This chapter reviews what is known about the prevention of mental ill health in later life and the protection and promotion of mental health. This includes research evidence and, importantly, the perspectives and lived experiences of older people. The relevance of conceptual issues, of models of ageing, and frameworks for understanding mental health promotion and prevention are also explored, as is their intersection with policy. Services and/or interventions are identified where useful.

Introduction

Before reviewing the material in the complex area, it is useful to make a number of overarching points about its nature and scope.

A key observation is that the literature on ‘good’ or ‘positive’ mental health among older people tends to focus on late life itself, that is, what promotes mental health in later life rather than what contributes to its promotion across the life course. Some of its determinants are life course linked, for example the availability of social support, but those links are rarely made in any robust way. This is a deficit even for those commentators who are committed to adopting a life course lens (Marmot et al, 2010). Given that we are beginning to unpick some of the links between childhood adversity, early life inequality and midlife mental ill health, it is timely to explore extending these links into later life. Arguably, longitudinal data should be able to contribute to building a stronger evidence base in this underdeveloped field (Understanding Society and Economic and Social Research Council, 2009; Hamer et al, 2014).

A second issue relates to distinctions between, and evidence about, promotion and prevention. While much of the literature considers these issues separately, they are often viewed as two sides of the same coin, particularly by older people; they also intersect with the notion of protective factors. For both prevention and promotion, it can be challenging to establish a relationship between inputs and outcomes: the role played by promotional activity in enhancing mental health or a preventive intervention in reducing risks is hard to prove. If the issue being targeted is a social one, for example decent housing or education, as opposed to a narrower health-related issue, for example a healthy diet, links are very difficult to establish.