Mental Health Troubles In Old Age: Know The Signs And Act

Indian industrialist and former chairperson of Tata Group, Ratan Tata, made “loneliness” a point of discussion in 2022. While launching a companionship start-up for seniors, he said, “You don’t know what it is like to be lonely until you spend time alone wishing for companionship.” That captures the root cause of the gamut of mental issues that senior citizens face in India.

Imagine feeling enveloped by despair, where everything around seems bleak, and hope feels elusive. Living with a mental health condition is a relentless and often debilitating battle. Individuals grappling with such challenges may appear calm and composed externally, yet they might be silently screaming within. These struggles can stem from distressing circumstances or profound loneliness, which can lead to serious mental health complications, including degenerative cognitive issues.

According to the World Health Organization (WHO), approximately 14 per cent of the global population aged 60 and above is plagued with a mental disorder. The elderly population in India is expected to double to 347 million by 2050, according to the United Nations Population Fund (UNFPA) projections in the India Ageing Report 2023.

WHO identifies several underlying causes, such as abuse (physical, psychological, verbal, or financial), social isolation, and chronic loneliness, that lead to mental health issues. Social stigma is another factor, since many seniors in India grew up at a time when mental health was never discussed, let alone treated. This also leads to lack of awareness.

Dr. Ritu Rana, mission head – healthcare, HelpAge India, a non-governmental organisation (NGO), refers to one of its 2021 surveys, according to which 60 per cent of elders experience feelings of isolation. “Seniors facing loneliness are 50 per cent more likely to develop dementia,” she says.

Retirement itself can be a turning point for many elders, marked by cessation of income, lack of purpose, or loss of partner, close family members, or friends, which can lead to depression, anxiety, loneliness, or even cognitive decline.

The problem that seniors having mental health issues face is myriad. Apart from the physical and emotional manifestations, financial vulnerability is a big factor that affects their lives.

Kavita Menon, a Securities and Exchange Board of India-registered investment advisor (Sebi RIA), highlights the link between mental health and financial vulnerability: “Lack of money causes continuous stress in daily life decisions, and one can never relax if one is always thinking about the next source of funds. For the elderly, with no social security in our country, the problem is further compounded due to the breaking down of the traditional family structures that often provided a safety net in the past.”

What can help battle the issue is being aware and having a financial cushion, whether it’s in the form of savings or a health insurance policy that really pays.

Be Aware

The first step is to distinguish between mental health and mental illnesses, which are often used interchangeably, but are not exactly the same.

Dr. Rajesh Sagar, professor of psychiatry at the All India Institute of Medical Sciences (AIIMS), Delhi, explains what mental health exactly refers to. He says: “Mental health is an integral part of overall health which is not merely the absence of a disease, but encompasses physical, mental, and social well-being. It refers to overall emotional, psychological, and social well-being.”

WHO has four identifiers of sound mental health: self-awareness of one’s potential, the ability to manage everyday stress, the capacity to work productively, and lastly, the ability to contribute to the family, society, or nation.

Mental health issues may include general emotional distress, such as anxiety or sadness, while mental illness refers to clinically diagnosable conditions using criteria, such as the Diagnostic and Statistical Manual of Mental Illnesses (DSM-5), International Classification of Diseases 11th Revision (ICD-11) and, others to diagnose disorders, such as schizophrenia, or other major depressive disorder, says Dr. S. Gajanan, consultant neuro psychiatrist and medical superintendent, VIMHANS, New Delhi.

Don’t Ignore The Signs

Mental health issues are often ignored, disguised as personality traits, age-related behaviour, attitude, or habit. Most Individuals delay seeking medical help until the symptoms become visibly disruptive for themselves or others. Being aware can solve that problem.

Dr. Gajanan urges vigilance to identify red flags. These include persistent sadness, memory loss, confusion, poor hygiene, or a change in sleep or appetite. More alarming signs are if one talks about suicide or death, becomes violent, experiences delirium, refuses food or water, wanders aimlessly, or faces paranoia. In these cases, immediate medical attention becomes necessary.

Dr. Sagar adds, “If mental health issues are not taken seriously, the quality of life gets affected. There could not only be more isolation, but also cognitive decline which means problems with memory, concentration, and so on. And more importantly, there could be an increased risk of suicide and self-harm. For instance, untreated depression in older adults is linked with higher rates of hospitalisation and mortality.”

Seek Help: Seeking help early can help nip the problem in the bud. Dr. Sagar says: “Do not hesitate. Do not feel stigmatised. Help is available. You just have to come forward.”

So, if you or someone close feels lonely, sad for extended periods, or experiences anxiety, seek help.

Check Insurance Terms

In 2018, the Insurance Regulatory and Development Authority of India (Irdai) mandated that mental health be treated on a par with physical illnesses.

The RiseUP for a Better Tomorrow Mental Health Report 2025 by Marsh McLennan, an insurance broking firm, and Mpower, a unit of Aditya Birla Education Trust, found that mental health claims comprise less than 1 per cent of the total health insurance claims in India.

The problem is that insurance coverage is largely restricted to treatments requiring hospitalisation, which is not common in cases of mental illnesses. Instead, lines of treatment, such as regular therapy, psychiatric counselling, or rehabilitation are relied upon, which do not require hospitalisation and come under outpatient department (OPD) consultations.

