Governments, policy makers, service providers, educators, clinicians and others were presented with wide-ranging calls to action at a Mental Health and Ageing summit held in Melbourne recently.
Marie McInerney reports below for the Croakey Conference News Service.
Marie McInerney writes:
A dementia expert has said the best measure the Federal Government could adopt to reduce suicide would be to boost critical social payments like the aged pension and Newstart, and to extend to young people many of the social nets already available to older people.
Associate Professor Stephen Macfarlane said the introduction of social advances like universal health care and the aged pension had been more significant in reducing elder suicide over the past century or so than psychiatric and medication developments.
Macfarlane, chair of the Royal Australian and New Zealand College of Psychiatry’s (RANZCP) Faculty of Psychiatry of Old Age and a geriatric psychiatrist, was speaking at a Mental Health and Ageing summit hosted in Melbourne by peak body Mental Health Victoria on July 24.
His verdict on the power of investment in social supports comes amid widespread calls from community, health and business groups for the Federal Government to #RaisetheRate on the paltry Newstart payment, which hasn’t been subject to a real increase in more than 20 years, and to consider the impact of poverty on mental and physical health more broadly.
Prime Minister Scott Morrison last month appointed a new National Suicide Prevention Advisor, declaring his government was “working towards a zero suicide goal”.
But he and his Ministers continue to resist widespread calls for lifting the $40 a day Newstart and other urgent social needs including investment in safe affordable housing, with Luke Howarth, Assistant Minister for Community Housing and Homelessness, recently playing down the homelessness crisis and urging “a positive spin” on the issue.
Elderly men neglected
Among other alarming statistics and stories, the Mental Health and Ageing summit heard that men aged 85 and older have the highest age-specific rate of suicide in Australia, yet receive very little relative attention in policy, funding, programs and media coverage.
Macfarlane said rates of elder suicide in countries like the UK and Australia are still unacceptably high, but have been falling steadily over the past century – though not, he said, “because of anything psychiatry has done”.
“What explains the decline is improvements in social services,” he said, citing the introduction of universal health care and the aged pension as having a far greater impact on reducing suicide in older people than interventions targeting high risk groups.
“For me the single thing that could most benefit the rate of older person suicide in Australia is to raise the rate of the aged pension at the moment because that economic deprivation is a big community risk factor for depression across the entire spectrum of older people rather than targeting an expensive but not very effective intervention for people identified as high risk.”
Macfarlane later told Croakey that better social supports for older Australians should also be offered to young people as part of a suicide prevention strategy.
“There is no nationally-subsidised supported accommodation program for young people [nursing homes], nor any equivalent of community aged care packages, Seniors subsidies on electricity, transport, car registration, etc, that elders have access to,” he said.
“Improve social supports for young people and the suicide rate will drop.”
The Mental Health and Ageing summit brought together consumers, carers and stakeholders from across sectors, including aged care, to shine a spotlight on mental health issues for older Australians.
Mental Health Victoria CEO Angus Clelland opened the event, saying the “planets are aligned now” on these issues, with investigations underway from the Royal Commission into Aged Care Quality and Safety and the Productivity Commission’s inquiry into mental health, as well as the state-level Royal Commission into Victoria’s Mental Health System.
But there’s concern that mental health issues for older Australians are often barely on the agenda and that support is usually focused at the crisis end of care.
Speakers also described the impact of ageism on care, saying that depression is seen as “normal” for older people and medication “a first port of call”, particularly in residential aged care where staff levels and skills are low and funding and profits often paramount.
The summit heard the Victorian Government’s own submission to its Mental Health Royal Commission was “silent on the issue” of ageing, and that the Royal Commission is yet to publicly highlight issues facing older people – although it is expected to do so.
“We have to make sure no one misses out,” Clelland said.
