It is the beginning of equal access to psychological services for people with a diagnosed mental health disorder living in residential aged care, write Dr Louise Roufeil and Dr Harriet Radermacher.
Up until this week’s Federal Budget, most aged care residents were only able to obtain pharmacological interventions for mental illness whereas older people living in the community accessed both medical and psychological interventions for mental disorders, the latter through the Medicare Better Access initiative.
This is despite the fact that multiple international and Australian studies have shown the prevalence of psychiatric conditions in older adults residing in long-term facilities as up to four times higher than non-institutional or community rates.
This situation has long been flagged as a major concern because it was argued that in the absence of any other evidence-based alternatives in residential care, medical practitioners had to rely on psychotropic medications that often had negative side effects, promoted polypharmacy and drug interactions and contributed to a decline in the overall quality of life of residents.
It was therefore pleasing that the 2018-2019 Federal Budget provided $82.5 million for psychological services for older Australians in residential care with a diagnosed mental disorder, particularly given the strong evidence for the efficacy of psychological treatment for older people experiencing conditions such as depression and anxiety.
This money will go a long way toward addressing the high level of mental ill health in this cohort, with the aim of improving functional capacity and wellbeing, and reducing the distressing side effects of medication.
This budget initiative will bring psychologists, and other eligible mental health providers, into aged care facilities where there has previously been only very limited funding available for this workforce. This is in stark contrast to countries such as the Netherlands, where many aged care facilities directly employ psychologists.
While it remains unclear how the government will implement this initiative, access to psychologists is unlikely to be a problem. In terms of workforce, psychologists are the largest mental health workforce in Australia with just over 29,000 fully registered and practicing psychologists.
Not all this workforce will be engaged in private practice and able to provide services to residential facilities, but Primary Health Networks have access to this independently practicing workforce and the Australian Psychological Society operates an online directory of psychologists, popular with general practitioners, who facilitate referrals.
Like all health professionals, psychologists are under-represented in rural and remote regions although their presence is substantially higher than other mental health professions, with the potential for access to also be facilitated through the use of innovative technologies such as telehealth, where appropriate.
Given this initiative represents a landmark change in the way mental ill health has previously been managed in residential aged care, it will be incumbent upon both the psychology profession and facilities to work collaboratively to ensure residents truly benefit from access to psychological treatment.
For too long erroneous beliefs that depression and anxiety are normal amongst older people have prevented residents getting the help they need. Medical practitioners and aged care staff will need to become familiar with evidence-based non-pharmacological approaches to mental illness and how these are delivered.
Equally, psychologists will need to understand the context and implications of working with individual clients within an aged care facility.
The APS is the largest peak body for psychologists in Australia with about 23,000 members and 42 branches spread across Australia; there will thus be both national and local support available to ensure this initiative makes a real difference to older Australians living in residential care.
While this funding is welcome and urgently required, hopefully it will pave the way to address a more pressing question – why there are such unacceptably high rates of mental disorders in aged care facilities in the first place, and how can they be reduced.
Dr Louise Roufeil is executive manager of professional practice and Dr Harriet Radermacher Research and Policy Officer, at the Australian Psychological Society.