Home' Australian Ageing Agenda : AAA Jan-Feb 2014 Contents Gary* had been living on the top of a noisy rural New
South Wales pub for four months before arriving at
St Francis Residential Aged Care in Orange.
Without money or social supports he frequently
took up offers of temporary accommodation in
between admissions to Bloomfield hospital for psychiatric treatment.
Clinical leader Katherine Groves says many of St Francis' 14
complex mental health residents have histories of homelessness
and extended stays in psychiatric institutions.
"A lot of these residents have quite fractured relationships
with their family, so there was no support network for them in
the community. They were often malnourished, on the wrong
medications, either in debt or had no money and faced stigma
related to their mental illness," she says.
For the past two years, the team at St Francis has been
accommodating older people with complex mental illness from
Bloomfield mental health hospital to ensure they receive appropriate
care and support in the least restrictive environment possible.
"When we decide to take a person from Bloomfield, it's a
multidisciplinary approach," she says.
Residents are linked into the community mental health team,
as well as to occupational therapy, speech pathology, social work
and nutrition services. All care staff have also undergone training
in mental health first aid.
While facilities like St Francis are the exception rather than
the rule in aged care, Groves says she expects mental health care
to become an increasingly critical issue for the sector.
A LONG ROAD AHEAD
While general awareness of the needs of older people with mental
illness is increasing, Dr Rod McKay, conjoint senior lecturer with
the School of Psychiatry at the University of New South Wales,
says many systemic and attitudinal barriers remain.
In fact, older people's access to mental health services has
been falling behind the rest of the population, despite the fact
that suicide in Australia is highest among men aged 85 and over.
"In national trends, the increase in access to mental health
services that governments have been working on has been much
more effective for younger people and people in mid-life than
older people," says Dr McKay. "Older people have had very
limited increase in access to services."
For example, access to GP mental health services by people
65 and over is 35 per cent less than the rate of younger people
and access to psychologists is around 21 per cent less.
In residential aged care, older people are excluded altogether
from Medicare-funded psychology services, most likely due to
perceptions of perceived double funding of services. However,
very few providers are able to fund these services through
current aged care subsidies.
BARRIERS TO MENTAL HEALTH CARE
Looking at the aged care system, many mental health advocacy
groups have identified areas of discrimination against older
people with mental illness and have called for special recognition
within the Aged Care Act.
In its submission to the Living Longer Living Better (LLLB)
reform process, the Royal Australian and New Zealand College
of Psychiatrists (RANZCP) says access to aged care services for
older people with a mental illness is still conditional on a person
having a predominately aged-related disability.
"Not only does this appear to contradict the inclusion of
psychological need as a reason for requiring residential care
in the Aged Care Act, it would also appear to contribute to
RACF providers' lack of preparation to meet these needs,"
says the RANZCP.
The peak body says this position excludes older people from
care based on the presence of a mental health condition and
therefore is discriminatory and ultimately detrimental to the
wellbeing of older people.
In its submission to government, the National Mental Health
Commission (NMHC) says discrimination through lack of recognition
of older people with a mental illness is contrary to Article 12 of the
UN Convention on the Rights of Persons with Disabilities and must
be explicitly addressed in the aged care system.
Out of sight
Despite the promise of mental health and aged care reform
in recent years, older people with mental illness continue to
be overlooked, reports Linda Belardi.
38 | JANUARY -- FEBRUARY 2014 | AAA
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