
Review Question
"What are the current mental health policies for older adults in Pakistan, their effectiveness, and barriers, in enhancing assistance for the elderly?"
Method
A literature review was done to find out the relevant findings. The databases used to perform the review included EBSCOhost CINAHL Plus with Full Text, Ovid MEDLINE(R), and Google Scholar. To develop the literature search, Keyword combinations used in the search included: "Mental health" or Mental illness* "Mental well-being *" or “Psychological support” and “Pakistan” and “Policies” or “Strategies” or “Planning” and “elderly” or “older people” or “seniors” or “aging” or “older adult”.
Findings
Insights into Geriatric Care and Mental Health Challenges among Older Adults in Pakistan:
Older adults are the most vulnerable population, especially with regard to vocalizing their need for emotional or psychological care to their caregivers. They require integrated geriatric care that focuses on the physical, social, financial, emotional, psychological, and spiritual aspects of care [7]. WHO (2010) defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. It determines the need to promote mental health for quality of life for older adults. For an active aging process, mental health must be reflected in every aspect of medical care because many physical illnesses are a result of mental health instability. Depression, loneliness, and stress are co morbid factors that increase the risk of many chronic diseases such as hypertension, diabetes, heart disease, and cancers (Canadian Mental Health Association, 2014). This signifies the urgent need for specialized care for older adults who suffer the burden of mental illness to ultimately decrease their chronic physical illness. Despite the clear need to develop integrated programs or policies to promote the mental well-being of older adults, little work is being done in Pakistan to ameliorate s mental health of older adults and explore the obsticales they face in the process of aging. In Pakistan, issues such as government instability, political hidden agendas, poverty, unemployment, lack of finances, and the dearth of evidence of the need for mental health services for older adults are the major hurdles to overcome for planning integrated mental health services for this group [4]. Moreoer, depression is a rapidly growing concern in older adults in Pakistan that requires integrative geriatric care; 40% of the elderly population suffers from depression, and the rates are higher for women than men [6]. Women in Pakistan generally remain at home and do not have opportunities for socialization, which can lead to isolation and depression [8]. Futhermore, the death of a spouse, separation or divorce, financial insecurity, the trend towards nuclear families, children’s move from their parents’ home, or the lack of children to support families can lead to serious mental illness in elderly women in Pakistan [9]. despite these challenges, the majority of older adults remain silent and do not reach out to seek professional help, due to the lack of geriatric care at the community level [6]. The changing trend from extended family to nuclear family is also a significant reason for mental illness and depression in older adults in Pakistan [3].
Challenges in Aging: Nuclear Family Trend
The government can play a major role in improving care for older adults. Pakistan has 1,000 government hospitals and 300 private hospitals [2]. The mental health services that government hospitals offer have not been adequate, and private health care is expensive [10]. The cost of health care, the lack of finances, and retirement create an enormous financial burden and insecurity, which can lead to mental health issues and depression in older adults in Pakistan [6]. The retirement age in Pakistan is 60 years for males and 55 for females, and only individual who are employed by the government receive some kind of pension; the rest of the population need to use their own savings or insurance to pay for their health [4]. However, those who are privately employed or have never worked, such as homemakers, become financially dependent on their family members. This highlights the need for pensions or old-age allowances to ensure the financial well-being of older adults and decrease the burden of mental health issues on older people [6].
Lack of Mental health services and training
In Pakistan, geriatrics lacks an independent speciality and training program, resulting in older patients being handled by general practitioners [11]. Despite the 1999 National Policy's goal of training healthcare practitioners for older adults, including geriatricians and mental health experts, implementation has not occurred revealing a scarcity of specialized doctors, with only a few geriatricians and clinicians trained in old-age psychiatry [11]. The shortage of specialist practitioners is exacerbated further by the fact that practically all of the country's 520 psychiatrists are general adult psychiatrists with minimal facilities for sub-specialities. As a result, mental illnesses in older adults, such as depression and dementia, are treated by general adult psychiatrists, neurologists, or general medical specialists [12]. Furthermore, the lack of a particular curriculum or training in mental health for nurses complicates matters [12]. This highlights a huge deficit in Pakistan's provision of mental health treatments for the elderly.
