Abstract
Dear Sir,
In its Newsletter of the National Health Strategy (issue 7, 1998), Australia's Department of Health and Family Services stated that the Mental Health and Wellbeing report (Australian Bureau of Statistics, 1997) provides a comprehensive picture of the mental wellbeing of Australians over 18 years of age. The Department noted the reported finding that the prevalence of mental illness is four times higher in young adults than in those aged 65 years and over, and it commented that ‘this supports the general thrust of the current national focus on early identification and mental health services for young people.’
By implication, the Department was suggesting there is less need to focus on mental health services for older people, and that proportionally less mental health resources need to be devoted to older persons.
The flaws in the methodology of the survey that led to the report have been pointed out previously (Snowdon et al., 1998). The data were not comprehensive. The survey did not include people in hospitals, nursing homes, hostels or institutions for homeless individuals. By assessing one person per dwelling, whether one or many people lived there, bias was introduced. The report did not provide information about the differential response rate of younger and older people.
The three groups of mental disorders assessed in the survey were those considered by a Technical Advisory Committee to have the highest prevalence in the population and which were able to be identified in an interviewer based household survey: anxiety disorders, affective disorders and substance use disorders. Organic disorders were not included, in spite of evidence of their high prevalence in those over 75 years of age. Indeed, those with significant cognitive impairment were excluded from the survey.
Because the report does not provide a comprehensive picture and is so obviously biased in a way that underestimates the prevalence of mental disorders in old age, the survey results should not be used as a basis for allocation of mental health service funds. Surely the Technical Advisory Committee should concede that comparisons of young and old based on the limited information available in the report are just not appropriate.