Mental Health

1
Establishing the evidence base for appropriate
mental health care in an aged care
environment.
Carolyn Kwok DCEO, RSL LifeCare Tracey McDonald
Professor
RSL LifeCare Chair of Ageing, ACU
National Ron Thompson CEO, RSL LifeCare Hon.
Clinical Associate Professor, ACU National
Presenter
2
Mental Health in Residential Aged Care Facilities
(RACF)

• ... beyond dementia care services

3
Demand drivers for mental health care in
residential aged care contexts

• Longer life accompanied by degenerative
  conditions as well as increasing prevalence of
  personality disorders within RACFs
• Current estimates of depression in older age are
  around 25 of those living at home, 40 of those
  in hospital and a range of levels within RACFs
• Future demand will require RACFs to include
  psychiatric services delivered by appropriately
  skilled clinical and care staff

4
RSL LifeCare strategy

• Review and respond to known resident needs for
  psychiatric services
• Determine the extent to which psychiatric and/or
  mental health care demand may be present
  throughout the resident
  population
• Develop mental health treatment and support
  strategies that can be applied across all
  care areas
• Ensure that all staff have the skills and
  knowledge to provide appropriate mental
  health care
• Establish a system for monitoring mental health
  status of residents and the
  effectiveness of mental health care strategies

5
Operationalising our strategy

• Establishment of on-site clinical psychology
  services
• Psycho-geriatrician services for residents
• Recruitment of nurses with mental health /
  psychiatric skills and experience
• Conduct whole-of-organisation mental health
  assessments
• Team development and implementation of mental
  health clinical pathway and PTSD clinical pathway
• Registered nurse competency training in mental
  health assessment
• Ongoing care staff training and coaching in
  mental health care

6
Building mental health care capacity in an aged
care environment

• Clinical psychology services
• 2004 retained clinical psychologist at RSL
  LifeCare, Narrabeen (ongoing)
• Case referrals and service planning for
  individual residents with mental health issues
• Staff training and coaching on care of older
  people with mental illnesses
• Collaboration with registered
  nurses on care and treatment
• Client case analysis and reports

7
Building mental health care capacity in an aged
care environment

• Psychogeriatric services
• Established links with psycho-geriatrician who is
  on-call to assist registered nurses
• Collaboration with nurses and general
  practitioners on psychiatric care and treatment
• Participation in family
  case conferences

8
Building mental health care capacity in an aged
care environment

• Mental health nursing and care services
• Recruitment of experienced and qualified mental
  health registered nurses
• Inservice training and assessment of care staff
  about care for people with mental illnesses
• Registered nurse competency in
  mental health assessment,
  treatment and management in
  an aged care environment

9
Building mental health care capacity and the
evidence base

• Mental health practice development
• Engagement of senior undergraduates in nursing to
  assess all residents on 4 psychiatric scales
• Geriatric Depression Scale (GDS)
• Dementia Behaviour Disturbance Scale (DBDS)
• Cornel Depression Scale (CSD)
• Psychiatric Assessment Scale (PAS)
• Assessments were validated by experienced
  nurses and data analysed by research
  team
• Reports provided to the managers of each
  care unit for follow-up

10
Building mental health care capacity and the
evidence base

• Development of mental health clinical pathway
• Expert team (internal and external members) led
  by our professor, developed a clinical pathway
  that addresses known and anticipated mental
  health issues
• Pathway applies to all with a diagnosed mental
  illness currently in residence or admitted to RSL
  LifeCare
• Goals (short and long-term) include safety,
  symptom stability and well-being
• Pathway begins with pre-admission assessment
  decision to admit engagement with family
  establishment of treatment, care and management
  strategy ongoing case monitoring

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Results Oct 07- Apr 08
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Transfer of evidence to practice

• Mental Health Clinical Pathway acceptance and
  usage is being monitored and a review will occur
  annually
• Education provided for all stakeholders
• Discussions at Medical Advisory Committee to
  ensure GPs are informed
• Nursing undergraduate
  assessment on all residents
  to be repeated
  Oct-Nov08
  providing time-linked data on
  uptake and resident outcomes

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SUMMARY

• Residents identified as at risk are commenced
  on Mental Health Clinical Pathway (MHP)
• MPH is commenced prior to admission
• Referring doctor service involved from time of
  referral
• Admission process is planned in
  detail and not rushed
• Use of internal and external
  resources eg. Day Care

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Outcomes

• Proactive identification of potential risks
• Admission plan is detailed and realistic
• Integration of services as appropriate
• Increased staff knowledge and awareness
  of mental illness and care
• Increased acute sector awareness of requirements
  and arrangements needed prior to admission of
  people with mental illness to aged care
  environments

15
Outcomes

• Relatives and carers feel more supported
• Residents are more settled during the admission
  period
• Clear guidelines provided for staff practices
• Care evaluation timeframes
• Validated data to use for
  decision making in staff
  recruitment, training and
  resource allocation

16
Evidence base to support ongoing mental health
care for older people

• Staff mental health skills and knowledge have
  been enhanced
• Environmental security assured in a context that
  improves mental health client care and protection
• Research into current and
  anticipated mental health needs of
  our residents is informing
  practice and management
  strategies

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Thank you