Government-subsidised mental health services are underused in Australian residential aged care facilities
Monica Cations
A B * , Luke R. Collier A , Gillian Caughey A C , Jonathan Bartholomaeus A , Catherine Lang A , Maria Crotty D , Gillian Harvey E , Steven Wesselingh A , Megan Corlis F and Maria C. Inacio A C
+ Author Affiliations
- Author Affiliations
A Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia.
B College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia.
C Division of Health Sciences, University of South Australia, Adelaide, SA, Australia.
D College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
E College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
F Aged Care and Research, Australian Nursing and Midwifery Foundation, Adelaide, SA, Australia.
* Correspondence to: monica.cations@flinders.edu.au
Australian Health Review 46(4) 432-441 https://doi.org/10.1071/AH22049
Submitted: 3 March 2022 Accepted: 15 June 2022 Published: 1 July 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
Abstract
Objective To describe patterns of use of the available Government-subsidised mental health services among people living in Australian residential aged care facilities.
Methods A retrospective population-based trend analysis was conducted, including all non-Indigenous people living in an Australian facility between 2012 and 2017. Adjusted incidence proportions and trends were estimated for four groups of mental health services.
Results The use of Medicare-subsidised mental health services was very low overall. The proportion of residents who accessed primary care mental health services increased from 1.3% in 2012/2013 to 2.4% in 2016/2017, while psychiatry service use increased from 1.9 to 2.3%. Claims for clinical psychology increased from 0.18 to 0.26%, and claims for a registered psychologist, occupational therapist or social worker rose from 0.45 to 1.2%. People with dementia were less likely than people without dementia to access all services aside from psychiatry services.
Conclusions Less than 3% of residents accessed funding subsidies for mental health services and people with dementia experienced pronounced barriers to service access. Mental health care is a pillar of the publicly-funded health system in Australia, and low use of these services among aged care residents indicates a need for organisational and policy changes to improve access.
Keywords: aged care, dementia, health services, mental health, older adults, policy, primary care, psychiatry, psychology.
References
[1] Blanchflower DG, Oswald AJ. Is well-being U-shaped over the life cycle? Soc Sci Med 2008; 66 1733–1749.| Is well-being U-shaped over the life cycle?Crossref | GoogleScholarGoogle Scholar | 18316146PubMed |
[2] Blazer DG. Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci 2003; 58 M249–M265.
| Depression in late life: review and commentary.Crossref | GoogleScholarGoogle Scholar |
[3] Schuurmans J, van Balkom A. Late-life anxiety disorders: a review. Curr Psychiatry Rep 2011; 13 267–273.
| Late-life anxiety disorders: a review.Crossref | GoogleScholarGoogle Scholar | 21538031PubMed |
[4] Australian Institute of Health and Welfare. Dementia in Australia. Canberra: Australian Government; 2021. Available at https://www.aihw.gov.au/reports/dementia/dementia-in-australia-2021-summary/overview [accessed 10 January 2021]
[5] Kuring JK, Mathias JL, Ward L. Prevalence of depression, anxiety and PTSD in people with dementia: a systematic review and meta-analysis. Neuropsychol Rev 2018; 28 393–416.
| Prevalence of depression, anxiety and PTSD in people with dementia: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 30536144PubMed |
[6] Hiskey S, Luckie M, Davies S, et al. The phenomenology of reactivated trauma memories in older adults: A preliminary study. Aging Ment Health 2008; 12 494–498.
| The phenomenology of reactivated trauma memories in older adults: A preliminary study.Crossref | GoogleScholarGoogle Scholar | 18791897PubMed |
[7] Mota N, Tsai J, Kirwin PD, et al. Late-life exacerbation of PTSD symptoms in US veterans: results from the National Health and Resilience in Veterans Study. J Clin Psychiatry 2016; 77 348–354.
