In the delicate balance between the greying demographic landscape and the economic pulse of Asia, a pressing challenge looms large: the continent is ageing at an unprecedented pace.
The repercussions of this demographic shift are felt across governments grappling with labour shortages and strained budgets allocated to support the burgeoning number of retirees. Take, for instance, Japan, South Korea, and China, where a substantial proportion of the population is now over the age of 65. Paradoxically, as these nations witness the silvering of their citizens, their economies are straining under the weight of a diminishing workforce. The dilemma unfolds as a confluence of social, financial, and occupational challenges, with heart disease, diabetes, continence care, dementia, and the need for psychological services for the elderly serving as the proverbial canary in the coal mine.
The saying, "a canary in the coal mine", goes back to when miners took canaries down into the mines to act as an early warning of dangerous gasses such as carbon monoxide. We have known for some time that Japan is the "canary in the coal mine" when it comes to the impacts of an ageing society. In the context of elderly mental health, the term "canary in the coal mine" is applied metaphorically to highlight how the mental well-being of the elderly population may serve as an early indicator or warning sign for broader societal issues. In other words, the mental health challenges faced by the elderly often reflect underlying problems within the healthcare system, societal structures, and related support networks.
For example, an increasing prevalence of stress, anxiety, or mental health disorders among the elderly population may signal inadequacies in healthcare services, social support systems, or the overall well-being of the aging demographic. Just as the canary's well-being was crucial for miners to assess the safety of the environment, the mental health of the elderly can be seen as indicative of the overall health of a society, with implications for the need to address and reform mental health care, social support systems, and other relevant psychological services.
As Thailand confronts a swiftly maturing demographic landscape, a specific hurdle arises in the form of a progressively growing prevalence of stress and anxiety among the elderly demographic. This trend is substantiated by reports from healthcare facilities, revealing a mounting burden of stress and anxiety in the older population. Recent research also indicates that the likelihood of experiencing stress rises with age, particularly in ageing communities.
Additionally, secondary data from rural Thailand implies that a notable percentage of the elderly grapple with mental health issues, encompassing mood disorders linked to feelings of loneliness and social isolation. Delving into the complex tapestry of factors contributing to depression in the aging populace reveals a multifaceted landscape. Familial relationships, financial stability, the fabric of social and community surroundings, physical health, and the enduring presence of health conditions have all been identified as key influencers.
These stressors, woven into the very fabric of elderly life, demand a nuanced understanding as we navigate the intersection of mental well-being and the aging process.
Mental Health Disparities
Addressing mental health challenges in Thailand presents an additional hurdle, notably in obtaining assistance.
In 2001, there were around 400 practicing clinical psychologists, a number that has since increased to 1,040, equivalent to approximately 1.6 psychologists per 100,000 individuals. However, the uneven distribution, primarily concentrated in Bangkok, creates significant challenges for elderly patients in other regions, exacerbating the workload for rural psychologists.
In some provinces, there is only one psychologist for every 50,000 people, with six provinces lacking psychologists entirely. The scarcity of psychiatrists adds to the concern, with only 850 serving the entire country, equating to about 1.3 per 100,000 people.
This stark imbalance underscores the urgent need for comprehensive mental health care reform.
Closing the Gap
To address limited accessibility to psychological services, a strategic plan is crucial for the equitable distribution of mental health professionals. Incentivising professionals to work in underserved areas, providing training opportunities, and leveraging telehealth initiatives can bridge the gap in remote locations.
Increased funding for mental health programs and facilities is essential to ensure all citizens, regardless of location, have access to vital psychological support.
In addressing the pressing need for mental health reform, it is crucial to recognise that geographical disparities in psychological service availability act as canaries in the coal mine, signalling a broader challenge that demands immediate attention and concerted efforts for a more equitable and accessible mental health care system for all.
Douglas Rhein is Associate Professor of Psychology at Mahidol University International College.