The life course, inequalities and mental health in later life

Chapter 3 explores the contribution of the lifecourse approach and social gerontology to understanding mental health outcomes in later life. It also explores the role played by health and social inequalities. By bringing these perspectives together the Chapter makes visible the ways in which lifecourse inequality and adversity e.g. childhood abuse, create and/or amplify risks to mental health in later life. It also exposes the embedded and structural nature of causative mechanisms. Health inequalities have profound implications for mental health. People from disadvantaged socioeconomic backgrounds suffer disproportionately from common mental disorders, such as depression, across the whole lifecourse. They are also exposed to higher levels of chronic psychosocial stress which, independently and additively, undermines mental wellbeing. These effects are cumulative over the longer term and in more unequal societies; also by exposure to discrimination and oppression. These arguments challenge the dominance of the ‘inevitable decline’ model of ageing exposing a more nuanced complex set of intersecting risks to mental health that are structurally located and socially produced. The role of policy in addressing health inequalities and their social determinants was a key dimension of mental health policy until 2011; since then it has become increasingly uncoupled from the policy agenda.