Mental Health Services

It is also important to understand age/ generational differences in mental disorder prevalence, risks, and needs, all of which are difficult to measure for several reasons. First, definitions of mental health, mental illness, and mental disorder are ambiguous and the terms are used loosely. Second, ageist assumptions about emotional and mental capacity in late life lead to confusion of mental disorders with "normal aging." Third, determining the incidence and prevalence of mental disorders is difficult when indicators are somewhat arbitrary and when people have biases against seeking treatment; needs in these cases remain hidden. Fourth, mental disorders in late life may mimic or mask other problems, particularly physical illnesses or the effects of medications. Fifth, cultural and/or generational differences may affect the identification and/or reporting of disorders. Sixth, distinctions between community- and institution-dwelling populations must be made when studying risks and needs, particularly in the eighty-five-plus age group; 20 percent of them live in nursing homes, and nearly 60 percent of those are affected by at least one mental disorder (including dementia) (Strahan and Burns). And finally, distinctions must be made between chronic and acute, mild and severe, and early- and late-onset disorders. These conceptual and measurement challenges inevitably affect the provision and delivery of mental health services.