| Late-life exacerbation of PTSD symptoms in US veterans: results from the National Health and Resilience in Veterans Study.Crossref | GoogleScholarGoogle Scholar | 27046308PubMed |
[8] Australian Institute of Health and Welfare. Australia’s Health 2020. Canberra: Commonwealth of Australia; 2020. Available at https://www.aihw.gov.au/reports-data/australias-health
[9] Ogrin R, Cyarto EV, Harrington KD, et al. Loneliness in older age: What is it, why is it happening and what should we do about it in Australia? Australas J Ageing 2021; 40 202–207.
| Loneliness in older age: What is it, why is it happening and what should we do about it in Australia?Crossref | GoogleScholarGoogle Scholar | 33783951PubMed |
[10] Amare AT, Caughey GE, Whitehead C, et al. The prevalence, trends and determinants of mental health disorders in older Australians living in permanent residential aged care: Implications for policy and quality of aged care services. Aust N Z J Psychiatry 2020; 54 1200–1211.
| The prevalence, trends and determinants of mental health disorders in older Australians living in permanent residential aged care: Implications for policy and quality of aged care services.Crossref | GoogleScholarGoogle Scholar | 32746615PubMed |
[11] Moilanen T, Kangasniemi M, Papinaho O, et al. Older people’s perceived autonomy in residential care: An integrative review. Nurs Ethics 2021; 28 414–434.
| Older people’s perceived autonomy in residential care: An integrative review.Crossref | GoogleScholarGoogle Scholar | 33000683PubMed |
[12] Khadka J, Visvanathan R, Theou O, et al. Development and validation of a frailty index based on Australian Aged Care Assessment Program data. Med J Aust 2020; 213 321–326.
| Development and validation of a frailty index based on Australian Aged Care Assessment Program data.Crossref | GoogleScholarGoogle Scholar | 32776351PubMed |
[13] Harrison SL, Lang C, Whitehead C, et al. Trends in prevalence of dementia for people accessing aged care services in Australia. J Gerontol Ser A 2019; 75 318–325.
| Trends in prevalence of dementia for people accessing aged care services in Australia.Crossref | GoogleScholarGoogle Scholar |
[14] Boyle G. The role of autonomy in explaining mental ill-health and depression among older people in long-term care settings. Ageing Soc 2005; 25 731–748.
| The role of autonomy in explaining mental ill-health and depression among older people in long-term care settings.Crossref | GoogleScholarGoogle Scholar |
[15] Okolie C, Dennis M, Simon Thomas E, et al. A systematic review of interventions to prevent suicidal behaviors and reduce suicidal ideation in older people. Int Psychogeriatr 2017; 29 1801–1824.
| A systematic review of interventions to prevent suicidal behaviors and reduce suicidal ideation in older people.Crossref | GoogleScholarGoogle Scholar | 28766474PubMed |
[16] Chaplin R, Farquharson L, Clapp M, et al. Comparison of access, outcomes and experiences of older adults and working age adults in psychological therapy. Int J Geriatr Psychiatry 2015; 30 178–184.
| Comparison of access, outcomes and experiences of older adults and working age adults in psychological therapy.Crossref | GoogleScholarGoogle Scholar | 24733724PubMed |
[17] Cuijpers P, Karyotaki E, Eckshtain D, et al. Psychotherapy for Depression Across Different Age Groups: A Systematic Review and Meta-analysis. JAMA Psychiatry 2020; 77 694–702.
| Psychotherapy for Depression Across Different Age Groups: A Systematic Review and Meta-analysis.Crossref | GoogleScholarGoogle Scholar | 32186668PubMed |
[18] Low L-F, Cations M, Koder D, et al. Rehabilitation to improve psychological wellbeing for people with dementia. Dementia rehabilitation: Evidence-based interventions and clinical recommendations. Sydney: Academic Press; 2020. pp. 111–128.
