Above: Chair of the RANZCP’s Faculty of Psychiatry of Old Age, Dr Roderick McKay.
By Yasmin Noone
The Minister for Mental Health and Ageing, Mark Butler, may have won favour with many in the sector for his promotion to cabinet yesterday but he has yet to fully please the Royal Australian and New Zealand College of Psychiatrists by better integrating two of his portfolios and addressing the needs of older Australians with mental health conditions.
The RANZCP, the principal organisation representing the medical specialty of psychiatry in Australia and New Zealand, believes the mental health needs of older Australians are currently being ignored.
That’s despite the government’s current focus on mental health – the mental health portfolio was created in 2010 – and the fact that the same minister is responsible for both the mental health and ageing portfolios.
Chair of the RANZCP’s Faculty of Psychiatry of Old Age, Dr Roderick McKay, said the older population is excluded from the mental health agenda partly because the evidence upon which the minister’s advice and government policies are based is flawed.
According to Dr McKay and the organisation, much of the current evidence around mental health conditions in the older population underestimates real prevalence rates.
“Minister Butler and other [government] planners are listening to evidence about the prevalence of mental health issues in the older population but the evidence has significant flaws in it,” Dr McKay said.
“…Unfortunately there are no alternate evidence-bases.”
A RANZCP position statement, released today, adds that the 1997 and 2007 National Survey of Mental Health and Wellbeing contains “methodological failings” as used surveying “methods unsuitable for older people and excluded people with dementia or living in residential aged care.”
Formulating policy on such a methodologically poor evidence-base, the statement explains, has partially resulted in a growing number of older people being denied adequate access to mental health care.
“Access of people 65 years and older to GP mental health services at 34 per cent of the rate for those aged 33 to 44 years,” the position statement says.
“Access to psychologists by people 65 years and older at 21 per cent of the rate for those aged 33 to 44 years; the highest age-specific suicide death rate for men being in the 85 years and over age group; and [the older population’s] anxiolytic, hypnotic and sedative drug prescription rates are approximately 500 per cent that of the general population.”
Dr McKay also believes that currently, the needs of older people with mental health issues are not being met because there is a “lack of coordination” between the mental health and ageing sectors.
“Both those responsible for mental health care planning and ageing planning hope the other lot of planning [people] will address the issue,” he said.
“…And older people continue to fall between those two gaps.”
The organisation has also expressed serious concerns regarding the inadequacy of planning for the mental health needs of the older person.
“The [fourth] National Mental Health Plan, [released in 2009], was the first to mention the mental health needs of older people but it doesn’t identify the priorities [or provisions that need to be implemented] to address their needs.
“…The Productivity Commission’s report into aged care itself acknowledges the mental health issues faced by older people but [the topic] drops out of the executive summary report. There are also no specific actions [mentioned by the PC] which recommend a feasible way forward of addressing the mental health concerns of older people.”
Dr McKay does, however, acknowledge that there is no better time for change than now, with the release of the Commonwealth’s 10-year Roadmap for Mental Health Reform earlier this year and an expected government response to the Productivity Commission’s report into aged care in 2012.
“Both are opportunities to make a significant improvement to the lives of older people with a mental illness. But, if the opportunity is not taken, there are risks that [this specific population] will be further neglected.
“A key challenge [for us] is to help [the minister] be aware of the opportunity to bring mental health and ageing together.”
The RANZCP therefore calls on the government to take action now to improve the mental health of older Australians.
Firstly, it wants the minister to order a thorough survey into the mental health and wellbeing of older Australians that identifies all older people and audits access to mental health care services.
“What is crucial with that is that the survey actually addresses mental illness in people living with dementia or a cognitive impairment, and people who live in residential aged care as it is known that older people have much higher rates of mental illness,” Dr McKay said.
National benchmarks for the availability and quality of mental health services for older people must be also established to improve the quality of mental health care for older people.
National principles for providing coordinated care across different services for older Australians with mental illness are also needed, as are basic mental health training for people working with older Australians.
Discrimination against older people with mental disorders must also be eradicated, positive images of older people with mental health issues must be circulated and the possible treatments for mental health conditions available to older people must be promoted.
The organisation also wants community and residential aged care services to be more inclusive of the needs of people with mental illness
“Untreated mental illness robs older Australians of their quality of life, physical health and independence at significant cost to individuals, family and community,” the position statement reads.
“While there are effective evidence based mental health treatments for older people in Australia, limited resources deny them equitable access.
“Action must start now to address this deficiency. Australia owes its older citizens and their families adequate support, respect, and dignity.”