Spotlights on Ageism: Mental Health
Professor Sharmi Bhattacharyya, Consultant Old Age Psychiatrist and Chair of Royal College of Psychiarty Wales’ Faculty of Old Age Psychiatry
Ageism remains one of the most pervasive and least challenged forms of discrimination in healthcare. In mental health services, its impact on older adults is profound, persistent, and too often invisible.
Working as a psychiatrist in Wales, I see daily how older people with mental health problems face barriers that would be unacceptable for any other age group.
These barriers affect people with dementia, but also those living with functional mental illnesses, such as depression, anxiety, bipolar disorder, and psychosis.[1]
This is not simply a question of limited resources. It reflects entrenched attitudes, assumptions, and systems that have normalised inequity in later life.
The scale of need in Wales
Wales is ageing rapidly, and this is not a distant or abstract challenge. Current figures show that 898,383 people aged over 60 live in Wales, with numbers expected to approach one million by 2030.[2]
Dementia prevalence will also rise accordingly, from an estimated 55,700 people aged 65 and over today to almost 80,000 by 2040.[3] Age is one of the strongest risk factors for dementia, making these projections critical for service planning now rather than later.
However, dementia is not the whole story. Thirty per cent of older people in Wales report mental or emotional health as a challenge in the past year. [4] This includes anxiety, depression, trauma responses, complicated grief, and psychosis, alongside cognitive disorders. The scale of unmet need is substantial.
What ageism looks like in everyday care
Evidence shows how ageist attitudes and fatalistic assumptions continue to shape mental health systems, leading to the exclusion of older people from effective support.[5] Anxiety and depression are frequently normalised as an inevitable part of ageing, with low expectations of recovery.
In practice, this can look like:
- Minimisation of symptoms, framed as understandable responses to ageing or loss.
- Diagnostic overshadowing, where depression or anxiety is missed or cognitive change is assumed to be “just dementia”.
- Lower therapeutic ambition, with care plans focused narrowly on medication at the expense of psychological or social interventions.
- System-level invisibility, with older adults excluded from redesigned pathways or new investment.
Ageism is also measurable. Eight per cent of older people in Wales report being made to feel too old to access health services.[6] Behind this single statistic lie thousands of individual experiences that should give us pause.
Disparities in service provision: dementia is not enough
Across Wales and the wider UK, mental health services for older people have largely been shaped around dementia. While essential, this focus is not sufficient. Older adults with functional mental illness often face reduced access to care, particularly at age thresholds or where service remits are narrowly defined.
Evidence shows that both all-age models and rigid age-based service divisions can disadvantage older people, leaving them with fewer pathways, less specialist input, and more limited options.[7]
These disparities reflect longstanding underinvestment in older people’s mental health services. The Royal College of Psychiatrists Wales has repeatedly called for a rebalancing of resources to reflect demographic change, clinical complexity, and levels of need.[8]
We are also aware of past examples where underspends in older adults’ mental health services were transferred to other areas of mental health to offset overspends elsewhere. Such practices risk embedding institutional ageism by diverting resources away from older people rather than reinvesting them to address unmet need.
The impact is most evident in crisis care, where a widening gap persists in access to timely, home-based alternatives compared with working-age services. This means many older adults experiencing severe depression, acute anxiety, bipolar relapse, or psychosis continue to face fragmented and inadequate routes to support.
Psychological therapies: still too rare
If we are serious about parity, older adults must have access to evidence-based psychological therapies. Yet access remains limited.
Equitable care requires both access to statutory talking therapies and a workforce skilled in later-life mental health.[9] Despite this, older adults are far less likely than working-age adults to be referred for psychological therapies, even when levels of need are comparable.
Indeed, younger adults are around 80% more likely to receive therapy,[10] with inequalities widening sharply with age. Those aged 85 and over are up to five times less likely to be referred than people aged 55-59.[11]
Access is further constrained by structural barriers. Older people from racially minoritised backgrounds, those with disabilities or long-term conditions, and those who do not speak Welsh or English as a first language are less likely to engage with therapy services. Digital-first service design, including reliance on text-based communication, may exacerbate these inequalities among certain groups of older adults.[12]
In my experience, the result is predictable: older people are offered medication (sometimes repeatedly) while the drivers of distress – be they bereavement, trauma, loneliness, chronic pain, carer strain, financial pressure, or long-standing interpersonal difficulties – remain largely untreated.
