Inspiring efforts to improve mental health across countries and ages

Mental ill-health in megacities was the theme for a presidential plenary session at 18th World Congress of Psychiatry. The audience heard about the near-overwhelming scale of the problem, but also of valiant attempts to tackle it. An engaging presentation on the mental health benefits brought by the wisdom of aging was also provided.

Already, more than half of the world’s population lives in cities. That proportion is expected to grow. This presents both challenges and opportunities, said Moitreyee Sinha (CEO at citiesRISE, an NGO in which the WPA is a foundation partner).

Among the many challenges inherent in rapid urbanization include the development of mental health conditions, a challenge likely exacerbated by social disconnectedness that rural-urban migration involves. But the opportunity lies in harnessing the enthusiasm and ingenuity of people to develop imaginative solutions, which may include bringing together formal and informal sectors.

The United Nations (UN) has added mental health to its sustainable goals, and this too is positive -- since it encourages practical, coordinated and urgent effort. In the urban context, citiesRISE has developed a model for action and the first five cities – Nairobi in Kenya, Chennai in India, Bogotá in Colombia, Sacramento and Seattle in the USA – have been chosen to pilot its implementation.

Successful interventions will be scaled up

One of the distressing features Dr Sinha emphasized is what she termed “the rising tide of suicide” in the world’s largest cities. India is particularly badly affected, with a 40% rise in suicides between 1990 and 2016. Of the 53 megacities in the country, the highest number of suicides is in Chennai.

It is a paradox that mental well-being can increase with age even if physical health declines

Central to addressing such mental health problems is that each city should design and run its own innovative interventions, which are underpinned by the provision of support for data collection, analysis and communication. Local innovators are then given the financial resources to scale up and disseminate innovations that have proven to be successful.

While much of Moitreyee Sinha’s focus was on young people in cities, Dilip Jeste (Stein Institute for Research on Aging, University of California San Diego, USA) concentrated on the need to develop age-friendly communities, and a society that takes advantage of the wisdom that accumulates through advancing years.

Wellness within illness – a paradox and virtue of aging

The Successful AGing Evaluation (SAGE) study involved more than a thousand-people aged 50-99 years living in the community of San Diego County.1 A somewhat surprising finding was that older age was associated with higher self-reported successful aging: despite worsening physical and cognitive functioning, people had greater mental well-being as they aged.2 There was, in Professor Jeste’s terms, “wellness within illness”.

Despite worsening physical and cognitive functioning, people had greater mental wellbeing as they aged

The factors that underlie this paradox are resilience (which facilitates activities such as self-care and adherence with exercise), optimism and social engagement. Dilip Jeste also emphasizes the benefits of accumulated wisdom. Age, he argues, brings with it self-reflection, better control of emotions, greater empathy, and an openness to the spiritual. And wiser folks are less often lonely, which means they are less prone to the erosion of mental and physical health which loneliness brings.

Age, he argues, brings with it self-reflection, better control of emotions, greater empathy, and an openness to the spiritual

A word to the wise

His confidence in the importance of wisdom is reinforced by collaborative work with the University of La Sapienza in Rome on the characteristics of people aged 90 and over living in Cilento, Italy. Among the factors that set the “old old” apart from others is positivity, hard work, spirituality, the strength of family bonds, love of the land, and adaptability.3 It is a balance between acceptance of change and having the determination to overcome adversity -- in essence “wisdom”.

And it is not too far-fetched to suggest – as Professor Jeste does – that a country’s “national wisdom index” might be a  more important indicator of mental well-being than its gross domestic product, or even (as has also been proposed) a happiness index.

  1. Jeste DV et al. Am J Psychiatry 2013
  2. Thomas ML et al. J Clin Psychiatry 2016
  3. Scelzo A et al. International Psychogeriatrics 2018
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