Aged care residents underusing mental health services

Australian researchers are calling for organisational and policy changes to improve access to Medicare-funded mental health services in aged care after new analysis finds residents’ “very low” uptake of subsidised support.

The Flinders University and the South Australian Health and Medical Research Institute study published in Australian Health Review this month found less than three in 100 residents accessed Medicare-subsidised mental health services despite a high prevalence of mental health conditions among this group.

The authors recommend:

• permanently widening eligibility criteria for Medicare access

• initiatives to train and embed the mental health workforce into aged care services

• upskilling existing staff

• clearer referral pathways

• the ongoing monitoring of programs to ensure quality and continued investment.

Study lead author Dr Monica Cations said aged care residents were four times more likely to have depression and nine times more likely to have anxiety disorders than the general population of older Australians yet less likely to access public-funded support.

“Less than 3 per cent of residents with a mental health condition in our cohort accessed funding subsidies for mental health services provided by GPs, psychiatrists or allied health professionals, in contrast to almost 10 per cent of the general population,” said Dr Cations, a psychology registrar and epidemiologist from Flinders University and affiliated Senior Postdoctoral Researcher with the Registry of Senior Australians at SAHMRI.

The study analysed data from ROSA on all non-Indigenous residents living in 2,851 Australian aged care facilities between 2012 and 2017. There was minimal increases in access across various categories in those five years, said Dr Cations.

The proportion of residents who accessed primary care mental health services increased from 1.3 per cent in 2012-2013 to 2.4 per cent in 2016-2017 while psychiatry service use rose from 1.9 per cent to 2.3 per cent. Claims for clinical psychology increased from 0.18 per cent to 0.26 per cent, while those for a registered psychologist, occupational therapist or social worker rose from 0.45 per cent to 1.2 per cent, according to the findings.

Appropriate treatment and management of psychological needs can have wide-ranging benefits including improved quality of life for residents and reduced staff turnover.

Residents with dementia were even less likely than residents without dementia to access any of the services, aside from psychiatry services.

“The under-identification and lack of non-pharmacological treatment of mental illness among people with dementia is a long-documented problem, partly explained by a widespread misbelief that people with dementia cannot benefit from non-pharmacological therapies,” Dr Cations said.

Aged care residents deserve equitable access

While residents may have received mental health services in other ways, such as via people those employed by the facility, the authors said aged care residents deserved equitable access to public services.

“Mental health care is a pillar of the publicly-funded health care system in Australia and the low use of publicly-funded services among those living in residential aged care is indicative of major barriers to service access and uptake,” said Dr Cations.

Many of these barriers were raised during the aged care royal commission and include “a lack of expertise among the workforce, complex mental health service arrangements and eligibility requirements, costs of transport and low priority given to mental health needs unless it was likely to disrupt care or was distressing for residents and staff,” she said.

Dr Cations said the study showed there was need for significant and sustained organisational, policy and funding changes to improve access to mental health care for aged care residents.

“Appropriate treatment and management of psychological needs can have wide-ranging benefits including improved quality of life for residents, reduced staff turnover and reduced behavioural disturbances and related costs.”