[19] Kok RM, Reynolds CF. Management of Depression in Older Adults: A Review. JAMA 2017; 317 2114–2122.
| Management of Depression in Older Adults: A Review.Crossref | GoogleScholarGoogle Scholar | 28535241PubMed |
[20] Australian Institute of Health and Welfare. Mental health services. Canberra: Commonwealth of Australia; 2020. Available at https://www.aihw.gov.au/reports/australias-health/mental-health-services
[21] Australian Psychological Society. Submission to the Royal Commission into Aged Care Quality and Safety. Melbourne: Australian Psychological Society; 2019. Available at https://www.psychology.org.au/About-Us/What-we-do/advocacy/Submissions/Professional-Practice/2019/Submission-to-the-Royal-Commission-into-Aged-Care
[22] Malkin G, Hayat T, Amichai-Hamburger Y, et al. How well do older adults recognise mental illness? A literature review. Psychogeriatrics 2019; 19 491–504.
| How well do older adults recognise mental illness? A literature review.Crossref | GoogleScholarGoogle Scholar | 30746830PubMed |
[23] Davison TE, McCabe MP, Mellor D, et al. Knowledge of late-life depression: An empirical investigation of aged care staff. Aging Ment Health 2009; 13 577–586.
| Knowledge of late-life depression: An empirical investigation of aged care staff.Crossref | GoogleScholarGoogle Scholar | 19629783PubMed |
[24] Royal Commission into Aged Care Quality and Safety. Final Report: Care, Dignity and Respect. Canberra: Commonwealth of Australia; 2021. Available at https://agedcare.royalcommission.gov.au/publications/final-report-volume-1 [accessed 6 January 2021]
[25] Radermacher H. Mental health and residential aged care: Are we there yet? Australas J Ageing 2021; 40 10–11.
| Mental health and residential aged care: Are we there yet?Crossref | GoogleScholarGoogle Scholar | 33739598PubMed |
[26] Inacio MC, Bray SCE, Whitehead C, et al. Registry of Older South Australians (ROSA): framework and plan. BMJ Open 2019; 9 e026319
| Registry of Older South Australians (ROSA): framework and plan.Crossref | GoogleScholarGoogle Scholar | 31221875PubMed |
[27] Inacio MC, Lang C, Bray SCE, et al. Health Status and Healthcare Trends of Individuals Accessing Australian Aged Care Programmes Over a Decade: The Registry of Senior Australians Historical Cohort. Intern Med J 2021; 51 712–724.
| Health Status and Healthcare Trends of Individuals Accessing Australian Aged Care Programmes Over a Decade: The Registry of Senior Australians Historical Cohort.Crossref | GoogleScholarGoogle Scholar | 32359019PubMed |
[28] Cations M, Lang CE, Ward SA, et al. Cohort profile: Dementia in the Registry of Senior Australians. BMJ Open 2021; 11 e039907
| Cohort profile: Dementia in the Registry of Senior Australians.Crossref | GoogleScholarGoogle Scholar | 33526495PubMed |
[29] Cations M, Lang C, Ward SA, et al. Dementia case ascertainment using aged care assessment data. Aust N Z J Public Health 2020; 44 517–518.
| Dementia case ascertainment using aged care assessment data.Crossref | GoogleScholarGoogle Scholar | 32865838PubMed |
[30] Stargatt J, Bhar SS, Davison TE, et al. The Availability of Psychological Services for Aged Care Residents in Australia: A Survey of Facility Staff. Aust Psychol 2017; 52 406–413.
| The Availability of Psychological Services for Aged Care Residents in Australia: A Survey of Facility Staff.Crossref | GoogleScholarGoogle Scholar |
[31] Creighton AS, Davison TE, Kissane DW. The prevalence, reporting, and treatment of anxiety among older adults in nursing homes and other residential aged care facilities. J Affect Disord 2018; 227 416–423.
| The prevalence, reporting, and treatment of anxiety among older adults in nursing homes and other residential aged care facilities.Crossref | GoogleScholarGoogle Scholar | 29154158PubMed |
[32] Jones TS, Matias M, Powell J, et al. Who cares for older people with mental illness? A survey of residential aged care facilities in the Australian Capital Territory: Implications for mental health nursing. Int J Ment Health Nurs 2007; 16 327–337.