The Urge for Mental Health Policies for Older Adults in Pakistan
Many developing countries have seen sharp declines in fertility, combined with rising life expectancies, which will eventually lead to an unprecedented aging population, which means that the government must have policy directives to ensure productive and efficient care for these members of the society [13]. Although care for the elderly is usually considered a family responsibility in the South East Asian culture, changing family systems have resulted in the extensive need for government involvement in this issue [13]. Many South East Asian countries, such as India, Malaysia, Thailand, Singapore, China, and the Philippines, are implementing a well-defined set of laws and policies to address the growing demands of their aging populations [14]. However, Pakistan has no programs or policies at the government level to fulfill the unmet needs of the elderly who have mental health issues [4]. The country has a general policy to improve mental health that should be restructured and extended to include the component of older adults’ mental well-being.
Restructuring should involve the MIPAA as a framework to design and implement the policy at the healthcare level to provide quality, integrated mental health care to older adults [15]. WHO stressed the need for government agency involvement to provide minimum income, security, social protection, and quality mental and physical health care to empower older adults in developing nations [5]. To achieve this goal, the government of Pakistan must align with different nongovernment organizations and the private sector to initiate mental health care programs that address the needs of the elderly by subsidizing costs and training more geriatric mental health care professionals in the community and hospitals to provide integrated mental health care to vulnerable older adults. Well-trained mental health care workers can not only provide quality care to the elderly but also raise the awareness of professionals and the public in general of the need for mental health care to ensure that the process of aging is successful. It is also necessary to reflect the principles of active aging in policies and programs for older adults because the social determinants of health, gender, and culture have a direct impact on mental and physical health [5]. Therefore, addressing these elements in policies for older adults will empower them and enhance their aging process.
Discussion
The lack of research and policy to ensure older adults’ mental health reflects the low level of attention that this group has received [16]. Increasing the visibility of issues related to older adults’ mental health must become a priority. Broader policies, collaboration among different stakeholders, the involvement of funding agencies on boards, and government willingness to resolve the issue at a policy and practice level are paramount [16]. Pakistan’s national mental health policy needs to be restructured to address the needs of older adults with mental illness based on WHO’s active-aging guiding principles and the UN’s MIPAA [5,15]. The government of Pakistan must allocate funding to research on geriatric health and mental well-being to guide policy formation and implementation [4]. The media also need to be involved in this process to promote the general public’s awareness, as well as at the government level, to prevent mental illness in older persons to ensure a quality aging process. There is also a need for older adults' senior citizens’ clubs and societies in Pakistan to create opportunities for the elderly to socialize, which will ultimatelydecrease the rates of depression and improve their quality of life [6]. Developing policy is easy, but implementing policy into practice sometimes take decades; therefore, government involvement and national and global collaboration with stakeholders are the key factors in developing an integrated policy and geriatric mental health services in Pakistan.
Pakistan needs to consider mental health programs for older adults and the aging framework to initiate comprehensive, integrated mental health services for seniors. The government of Pakistan must play a key role in providing funding for research, spending a fixed amount of money to improve the care of older adults, and collaborating with different countries to improve the healthcare delivery system [10]. Older adults with mental health illnesses are vulnerable and frequently neglected or overlooked in the health care system and the community. Joint efforts and global partnerships are required to promote seniors’ mental well-being and enhance the process of aging.
Conclusion
The need to improve mental health services for older adults does not garner enough attention from policymakers and health care providers. Older adults face various barriers to access to mental health services, such as stigma, lack of resources, and lack of knowledge. There is a huge need for education and awareness programs to dispel myths about aging and mental health. Knowledge dissemination at various levels, such as health care workers, policymakers, the media, and government organizations, will improve overall mental health care across the lifespan. Geriatric expertise is also needed in designing and implementing programs and policies for older people. Older adults are the most significant and resourceful members of our society and should not be left out because of mental illness.
Disclosure Statement
The authors have no financial or other relationships that would be considered a conflict of interest. Both authors contributed to the writing of this review paper. No artificial intelligence or assisted technology was used in the writing of it. This is original work, not in review or published elsewhere and no funding was obtained for the writing of this review.
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