By midlife, Susan had seen a few therapists. A qualified lawyer and adjunct professor, she had struggled off and on with anxiety and depression and had developed a binge eating disorder. She was never hospitalized, but for years felt distressed by her symptoms.
Then, at age 60, she began psychotherapy she describes as “life-changing.” What made it so powerful, she told me, was that the therapist helped her let go of shame. “I’d be beating up on myself and she’d focus on noticing instead of judging. Her willingness to accept where I was and who I was helped me to stop judging and to accept myself.”
Shame and stigma have long accompanied mental health issues. Now, people are beginning to speak openly about their experiences, and policymakers are raising the alarm. This is especially important as we head into winter. The cold weather makes it harder for older people to get out, which can increase feelings of isolation and loneliness.
The Surgeon General, Vivek Murthy, has called attention to the mental health challenges facing children and young adults, and recently released a major report on the mental health of parents and caregivers of children. These are incredibly important steps, but we need to address mental health across the whole life course—including with older people, who are at some of the highest risks of social isolation and death by suicide and represent the fastest growing rate of mental health diagnoses.
The good news is that we know the sort of things that can help those who are suffering, but we must act decisively to ensure people of all ages get the care they need. One in four Medicare beneficiaries live with mental illnesses such as depression, anxiety, schizophrenia, and bipolar disorder, with depression the most common diagnosis. About 12 million older people on Medicare report symptoms of depression.
On the whole, emotional well-being does get better in our later decades. Recent AARP research showed that more than four in five people 60 and over feel happy and are optimistic about their future. But when older people have serious difficulties or feel isolated, the outcomes can be devastating: A new AARP survey finds that one in three women over age 60 report feeling sometimes or often lonely and about a quarter of women in this age group say they sometimes or often feel isolated.
More alarmingly, Americans 75 and over have the highest rate of suicide of any age group. In fact, the rate for men in this group is almost twice as high than it is for males age 15 to 24. Between 2001 and 2022, suicide rates actually increased significantly for men and women over 55, while it declined for those age 15 to 34.
Making sense of the statistics
To better understand these trends, I called Kim Van Orden, a clinical geropsychologist at the University of Rochester who oversees the HOPE Lab—Helping Older People Engage. The lab studies the causes and effects of social isolation for older people and develops interventions to increase connectedness and prevent suicide. Van Orden explained two critical factors that together increase older people’s risk of death by suicide: feeling a lack of belonging—to relationships, social groups, or society—and feeling like a burden on others. She also cites the “5 Ds” linked to late-life suicide: depression, disconnection, disability, disease, and access to deadly means.
Meanwhile, a shocking number of older people are going undiagnosed and untreated. Medicare covers depression screening as part of the Annual Wellness Visit, but only 6 percent of people with traditional Medicare were screened in 2018. One third of those with a mental illness don’t receive treatment. Medicare has improved access to mental health services, such as covering more types of counselors and therapists, but access still lags behind. I worked in the Senate on legislation passed in 2008 requiring private insurance to cover mental health conditions just as it does physical conditions.
Unfortunately, that law didn’t include Medicare, which still limits the number of days of inpatient mental health treatment a person can get over their lifetime. And Out-of-pocket costs can discourage people from seeking treatment.
Another reason for undertreatment may be the mistaken ageist assumption that older people should feel depressed. “But depression is not an inevitable part of aging,” Van Orden says. “Neither is loneliness or anxiety.” We can suffer in terms of our physical and cognitive health as we age, but we also tend to learn ways to adapt to those stressors.
And, when we struggle, there are treatments that work, including some used with younger people. A 2024 study by researchers from Macquarie University in Sydney, Australia examined the long-term effects of cognitive behavioral therapy (CBT) for older adults suffering from anxiety and/or depression. Ten years after either receiving CBT or participating in a facilitated support group, the CBT group had significantly lower rates of anxiety and depressive disorders.
How to prevent mental health issues as we age
We can all take steps to support our mental health as we age and that of the older people in our lives. Perhaps most important is connecting with our primary care doctor—or, better still, a geriatrician—and talking about any mental health concerns.
Be proactive about staying connected so as not to slip into isolation. One program Van Orden’s team uses helps people to identify their drivers of loneliness and create social action plans. It could start by simply inviting someone for a walk or coffee. Even “peripheral” social ties—acquaintances, people met at group events, your bank teller—have been linked to more physical activity, better mood, and fewer negative feelings.
Meanwhile, family, friends, and medical professionals should know the signs of depression and anxiety. Older people may be uncomfortable discussing mental health or will use different language—more likely, for instance, to mention difficulty sleeping or lack of concentration than a sad mood. Younger people in their lives can help by talking openly of their own challenges and treatments. And, especially with the onset of winter, we can all remember to check in on those who may be isolated.
Help is out there. And, as Susan reminded me, life-changing treatment can begin at any age. “It’s never too late,” she said. “Every day counts. And getting help matters. You matter. Your life matters.”
The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of Fortune.
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