Dr. Sagar estimates that only around 5-7 per cent of patients require hospitalisation in mental health cases. It means that a significant number of patients are left uncovered and are exposed to out-of-pocket expenses.

OPD services, typically, fall outside the scope of standard policies. Says Priya Deshmukh, head-health products, operations and services, ICICI Lombard: “Coverage under standard plans generally becomes applicable upon hospitalisation for a minimum of 24 hours. OPD-based treatments like therapy, for which hospitalisation is not necessary, are only covered if the policy explicitly includes such benefits.”

Adds Dinesh Mosamkar, senior vice president, consumer underwriting, Tata AIG General Insurance, “However, some products and riders offer comprehensive coverage specifically tailored to address the OPD needs, including preventive services, procedures, therapies, and teleconsultations.”

The scope of coverage is large in terms of specific conditions and diseases. Deshmukh adds: “Common conditions like depression, anxiety, bipolar disorder, schizophrenia, and other diagnosable age-related psychiatric illnesses, such as dementia, Alzheimer’s, and mild cognitive impairment are generally covered, subject to policy terms. (But the) coverage is usually linked to the requirement of hospitalisation.”

That is why it is essential to check the policy terms.

Prepare For Out-Of-Pocket Expenses

If you do not find a policy to your liking or do not want to opt for one that covers OPD expenses, create a health corpus, which can pay for such illnesses, because out-of-pocket expenses can be substantial.

The average cost of counselling per session typically ranges from Rs 1,000 to Rs 3,000 in most private hospitals, according to our research. The exact fee can vary depending on the city and the doctor’s experience. For instance, the fee for mental health consultation in Max Hospital in Delhi is between Rs 1,000 and Rs 1,500 per session, whereas in Lucknow, it is approximately Rs 700. Therefore, the OPD treatment cost depends on the number of sessions a patient requires and whether any medication is prescribed. Depending on the case, these consultations could be weekly, fortnightly, and so on. Assuming one needs a weekly consultation and is going to a private hospital, the monthly fee could be Rs 2,800 and the annual fee Rs 33,600 in cities like Lucknow. However, in government hospitals like AIIMS Delhi, there is no registration and consultation fee.

Besides this, the cost of medication can range from Rs 2,000 to Rs 8,000 per month, depending on the type of medication, brands, and severity of the condition. In case a patient needs to be hospitalised, the charges in a private hospital might range between Rs 5,000 and Rs 15,000. For advanced stages of conditions, such as dementia or Parkinson’s disease, monthly expenses can range from Rs 20,000 to Rs 50,000, says Dr Gajanan.

Such cases may also require families to keep a qualified nurse or caretaker, which will add to the overall cost.

What Should You Do?

First, while buying health insurance is important, you must have a separate health corpus, too, to meet any out-of-pocket expenditure. Says Menon: “Having a health corpus and health policy are necessary. The health corpus will meet expenses over and above those covered by the policy. Expenses, such as caretaker costs, physiotherapy, etc. may not be covered by mediclaim. The policy covers recurring expenses and should not be stopped. Many senior citizens find insurance costs too high and stop paying premiums. They rely on a health corpus for hospitalisation expenses. This is a blunder and must be avoided. Your health corpus will not replenish itself, but the medical cover will. A health corpus complements a mediclaim policy but can never substitute it.”

Second, even if you find a policy that is to your satisfaction, buying insurance in old age can be expensive and you may end up with inadequate cover. Premiums are prohibitively high, and hence, it is always better to buy a large cover in your younger years when the premium is low.

If you haven’t, assess the premium for affordability and compare with your health corpus. This will ensure financial security. Menon says financial security is a potential cause behind abuse and mental health issues. She says: “Seniors should consult financial advisors to plan their old-age finances, buy adequate insurance cover in their 40s to manage costs better, opt for a separate cover for themselves instead of a family floater policy, remain engaged in activities that can ensure an income stream, and stay relevant, productively occupied, and financially secure.”

Third, prevention is important and remaining active can help. At least three doctors we spoke to recommended regular physical activity, mental stimulation, a nutrient-rich diet, and social engagement. They can help seniors remain mentally healthy.

Being vigilant about yourself or seniors around you can help contain the problem in the early stages. At the same time, being financially prepared will help you handle any surprises. So, start now.

versha@outlookindia.com

Where To Seek Help From?

Here’s a list of some government initiatives that may come in handy for primary consultation and in cases of emergency.

Tele Mental Health Assistance and Networking Across States (Tele-MANAS) toll-free helpline number ‘14416’ under the National Tele Mental Health Programme (NTMHP)

The Tele-MANAS helpline provides free 24x7 tele-counselling, psychiatric consultations, and urgent care services. This help is available in 20 lndian languages

Tele-MANAS Mobile App

The app offers help to those struggling with mild to serious mental health issues. It offers self-care strategies, and direct access to experts. Video consultations are also provided

Ayushman Arogya Mandir

Healthcare centres under Ayushman Bharat Yojana provide free mental health services at the primary care level

The Cost Of Mental Health Counselling

List of five well-known hospitals and their consultation fees for mental health issues:

Apollo Hospital Delhi Rs 1,500-2,500

Max Hospital Lucknow Rs 700

Manipal Hospital Baner, Pune Rs 1,500

Medanta Hospital Gurugram Rs 1,000-2,500

VIMHANS Delhi Rs 1,000-3,000

AIIMS Delhi Nil

Source: OLM Research