At long last, mental health support for residents

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.

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.

Related budget coverage

Residential places to go to consumers, new bond levy for providers

Tags: australian-psychological-society, better access initiative, Dr Harriet Radermacher, Dr Louise Roufeil, federal-budget,

14 thoughts on “At long last, mental health support for residents

  1. While i welcome the recognition of mental health in older people, I am concerned about the delivery of interventions by psychologists or mental health nurses. There are also counsellors with a focus on caring for older people both in community and residential care. We need to recognise the diversity of interventions, skills and resources available to older people to support their mental health rather than prioritise one group over another. Counsellors can certainly deal and support the every day concerns of living in a facility or the experiencing depression or anxiety or grief and loss. Here’s an opportunity to create a skilled workforce and encourage a diversity of professions across the spectrum of mental health care.

  2. Another profession to look at would be Social Workers. Social Workers are experienced in a wide range of issues that may affect an individual within any stage of life. They are also concerned with human rights and justice which would provide more support and advocacy in circumstances of elder abuse and oppression, which is another area of great concern. Elder abuse is also gaining significant funding, although what is lacking is changes on the ground floor where these issues are occurring. The budget stipulates that $22m will go towards addressing elder abuse including elder abuse support services.

    Implementing a care staff ratio would also provide residents with adequate staff to have their basic needs met in an appropriate time. This could see the reduction in continence pads being used and more residents being able to be escorted to the toilet and not have to wear such ‘aids’ when in fact it is detrimental to their dignity and sense of self worth which is a contributing factor to the mental status of all individuals, among other issues being faced by Aged care Residents within Australia.

    Social Workers have the ability to address mental health concerns within the aged care sector and they also have the knowledge and skills to be able to advocate for individuals and address such abuse and oppression in a professional manor. Providing an opportunity for Social Workers to practice within an RACF (much like that of the US model) could help to achieve lower levels of mental health issues and elder abuse. Bring together the funding for issues within the RACF and seeking solutions from the ground up to directly fight against these oppressive structures, in my belief, would provide our elderly with a greater support network that addresses current issues and provide direct support measures to our Elderly living within RACF.

  3. This is great news and I hope that the professional counsellor will be identified as the best recourse to use in a RACF.

    Psychologist will have a great role to play in diagnosis and treatment plans, however most of the experienced issues in RACF could be well managed with a continuity of good counselling and family focus on the transitions and journeys people undertake in the palliative space.

  4. There are a number of professionals who would be able to provide this service to people living in residential aged care facilities, including psychologists, Occupational Therapists, counsellors and social workers. The better access to mental health plan has already recognised all of these professionals ability to provide services to people in the community so why would it be different in RACF?
    Having a larger skilled workforce to draw on will result in greater diversity and provision of services including up skilling of staff at the RACF

  5. My understanding of this new funding is that it will be available for use for all the professional groups that are currently recognised in the Better Access program – as Sandra Smith suggests. All professional groups have something different to offer in this type of setting. However I also agree with S Farquharson that Social Workers are particularly in a good position to offer advocacy skills as well as counselling to residents (and I’m a Psychologist not a social worker!!) The fact that any of us could end up providing services in the aged care sector will also put us in a good position to lobby for a better carer / resident ratio which would be the single most important factor in improving care for elderly residents. In fact I was arguing for this just today at the aged care facility in which my father is a resident. I constantly see the effect of rushed and overworked staff resulting in rough handling, poor communication with residents, poor cleanliness…….I could go on and on.

  6. I value greatly the reflections above that a range of skilled counsellors – from a variety of backgrounds – are needed in aged care. I echo these sentiments and thought it was particularly admirable for Judy Christian, being a psychologist, to speak highly of social workers in particular.

    As a sessional lecturer in the graduate program of counselling and psychotherapy for the University of Adelaide I can tell you that there is a lot of talent out there and those recognized through PACFA, but who might not be classed as a mental health clinician, should not be overlooked in what they can offer a senior clientele.

    I am an accredited mental health social worker myself specializing in work with advanced seniors. My book Counselling and Psychotherapy with Older People in Care: A Support Guide through Jessica Kingsley Publishers of London argues for a diverse group of practitioners supporting advanced seniors – beyond clinical geropsychology – and presents a new model of psychological intervention as well as sociological analysis with regard to ageism and building senior friendly systems of care.

  7. You may or may not know that counsellors with no Medicare # lie on the bottom of the tree!! I do not believe counsellors are recognised in the Better Access program. So there is very little options for counsellors to support people in any aged care space. The only possible option is in community where people have the option to pay or through a person’s home care package or as a private service.

    Yes, certainly social workers are part of the mix of mental health professionals who can support older adults in any aged care space. While they may operate within a social justice framework, so can counsellors who choose to embrace this framework.

    I am certainly on a mission to raise awareness of counsellors as a valuable resource in any aged care space, working along and besides social workers, psychologists and psychiatrists.

  8. Felicity Chapman, I am super excited to read about your support for a diverse group of practitioners. I am going to order and read your Guide. With a background in Sociology and Counselling, I believe older adults are missing on support from a valuable group of professionals!! Go Felicity!

  9. Felicity Chapman, I explored the research around CBT, narrative and existential therapy to support older adults (with addictions). Now to get counselling on conference and workshop agendas!!

  10. The Federal government has recognised counsellors as providers under the NDIS so it would be logical to extend the recognition to PACFA and ACA accredited counsellors to provide services to the aged in residential care facilities. I am a student member of PACFA, currently completing a counselling placement in a residential aged care facility. I will be asking PACFA what representations they are making on my behalf to gain recognition for counsellors as providers. I am experiencing first hand the need for counsellors in this setting. I would like to acknowledge the work of Felicity Chapman in raising awareness of the counselling and therapy needs of this cohort and the tremendous preparation reading her book gave me.

  11. Dear Caroline, thank you so much for your comments above.
    And I absolutely agree with you – lets get counselling on conference and workshop agendas. Currently I am awaiting abstract approval for the next Australian Association of Gerontology conference because I hope to do just that!!

    And Jennifer thank you, too, for your words above. There is so much work to be done but it is good to see the ‘winds of change’ starting to blow re getting residents emotional and psychological needs on the national agenda.

  12. Teamwork is what is needed in RACF and in the hospitals too. Qualified pastoral and spiritual care practitioners are invaluable to supporting and residents and patients and their families as well as fellow staff. Mental health support will go along way to support spiritual distress that often is exacerbated by physical illness, moving to aged care and loss of identity, independence and connections with family and community. I also would advocate for mental health support funding for weekend and evening shift work, when perhaps people are most isolated and vulnerable. Mental health support is finally being more recognised but there is a long way to go yet. All will benefit in the end.

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