Too much medicine, not enough care
Another troubling statistic presented by Macfarlane at the summit was that people aged over 75 are the most likely group to be prescribed psychotropic medications like antipsychotics but among the least likely – along with primary school children – to receive a service from a mental health professional.
That was graphically illustrated by former school chaplain Ian Higgins who delivered the consumer keynote address at the summit, talking about the late onset bipolar event he experienced two years ago as he approached the age of 80.
He traced his life story of being both “the carer and the cared for”, growing up with a single parent mother whose children heard of no bipolar diagnosis but knew her as “always down in the dumps or up in the clouds – rarely in between”. She later died by suicide.
“Jump 50 years roughly,” Higgins said, and he went into a post-Christmas “slump”. His GP put him on antidepressant medication and his moods “went up and up and up and I took off”. He woke up as an involuntary patient in an aged person’s mental health service in hospital.
Unlike other mental health consumers who are calling for an end to involuntary treatment and the use of seclusion and restraint, Higgins had no complaints about the service and the ambulance team that took him there.
But he said he was let down by GPs who opted for medication over therapy.
He said: “I asked to get counselling and (one) said ‘no, you’re on pills, you don’t need it anymore’.”
This was a common theme at the summit, which heard there was ample evidence that GPs spend less time in a consultation with an older person, prescribe more medication, and refer fewer older people to mental health treatment plans.
That only gets worse in institutional aged care, particularly through “chemical restraint” – the use of often harmful medications to address behavioural issues, it heard.
“GPs go in and prescribe medication, (saying) ‘nurses tell us they’re needed’ as if they have no say,” said Victoria’s Deputy Chief Psychiatrist Daniel O’Connor, suggesting that GPs should be required to sign a declaration that the medication they are prescribing is both “clinically indicated (with) beneficial impact”.
Victoria’s Public Advocate Dr Colleen Pearce called for regulatory oversight of “restrictive practice” in aged care as has been introduced in disability services.
“One of the things we do know is that with oversight comes changing practices,” she said. “In the absence of that we see significant human rights breaches that occur every day in residential age care facilities.”
Watch this interview with Dr Colleen Pearce.
Focus on relationships, dignity and purpose
The summit heard many calls for better funding of residential aged care and of aged care mental health supports – “just because you turn 65, your funding shouldn’t decrease,” said one participant – as well as for improved skills and understanding of dementia in aged care, and not just from the lowest paid personal care attendants but also doctors and nurses.
But it also heard of a program that is improving health and wellbeing among nursing home residents that doesn’t involve extra funding or staff or medical interventions, just a focus on building relationships and providing comfort, dignity and purpose.
Professor Marita McCabe from Swinburne University is leading the Resident at the Centre of Care Program, which is being rolled out at 39 residential aged care centres (notably all of those that nominated for it are not-for-profit) across Australia after a successful trial at nine.
It is introducing a model of care that is centred on the needs and wants of residents, who are “not looking for hot air balloon rides”, McCabe said.
Rather, they are asking for very simple changes: for their cup of tea to be hot, not tepid; to not have to shower at 5.30am to fit a roster; for the kitchen to stay open later or have a microwave available so dinner doesn’t have to be at 4.30pm; and to do a bit of gardening.
McCabe has conducted training programs over decades for aged care staff to better recognise and manage depression and to address behavioural and psychological problems associated with dementia without resorting to psychotropic medication.
But her teams realised the people they trained “were not being given permission to implement their training”.
The new program introduces a new way of rostering and relating for staff – where duties aren’t divided up so one personal care attendant does all the showers, another all the transfers from beds to chairs, another all the meals, she said.
Instead, staff are allocated a number of tasks with the one resident and given permission and encouragement to build a relationship as they undertake them.
It’s what many of us would expect would be standard from residential aged care, but marks “a major shift in the way these facilities work,” McCabe said.
It is, she says, having measured impact and, importantly for the services, it does not mean a change in staff numbers or need for additional funding, just a “change in mindset”.
