Sector needs better mental health service: expert

Mental health issues are prominent and under-addressed in aged care and there needs to be more mental health nurses, psychologists and psychiatrists who know about treating older people, Professor Nancy Pachana tells AAA.

When clinical psychologist and neuropsychologist Nancy Pachana is told an aged care resident with dementia is unable to communicate, she starts an exchange to show otherwise.

“People will say they can’t talk. The best thing to do is have a conversation with George and they say ‘ooh, George can talk,’” says Pachana, a professor in clinical psychology at the University of Queensland.

How you approach the person is just as important as what you say, she says, because even if the person doesn’t understand all the words, they take in the tone of voice.

“If you are angry or frustrated with them they pick that up 100 per cent. Staff will say they don’t talk and they can’t understand but that is just not true.”

Professor Pachana works with healthy community-dwelling older adults and those who may have illnesses, dementia or live in residential aged care. She also trains students to work with older adults across a range of settings.

A native of the United States who has been in Australia for 14 years, Pachana is director of clinical training at UQ’s school of psychology, where she coordinates its professional doctorate degree in clinical geropsychology. With UQ colleague and psychiatrist Professor Gerard Byrne, she established the Ageing Mind Initiative, a virtual space for people interested in older adults for practice or research.

Her practice includes providing outreach to community carers and residential aged care facilities through Alzheimer’s Australia Queensland’s Dementia and Behavioural Management Advisory Service in Brisbane. It involves going with a multi-disciplinary team to a facility when called upon.

“We try and teach people a systematic way of looking at behaviours and then teach ways of managing those behaviours in ways that don’t rely on medication; that rely on strengthening the communication and the relationship with the person with dementia,” she says.

Pachana says she loves working in aged care facilities because in addition to helping an individual they talk about basic principles with staff.

“It is like throwing a stone into a pond. I can have this spreading degree of activation in the nursing home and help many more people.”

One of the challenges is getting people to think beyond the diagnosis, says Pachana, highlighting that a person with dementia retains the essence of their personality so understanding their background is critical to understanding the person.

All of Pachana’s clinical practice and research is with older adults. Much of that research involves residential care but also extends to driving in older people and in people with dementia.

In addition to “liking older adults” she says seeing her supervisor, who was a neuropsychologist, working with older people during her training led her in this direction.

“What resonated with me was the fact that older people have such a rich lifetime of experience that actually working with them in therapy is easy because you are not teaching somebody a new skill. Often times you are saying in the past you did cope with this how can we help you get back to that level.

“For illnesses like Alzheimer’s or other neurological or physical illnesses, people often have complicated presentations and family histories so you have to be a detective, a mediator and good at communicating with other health professionals,” she says.

Pachana says listening is the key to a lot of mental health care in older adults, which she describes as a group open and receptive to talking therapies. Myths and stereotypes that pitch all older people as the same is the common issue for this most heterogeneous group of all, she says.

“It is perpetuated in nursing homes where people’s past becomes almost invisible. One of the problems that is most common in nursing homes is de-individualisation. All of the studies show that if you can introduce a more person-centred approach and have as much personal meaning brought back into that person’s life than people do better.”

While noting the best approach is multi-disciplinary, she says she wishes there were more psychologists consulting to aged care because mental health issues are prominent and under-addressed.

The Australian Psychological Society’s national psychology and ageing interest group, of which Pachana is the immediate past convenor, is currently surveying psychology practitioners nationally to understand barriers to accessing psychological treatment for people in aged care. It is also trying to push students to get aged care experience in their training, she says.

There needs to be more people on board because there are not enough mental health nurses, psychologists and psychiatrists who know about treating older people, Professor Pachana says.

“We need to increase the workforce there and we need to reduce the stigma of treating older people. I do it all the time so I don’t understand why you wouldn’t. Older people are incredibly articulate in therapy and you see amazing benefits.”