| Who cares for older people with mental illness? A survey of residential aged care facilities in the Australian Capital Territory: Implications for mental health nursing.Crossref | GoogleScholarGoogle Scholar | 17845552PubMed |
[33] Australian Government Department of Health. 2020 Aged Care Workforce Census. Canberra: Commonwealth of Australia; 2021. Available at https://www.health.gov.au/resources/publications/2020-aged-care-workforce-census [accessed 9 March 2021]
[34] Wuthrich VM, Frei J. Barriers to treatment for older adults seeking psychological therapy. Int Psychogeriatr 2015; 27 1227–1236.
| Barriers to treatment for older adults seeking psychological therapy.Crossref | GoogleScholarGoogle Scholar | 25739459PubMed |
[35] NSW Ministry of Health, Australian and New Zealand College of Psychiatrists. Assessment and Management of People with Behavioural and Psychological Symptoms of Dementia (BPSD): A Handbook for NSW Health Clinicians. North Sydney: Royal Australian & New Zealand College of Psychiatrists; 2013. Available at https://www.ranzcp.org/files/resources/reports/a-handbook-for-nsw-health-clinicians-bpsd_june13_w.aspx [accessed 27 September 2021]
[36] Westera A, Fildes D, Grootemaat P, et al. Rapid response teams to support dementia care in Australian aged care homes: Review of the evidence. Australas J Ageing 2020; 39 178–192.
| Rapid response teams to support dementia care in Australian aged care homes: Review of the evidence.Crossref | GoogleScholarGoogle Scholar | 31742880PubMed |
[37] Leading Aged Care Services. Improved access to psychological services in residential care. Canberra: Leading Aged Care Services; 2018.
[38] Parliament of Australia. Budget Review 2018–19. Canberra: Commonwealth of Australia; 2018. Available at https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/BudgetReview201819 [accessed 27 September 2021]
[39] Department of Health. Extending Mental Health Support for Aged Care Residents During COVID-19. Canberra: Commonwealth of Australia; 2020. Available at http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-Mental-Health-Aged-Care [accessed 27 September 2021]
[40] Obata H. Analgesic mechanisms of antidepressants for neuropathic pain. Int J Mol Sci 2017; 18 2483
| Analgesic mechanisms of antidepressants for neuropathic pain.Crossref | GoogleScholarGoogle Scholar |
[41] Shen Y-T, Radford K, Daylight G, et al. Depression, suicidal behaviour, and mental disorders in older Aboriginal Australians. Int J Environ Res Public Health 2018; 15 447
| Depression, suicidal behaviour, and mental disorders in older Aboriginal Australians.Crossref | GoogleScholarGoogle Scholar |
[42] Isaacs AN, Pyett P, Oakley-Browne MA, et al. Barriers and facilitators to the utilization of adult mental health services by Australia’s Indigenous people: Seeking a way forward. Int J Ment Health Nurs 2010; 19 75–82.
| Barriers and facilitators to the utilization of adult mental health services by Australia’s Indigenous people: Seeking a way forward.Crossref | GoogleScholarGoogle Scholar | 20367644PubMed |
[43] McSweeney K, Jeffreys A, Griffith J, et al. Specialist mental health consultation for depression in Australian aged care residents with dementia: a cluster randomized trial. Int J Geriatr Psychiatry 2012; 27 1163–1171.
| Specialist mental health consultation for depression in Australian aged care residents with dementia: a cluster randomized trial.Crossref | GoogleScholarGoogle Scholar | 22344753PubMed |
[44] Foà C, Guarnieri MC, Bastoni G, et al. Job satisfaction, work engagement and stress/burnout of elderly care staff: a qualitative research. Acta Biomed 91 e2020014
| Job satisfaction, work engagement and stress/burnout of elderly care staff: a qualitative research.Crossref | GoogleScholarGoogle Scholar |
[45] Schnaider Beeri M, Werner P, Davidson M, et al. The cost of behavioral and psychological symptoms of dementia (BPSD) in community dwelling Alzheimer’s disease patients. Int J Geriatr Psychiatry 2002; 17 403–408.
| The cost of behavioral and psychological symptoms of dementia (BPSD) in community dwelling Alzheimer’s disease patients.Crossref | GoogleScholarGoogle Scholar |