“The staff member feels more empowered, the resident feels better because they feel they have a voice, are being treated with dignity and have purpose, and the organisation functions better because everyone is happier and there is a more homelike atmosphere that’s created.”
Watch this interview with Professor Marita McCabe.
Epidemic of loneliness
The summit made clear that that need for connection, meaning and purpose goes way beyond residential aged care, amid growing concern about an “epidemic of loneliness” in our communities – issues that has prompted the UK to appoint a Minister for Loneliness.
Gerard Mansour, Victoria’s first Commissioner for Senior Victorians and its Ambassador for Elder Abuse Prevention outlined the findings of two workshops he recently held with mental health consumers and carers to get a sense of what’s it like to be engaged in the Victorian mental health system from an older person’s perspective.
The workshops heard about many pockets of excellent care. The system’s weakness, he said, is its failure to ensure the same care for everyone who needs it.
Like so many people and services have been doing at the Royal Commission into Victoria’s Mental Health System, participants at his workshops painted a picture of a flawed system that is crisis driven, siloed, with big regional variations and barriers for different groups.
They outlined difficulties in accessing information and support, in navigating the way to other systems such as family violence and drug and alcohol services, and misdiagnoses that led to inappropriate care.
But they also raised issues of isolation and loneliness that go beyond the service system, underscoring an earlier report published by Mansour on the issue which identified that ten per cent of older people will, as they age, experience chronic isolation and loneliness.
And he said it’s likely to become a bigger factor, with research emerging from the US now suggesting that loneliness will “not only reduce the quality of life but shorten life”.
Watch this interview with Gerard Mansour.
The summit heard across multiple panels of isolation and loneliness that hits many people from different backgrounds, who may lose connections and a sense of purpose from leaving work, through death or family breakdown, and poorer health and mobility.
“Once you don’t go into the bank, once your shopping is delivered to the door, the world is shrinking for all of us and we don’t realise it when it’s convenient – but when we start to feel lonely, that’s when we notice it,” said Melanie Joosten from Seniors Rights Victoria, who said such isolation can put vulnerable people more at risk of elder abuse.
But it’s also exacerbated by mental illness, stigma, carer demands, and poverty. COTA’s 2018 State of the (Older) Nation survey found that one in five older Australians don’t have any money to spend on leisure or social activities once they’ve met their basic living needs.
And it can be structural, as the summit heard is too often the case for carers of partners, children and others with mental illness, who not only become isolated because of the demands of care or the stigma around mental illness but in being “invisible” in the service system.
Their care contributions are valued at about $3 billion a year for the community yet they are “a support network that is largely unsupported” and at risk as they themselves grow older or experience mental illness, said Marie Piu, CEO of Tandem Victoria.
She said the problem is not that individual services or staff members do not show compassion or kindness: “it’s the system as a whole: families feel inconsequential, they are not provided information, not routinely included, therefore left to cope without support.”
Watch this interview with Marie Piu.
See more of the discussions from the summit via Twitter below or this wrap of the day’s aims from Mental Health Victoria chair Damian Ferrie.
• If you or someone you know needs help or support, call Lifeline on 13 11 14 (24 hours-a-day), contact your local Aboriginal Community Controlled Organisation, call Beyondblue on 1300 22 4636 or call Q Life: 1800 184 527.
Please see a selection of the tweet coverage by Dave Peters when guest tweeting for @WePublicHealth (scroll down to week of 22 July).
Analytics via Symplur show 125 Twitter accounts sent a total of 1,242 tweets, creating 9.89 million Twitter impressions during the period of Croakey’s coverage of #MHAgeing (23 July-4 August). Read the Twitter transcript here.
The hashtag trended nationally, and reached number one in Melbourne.
Marie McInerney covered the #MHAgeing Summit for the Croakey Conference News Service. This link compiles all of the coverage. Disclaimer: Marie McInerney provides occasional freelance writing and editing services to Mental Health Victoria.