Beyond medication: complex emotional needs in later life
There is growing recognition that some older people live with complex emotional needs, including presentations consistent with personality disorder or complex trauma. Historically, many were overlooked, mislabelled, or excluded from specialist interventions simply because of their age.
The Royal College of Psychiatrists Wales has been clear that older adults should not be excluded from specialist pathways, including those addressing emotionally complex needs. The College has highlighted the need to strengthen the evidence base for psychological therapies for older people with severe and trauma-related mental health difficulties.[13]
This matters because medication alone is often insufficient. In later life, polypharmacy and physical comorbidity make an over-reliance on prescribing potentially ineffective or harmful. Many older adults require safety, relational continuity, structured psychological therapies, and sustained community support – not symptom suppression alone.
Older adults as contributors, not dependents
One ageist narrative that continues to fuel underinvestment is the assumption that older people are less “economically productive”. This does not bear scrutiny when set against the evidence:[14]
- Nearly two-thirds of people aged 65 or over pay income tax, contributing over £800 million in Wales.
- PAYE contributions from older workers increased by more than 10% between 2023 and 2024.
- Nearly two-thirds of grandparents provide childcare, valued at around £325 million in Wales.
- Older adults are the most active age group in volunteering.
- Around 275,000 older people in Wales provide unpaid care, accounting for over half of all unpaid carers.
Failing to support older people’s mental health is both unjust and economically short-sighted. Mental health services must reflect the central role older adults play in families, communities, and the Welsh economy by supporting participation, contribution, and independence in later life.
Policy opportunity: all-age strategy and specialist care
The new Mental Health and Wellbeing Strategy for Wales adopts an all-age approach.[15] While welcome, this must not become a justification for one-size-fits-all care.
Later-life mental health needs are distinct. Multimorbidity, frailty, sensory impairment, bereavement, safeguarding concerns, care home interfaces, and higher dementia prevalence all shape assessment and treatment.
It is encouraging that the strategy recognises the need for a stronger focus on services for older people with complex needs. The challenge now lies in delivery: turning intent into age-equitable outcomes while protecting specialist expertise.
A call to action
Tackling ageism in mental health services requires more than awareness. It demands action.
- Parity of esteem: Developing equitable crisis and community pathways for older adults with functional mental illness, not solely dementia-focused care.
- Access to psychological therapies: Providing routine, age-inclusive referral routes with appropriate adaptations for impairment and comorbidity.
- Workforce capability: Investing in the older people’s mental health workforce, while strengthening later-life competencies across all-age teams.
- Rebalanced investment: Aligning resources with demographic change and clinical need, addressing historical underinvestment.
- Better data and accountability: Ensuring consistent reporting of older people’s needs and outcomes, including access to therapies.
- Co-produced services: Involving older people, carers, and communities in shaping effective later-life mental health care.
Ageism thrives when expectations are low and services are thin. The antidote – equity, ambition, and investment – is clear.
Older people in Wales deserve mental health care that is timely, compassionate, evidence-based, and free from ageist bias. Until that becomes reality, too many will continue to suffer in silence – and that is something we should no longer accept.
Acknowledgement: I am grateful to Dafydd Huw, Policy and Public Affairs Manager at RCPsych Wales, for his support and assistance in the preparation of this blog.
Professor Sharmi Bhattacharyya, Consultant Old Age Psychiatrist and Chair of Royal College of Psychiarty Wales’ Faculty of Old Age Psychiatry
References
[1] ‘The term “functional” mental illness applies to mental disorders other than dementia, and includes severe mental illness such as schizophrenia and bipolar mood disorder. Symptoms of these disorders frequently persist into old age or, less frequently, begin in old age.’ Hatfield, C., & Dening, T. (2011). Functional mental illness. In T. Dening & A. Milne (Eds.), Mental health and care homes (Vol. 1, pp. 191-204). Oxford University Press.
