Above: NSW Minister for Mental Health, Kevin Humphries, opens the Putting Mental Health on the Aged Care Agenda forum, chaired by Professor Henry Brodaty (in background).
By Stephen Easton
Aged care and mental health reform can only be successful if the two processes are integrated with one another, and with the wider process of national health reform, an aged care forum at NSW Parliament House heard yesterday.
The forum, Putting Mental Health on the Aged Care Agenda, was arranged by the South East Sydney Local Health District (SESLHD) aged care psychiatry team and was chaired by its director, Professor Henry Brodaty.
According to Professor Brodaty, the forum’s purpose was to help “strengthen the services, bridge the gaps and strengthen the partnerships” between the various providers of aged care, healthcare (including mental health) and social services for older people, particularly those who live in the community.
To open proceedings was NSW Minister for Mental Health, Kevin Humphries, who also declared his support for aged care providers, saying he had previously managed an aged care facility in Moree.
“… So any of you that are involved in community-based care or in residential aged care and the difficulties of providing that in some pointy parts of our community: thank you for what you’re doing,” Mr Humphries said. “This forum is about your views on where aged care should go, particularly from a policy dimension.”
Develop new models
The keynote address was given by Professor Ian Hickie, a member of the team led by Professor Patrick McGorry that produced the comprehensive Blueprint to Transform Mental Health and Social Participation in Australia for the federal government in March.
The executive director of the University of Sydney Brain and Mind Research Institute urged aged care, healthcare and social service providers to begin considering new models of care that could deliver better outcomes for older people living in the community. These, he said, must involve increased collaboration between various service providers, and with those who assess the needs of potential clients.
Professor Hickie suggested that reform should “focus on small changes that are transformational” and said political debates needed to move beyond focusing on the number of acute care beds, to instead examine new service models that could actually take pressure off hospitals.
“Any argument to stick more money into existing systems or failed systems … like existing institutional or acute care services, is a dumb idea. We have to resist that temptation.
“We need to work out new service models – which will often be based on the social services models, not based on the health models – and actually contracting out to groups like Mission Australia and other big service providers, or private health providers, who will not only do clinical care, they’ll link with housing, they’ll link with education and so on, so the person has their [complete] needs met.”
Above: Professor Ian Hickie delivers his keynote address.
Professor Hickie highlighted two must-haves – collaborative geriatric medical teams and activities that enhance social inclusion for elderly people – from among 20 ‘best buy’ recommendations from the mental health reform ‘blueprint’ he co-authored earlier this year.
He also advised the NSW aged care providers in the audience to decide which models they would favour over the next six to eight months, before the 2012 Federal Budget, and suggested they should also be ready to engage with the new, national statutory body that is proposed to preside over primary care and would be based in Sydney.
“We don’t know what is going to happen in primary care [through the national health reform process], but there will be a new national commission, which will be very interested in what the models of care will be and, when it comes into being in January … the aged care sector needs to engage with that very urgently.”
Treating the whole person
Next, Professor Brain Draper from Prince of Wales Hospital Aged Care Psychiatry Services used his address to give forum participants a factual ‘profile of older people with mental illness’, arguing that “when we talk about delivering mental health services to older people, we have to think about what their needs are first”.
Professor Draper added later that he thought healthcare services had generally failed to understand people’s complete needs well enough, which he said had “grown out of the idea that health is just about health, failing to recognise that health is just one part of the whole, total lifestyle”.
Above: Professor Brian Draper.
The University of New South Wales Conjoint Professor of Psychiatry then related survey data showing that exisiting services do not meet the needs of middle-aged and older people with mental illnesses.
The survey data showed that in Sydney at least, the majority of people aged over 50 and living with a mental illness had, on average, only one third of their social needs and two thirds of their accommodation and food needs being met (using the Camberwell Assessment of Need for the Elderly). Most had also underestimated their own level of need, by about 25 per cent.
“For mental health services to actually meet those needs, they need to collaborate with people who can do that,” Professor Draper said. “That will be a whole range of non-government organisations, and other government agencies, working together in collaboration, and I think if we can develop better models for that, then that will improve the wellbeing of these people.
“… One’s social life, one’s interaction with other people, work and so on – all of this impacts on our mental and physical health, so as a healthcare provider, if I don’t understand the total circumstances of a person I’m dealing with, and understand what their needs are in those different areas, then I’m not really going to fundamentally help that person as much as I could, potentially.”
Professor Draper said later that workforce expansion would also be required to meet the current and future needs of older people with mental illnesses.
“We currently have a major under-resourcing of people in aged care mental health, and aged care generally,” he said. “The training needs that we currently have for the future are simply huge. Really, to meet the future needs of older people – whether we’re talking about the social, medical or mental health components of their needs – we need to train a lot more people to be able to do that.”
More work to be done
Dr Kate Jackson, manager of the Older People’s Mental Health Policy Unit within NSW Health’s Mental Health and Drug and Alcohol Office spoke of the progress that had already been achieved in NSW through working with aged care providers and their industry peak bodies, but said there was still “a lot more to do, particularly in the community care area”.
Above: Dr Kate Jackson.
“The picture is quite different nationally,” Dr Jackson said, “but I think there’s a growing awareness of mental health needs among the aged care sector. The focus of today is really more on the community care end of things, and I think that’s where there’s probably a bit more work to be done.
“I think the first step is [for aged care providers] to start to get a bit of an understanding of what some of those mental health issues are, and the associated needs which we’ve been talking about today; some of the social support needs and things like that.”
The day before the forum, in another step towards better mental health services, the Prime Minister announced an agreement had been reached by the Council of Australian Governments on a National Partnership Agreement on Mental Health, which will see state and territory governments receive $200 million from the Commonwealth to help address service gaps in accommodation and emergency department planning.