Mental health service delivery to older people in New South Wales: perceptions of aged care, adult mental health and mental health services for older people

Service provision for older people with mental health problems in a rural area of Australia

OBJECTIVES

Unmet mental health care needs of older people (aged 65 and over) have been identified as a serious problem internationally, particularly in rural areas. In this study we explored the views of health and social care providers of the barriers to effective mental health care for older people in a rural region in Australia.

METHOD

Semi-structured interviews were conducted with 19 participants from 13 organisations providing care and support to older people in a rural region of Australia. A framework analysis approach was used to thematically analyse the data.

RESULTS

Two main themes were identified: 'Recognising the Problem' and 'Service Availability and Access'. In particular the participants identified the impact of the attitudes of older people and health professionals, as well as service inadequacies and gaps in services, on the provision of mental health care to older people in a rural region.

CONCLUSION

This study supports previous work on intrinsic and extrinsic barriers to older people with mental health problems accessing mental health services. The study also offers new insight into the difficulties that arise from the separation of physical and mental health systems for older people with multiple needs, and the impact of living in a rural region on unmet mental health care needs of older people.

Barriers to collaboration in mental health services for older people: external agency views

The need for mental health services for older people living in rural areas is increasing in South Australia. Providing such care requires coordination between several types of services across government, hospital and non-government sectors. The purpose of this study was to identify barriers to collaboration from the perspective of external aged care agencies. A total of 42 responses from an online survey were qualitatively analysed. Four categories emerged, within which participants had identified barriers to collaboration: (1) awareness of services and certainty about responsibilities, in particular, a lack of awareness of which services are available; (2) referral criteria and processes, including the specific criteria needed to be eligible for these services; (3) opportunities to collaborate, with a perceived lack of formal opportunities for collaboration between individuals working across agencies; and (4) education of staff, with more joint education between agencies being recognised as having the potential to increase local knowledge and provide an opportunity for networking and relationship building, with greatest barriers experienced between mental health and social care services.

Testing and using Goldberg's General Health Questionnaire: Mental health in relation to home nursing, home help, and family care among older, care-dependent individuals

The aims of this study were to test the Norwegian version of Goldberg's 30-item General Health Questionnaire (GHQ-30) in a group of older, care-dependent individuals living at home; to describe self-reported mental health; and to relate mental health to receiving home nursing, home help, and family care. A sample of 234 home nursing patients in Norway aged 75 years and older was interviewed. Mental state was assessed using the GHQ-30. Reliability and validity were calculated with Spearman's rank correlations, Cronbach's alpha coefficient, and Mann-Whitney U-test. The factor analysis was performed using the principal components analysis with varimax rotation and Kaiser normalization. Demographic characteristics and amounts of formal and family care were recorded, and descriptive statistics and stepwise multiple regression were used in the analyses. Cronbach's alpha coefficient for the GHQ was 0.92. The item-total correlations were generally acceptable. For items concerning depression and anxiety, the item-total correlations ranged from r(s)= 0.60 to 0.77. The factors extracted in the factor analysis explained 70% of the variance in the group. Females <85 years of age living in urban areas were associated with reduced mental health. There were no associations between general mental health and the amounts of formal and family care provided.

Accessing health care professionals about antipsychotic medication related concerns

The purpose of this research was to describe mental health service users' access to and satisfaction with health care professionals, including nurses, as related to users' antipsychotic medication concerns. Eighty-one service users were interviewed using a questionnaire. Participants stated that case managers were the most accessible, while psychiatrists were the least accessible. It was perceived that most professionals, apart from general practitioners, had adequate knowledge of medications. Most participants were satisfied with the way health care professionals dealt with the service users' concerns about medications, but almost 16% were dissatisfied with general practitioners. The findings emphasize that access to and satisfaction with health care professionals is an important factor in medication adherence.

A survey of publicly funded aged psychiatry services in Australia and New Zealand

OBJECTIVE

To map the size and distribution of publicly funded aged psychiatry (psychogeriatric) services in Australia and New Zealand in 2003.

METHOD

Services were tracked exhaustively through personal, professional and academic contacts, electronic searches and word-of-mouth. Directors or managers of services were asked to complete a brief questionnaire concerning their locality, services, staff profile and patient contacts.

RESULTS

Services varied widely with respect to their numbers, size and community outreach. Victoria was the only Australian state to provide specialist, multidisciplinary aged psychiatry teams with community, acute inpatient and residential arms in all its major cities. New South Wales, the state with the largest aged population, performed relatively poorly on most indicators. New Zealand performed relatively well despite its small size and widely dispersed population.

CONCLUSIONS

Publicly funded aged mental health services are effective and reach frail, multiply disabled old people who cannot access private psychiatrists and are often overlooked by services for younger adults. At the time of our survey, such services were distributed in Australia in a highly inequitable fashion.