[2] Older People’s Commissioner for Wales (2025). Growing older in Wales: A snapshot of older people’s experiences (September). Available at: https://olderpeople.wales/wp-content/uploads/2025/09/Growing-Older-in-Wales-A-Snapshot-of-Older-Peoples-Experiences.pdf
[3] Older People’s Commissioner for Wales (2025). Growing older in Wales: A snapshot of older people’s experiences (September). Available at: https://olderpeople.wales/wp-content/uploads/2025/09/Growing-Older-in-Wales-A-Snapshot-of-Older-Peoples-Experiences.pdf
[4] Older People’s Commissioner for Wales (2025). Growing older in Wales: A snapshot of older people’s experiences (September). Available at: https://olderpeople.wales/wp-content/uploads/2025/09/Growing-Older-in-Wales-A-Snapshot-of-Older-Peoples-Experiences.pdf
[5] Centre for Mental Health & Age UK (2024). Mental health in later life: Understanding needs, policies and services in England (March). Available at: https://www.centreformentalhealth.org.uk/wp-content/uploads/2024/03/CentreforMH_MentalHealthInLaterLife-1.pdf
[6] Older People’s Commissioner for Wales (2024). Understanding Wales’ ageing population: key statistics (September). Available at: https://olderpeople.wales/wp-content/uploads/2024/09/Understanding-Wales-ageing-population-September-24.pdf
[7] Faculty of Old Age Psychiatry & Royal College of Psychiatrists (2018). Suffering in Silence: age inequality in older people’s mental health care (College Report CR211). Available at: https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr221.pdf?sfvrsn=bef8f65d_2
[8] Faculty of Old Age Psychiatry & Royal College of Psychiatrists (2018). Suffering in Silence: age inequality in older people’s mental health care (College Report CR211). Available at: https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr221.pdf?sfvrsn=bef8f65d_2
[9] Centre for Mental Health & Age UK (2024). Mental health in later life: Understanding needs, policies and services in England (March). Available at: https://www.centreformentalhealth.org.uk/wp-content/uploads/2024/03/CentreforMH_MentalHealthInLaterLife-1.pdf
[10] Cooper, C., Bebbington, P., McManus, S., Meltzer, H., Stewart, R., Farrell, M., King, M., Jenkins, R., & Livingston, G. (2010). The treatment of common mental disorders across age groups: Results from the 2007 Adult Psychiatric Morbidity Survey. Journal of Affective Disorders, 127(1-3), pp. 96–101. Available at: https://doi.org/10.1016/j.jad.2010.04.020
[11] Walters, K., Falcaro, M., Freemantle, N., King, M., & Ben-Shlomo, Y. (2018). Sociodemographic inequalities in the management of depression in adults aged 55 and over: An analysis of English primary care data. Psychological Medicine, 48(9), 1504–1513. Available at: https://doi.org/10.1017/s0033291717003014
[12] Prosser, R., Dosanjh, L., Jell, G., & Churchard, A. (2024). Which older adults do not opt-in to Talking Therapies and why? The Cognitive Behaviour Therapist, 17, e16. Available at: https://doi.org/10.1017/S1754470X24000151
[13] Faculty of Old Age Psychiatry & Royal College of Psychiatrists (2018). Suffering in Silence: age inequality in older people’s mental health care (College Report CR211). Available at: https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr221.pdf?sfvrsn=bef8f65d_2
[14] Older People’s Commissioner for Wales (2025). Growing older in Wales: A snapshot of older people’s experiences (September). Available at: https://olderpeople.wales/wp-content/uploads/2025/09/Growing-Older-in-Wales-A-Snapshot-of-Older-Peoples-Experiences.pdf
[15] Welsh Government (2025). Mental Health and Wellbeing Strategy 2025 to 2035 (April). Available at: https://www.gov.wales/sites/default/files/publications/2025-04/mental-health-and-wellbeing-strategy-2025-to-2035.pdf
Spotlights on Ageism
The Commissioner’s Spotlights on Ageism series, a collaboration with public service leaders and other experts from key sectors in Wales, aims to shine a light on the impact of ageism on older people’s everyday lives and the significant barriers this creates for individuals and society.
Find out more