Ageist attitudes and actions toward older adults remain prevalent in the mental health care system, by health care providers, and in nursing homes. Ironically, ageism also exists in the aging network, the system that is charged, at least in part, to empower older adults and to help them maintain independence.

“Ageism refers to the stereotypes (how we think), prejudice (how we feel) and discrimination (how we act) toward others or oneself based upon age” (Ageism & Culture Advisory Council, ASA, 2023).

Ageism in mental health care may translate into older adults not seeking services from the specialty mental health sector, not having appropriate services and well-trained psychiatrists (geriatric psychiatrists educated in geriatric psychopharmacology) available. Depression may be viewed as a normal part of aging (a myth) and depressive symptoms may be undertreated.

Ageist attitudes and behaviors in the specialty mental health sector may result in older adults being treated as if they cannot make decisions on their own or that they need to be told what is best for them. The power differential may be especially marked when mental health professionals are providing care to older adults.

There also is a line between being ageist versus violating patient rights, not securing informed consent using the “meant-to-be” process, and providing ineffective and inadequate mental health care.

Questions to ask yourself –

• How frequently does your age come up, as if that defines who you are and limits your potential for recovery?

• Do you engage in a “shared dialogue” or “shared decision-making” in your appointments with mental health care providers?

• Suggestions for optimizing overall well-being are appropriate to provide, at least from my perspective. However, do they focus on actions or decisions that will make you more dependent, less self-empowered? When you talk about what you would like to do or what you used to do, do you hear comments that that is not possible anymore?

• If you bring someone with you to an appointment (e.g., a family member, a friend or peer, or an advocate) – are questions and recommendations directed to the other person, rather than you, even if he/she has no authority to speak on your behalf?

• Does the medication prescriber “decide” which side effects are acceptable? Does he/she note that certain adverse side effects are basically what you find in older adults? Does he/she address the potential long-term side effects, even permanent side effects, if you were to take a specific medication on a long-term basis, even permanently?

• Is the prescriber committed to medication optimization principles? Is he/she aware of all of your medical conditions? Are questions posed to get at whether or not you should be prescribed the medication in any instance? Do you turn to pharmacists and seek clear explanations of risks, especially when long-term use seems to be a possibility?

• Who ultimately is the primary or final decision-maker about the mental health services you receive, the medications you take?

• Are you aware of patient rights and the meaning of informed consent?

• Are you concerned about the ramifications if you were to challenge a mental health provider? Do you insist that shared decision making takes place, that risks and benefits of taking prescribed psychoactive agents are explained clearly?

• If your rights are violated, do you know how to file a grievance or complaint? Do you know who might be able to help you with the process?

What can we do to fight against ageism in mental health:

• Educate older adults about how to be a mental health self-advocate, how to insist shared decision making takes place in all encounters, how to identify ageist attitudes and actions. Older mental health service consumers must be educated about patient rights, how to file grievances, and how to issue complaints with the Ohio State Medical Board.

• Reach out to the executive director and board leadership at the Mental Health and Recovery Board of Ashland County (419-281-3139). Insist all concerns about ageism in receiving mental health services are addressed, even in a public forum. Advocate to ensure some of the mental health levy dollars be used to provide education about ageism to all stakeholders.

• Older adult mental health consumers should be informed about agencies that they can contact and resources that they can refer to. For example, if ageism is encountered, I suggest you reach out to experts at the Area Agency of Aging, District 5 (419-524-4144; 800-860-5799) to share your concerns, to seek information, and to receive support.

Diana Spore, PhD, MGS, is a freelance writer, mental health advocate, social gerontologist, educator/researcher, and expert in mental health and aging. Spore is an older adult, and a mental health consumer in recovery.

This article originally appeared on Ashland Times Gazette: Column: Spotting ageism in mental health, what to do