Removing the stigma attached to admitting mental health issues is essential for diagnosis and constructive care, says Kevin Rocks.
Mental health is a serious and growing concern in Australia. The Australian Bureau of Statistics has estimated that more than 7.3 million Australians have experienced a mental health disorder at some stage of their life, and research by Australian Institute of Health and Welfare has shown that mental illness is the leading cause of disability in Australia.
While mental health support is becoming increasingly accessible, programs and government assistance packages typically target younger Australians, overlooking the very real needs of our ageing population.
Aged-care providers across Australia are under mounting pressure to cope with a range of mental-health challenges related to psychogeriatric residents, ranging from long-term illnesses such as bipolar disorder, addiction or depression to those suffering from a dementia illness.
For many aged-care providers, the challenge to managing the mental healthcare needs of residents starts with the admission process. The current assessment process allows for the misdiagnosis of mental-health symptoms as dementia by overlooking existing conditions.
Families, too, can fear that if they disclose the mental-health history of their family member that they might not be able to access the care their loved one requires. Many also remain silent in the belief that their family member will be okay once they are in care.
Not having a full overview of a potential resident’s mental-health could place the resident at risk because they are not receiving proper care. It can also place other residents and staff members at risk as resources become strained.
Furthermore, support for psychogeriatric services to assist aged care providers is woefully inaccessible.
Change is desperately needed to ensure that aged-care staff can identify when a resident needs mental health support and that access to quality care is available to every resident.
Assessing mental health
Currently, the assessment process to determine an individual’s suitability and need to enter aged care (ACAT) is tailored to address the physical health and lifestyle needs of the resident.
The ACAT process determines the level of care needed for a patient, so that the correct amount of funding under ACFI guidelines can be allocated to cater to that need. If the ACAT assessment misses important diagnoses, an inadequate amount of resources may be allocated to the patient’s care plan, and the aged-care facility is placed under additional financial and staffing strain.
During the four-week assessment process, the resident’s physical and personal needs are identified and used to develop a tailored care plan. The doctor involved in the assessment may or may not be familiar with the resident and their medical history. The assessment process does not have a mandatory mental health component to identify pre-existing conditions, such as bipolar or chronic depression.
Although there is a psychogeriatric section to the current ACAT system, it is often overlooked by practitioners who deem it too complex or difficult to complete. Assessors are also unable to request that past medical files be made available to identify any mental health needs.
Families are not required to disclose any long-term mental illnesses, and in some instances residents may not be able to verbalise their mental-health history during the assessment either. The result is that psychogeriatric cases are routinely admitted to care facilities without sufficient information to develop and resource an adequate care plan.
Sometimes psychogeriatric issues can appear after admission to an aged-care facility simply as a result of a patient being taken off medication for an ongoing illness. Once returned to a medication plan they can be easily managed.
However, when more serious psychogeriatric issues are missed during the assessment process, it places the patient at risk of worsening health, makes treatment difficult for staff and can negatively impact other residents.
A detailed and more sophisticated assessment process is required to ensure that each resident has access to the right level of care. The assessment should consider each resident’s whole medical history in order to identify previously undiagnosed mental illness or treat pre-existing conditions.
Finally, the ACATs should also prioritise gaining input from the resident and their family where possible. Increased communication may take longer, but it will give a sense of the whole individual and what kind of care they need.
Letting families know it’s okay to talk about mental health
While families are sometimes unaware of a loved one’s psychological illness, many withhold information out of fear their relative will not secure a place. Some are simply embarrassed due to the perceived stigma many still feel towards mental illness.
Unfortunately, this means the short-term solution of placing a loved one into any available care is often prioritised before taking the time to find a care provider who can best accommodate the needs of the resident. This is a dire situation for Australia’s ageing population, as inadequate assessment before admission means that residents, their co-residents and staff all suffer. If residents are prevented from receiving the informed care they deserve, their quality of life can deteriorate. Other residents can be put in harm’s way and staff can be placed under pressure to provide care without adequate training or resources.
Greater honesty is needed on all fronts to develop a comprehensive plan for each individual. This includes an active role for families in caring for their relative by having an honest conversation about mental stability prior to admission. An open appraisal of any mental health issues from the patient’s family helps to remove to the stigma of mental illness. It is essential in order to create an environment of care that benefits their family member, and should never be seen as criticism.
If mental illnesses are disclosed early, responsibilities can be allocated based on the person’s need and the suitability of facilities, allowing providers to fulfil their duty of care to all residents.
Getting real support for mental health
If an untreated or incorrectly diagnosed psychogeriatric case is admitted into residential care, it becomes difficult to provide the right level of care from day one. In the case of more serious issues, a resident may need to be isolated or placed under increased supervision due to unpredictable or harmful behaviour. Centres do not always have the space or staff to deal with the seriousness of cases requiring this action.
With no prior warning, and without the resources to manage the needs of a resident with significant mental health concerns, aged-care providers often have to call on an ambulance to manage critical incidents.
The federal government provides basic care subsidies for aged-care facilities under the Aged Care Funding Instrument (2008). In the event of a mental health emergency, facilitators can apply for a Behavioural Supplement (BEH) to assist with care.
However, the BEH equates to approximately $15 more funding a day – not enough to cover one new staff member for an hour a day.
In some instances, residents may require 24-hour care that the centre simply cannot provide. Whether this is making room arrangements to keep a psychogeriatric case closer to nurses’ stations or providing increased supervision, the subsidy is simply not enough to provide adequate resources to care for serious cases.
If the assessment process is refined and optimised to diagnose mental health issues from day one, facilities know what care they need to provide and are in a better position to fulfil their duty of care.
Facilitators want to act in the best interests of their residents, but they are being left in the dark on long-standing mental health issues. The unexpected strain of a resident being admitted without a correct mental health diagnosis puts both the patient and other residents at risk of neglect.
Ultimately, the only way we can address these issues is with increased, honest communication between the resident, families, ACATs and medical professionals associated with the admissions process.
There needs to be a whole new approach, both from the way the aged care sector and the government approaches mental health care for older Australians.
While this is not an easy process, it helps to secure a more sustainable aged care sector and is a much needed step towards an environment where residents are safe, understood, valued, and most importantly – given the care they need.
Kevin Rocks is chief executive officer of Holy Family Services, a community organisation in NSW that provides aged care, childcare and retirement villages.Do you have an idea for a story?
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