iii
3.6 Penticton . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .196
3.7 Duncan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .197
3.8 Chilliwack . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .198
3.9 Creston . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .199
3.10 Castlegar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .199
3.11 Vancouver Hospital GPOT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .200
3.12 Vancouver Hospital Consultation Liaison Service . . . . . . . . . . . . .202
3.13 Victoria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .203
3.14 Prince George . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .206
3.15 Vancouver Community Geriatric Mental Health Services . . . . . . . .208
3.16 Integrated Group Therapy Program, Kelowna . . . . . . . . . . . . . . . .216
Glossary of Terms and Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .223
Feedback Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .229
Guidelines for Elderly
Mental Health Care
Planning for Best Practices
for Health Authorities
was developed to guide
the design of the service
system and the delivery
of care
v
Executive Summary
The purpose o
ft
his document is to serve as a guide for health authorities
in designing, developing, implementing and evaluating services that maximize
quality o
fl
ife for elderly people who have complex and challenging mental
health problems. It is anticipated these activities will be reflected in the health
authorities' planning.
The demographic profile of British Columbia's population will change
significantly over the next three decades. During that time it is estimated
the elderly population will increase by 121 per cent, compared to an increase
in the under 19 population o
f1
1 per cent.
I
f efficient, effective and innovative
approaches to providing care are not developed, the resulting service pressure
will reach crisis proportions for the baby boom generation of about 1,186,000
seniors in 2026. Studies show the prevalence of mental health problems
affecting elderly people is between 17 and 30 per cent: McEwan, et al (1991),
1
suggested 25 per cent as a reasonable figure.
The Principles o
fE
lderly Mental Health Care
2
and nine key elements, considered
vital to the provision o
fm
ental health care for the elderly, provided the core
principles and assumptions upon which the recommendations made in this
document were founded.
The Principles o
fE
lderly Mental Health Care were developed to guide the design
of the service system and the delivery of care. They are:
. client and family centred;
. goal oriented;
. accessible and flexible;
. comprehensive;
. specific services; and
. accountable.
EXECUTIVE SUMMARY
Primary care services
and programs are
the backbone of elderly
mental health care
vi
The key elements considered vital to the provision o
fm
ental health care are:
. health promotion and early intervention;
. education;
. family support and involvement;
. psychosocial rehabilitation and recovery;
. environmental milieu (i.e. housing);
. integrated and continuous services;
. quality improvement and evaluation processes;
. volunteers, mentors and peer counselors; and
. advocacy and protection.
Primary care services and programs are the backbone of the elderly mental
health care system. Professionals with specialized knowledge and skills
in geriatric care who work in the secondary and tertiary care sectors only
provide care to those elderly people whose problems are more complex
or challenging than can be accommodated in the primary care system.
They also provide consultation to many primary care providers to divert
referrals from the secondary or tertiary system.
The formal service system for elderly mental health care consists of:
Primary
Preventive, diagnostic and therapeutic health care provided by general
practitioners and other health care providers, such as home nursing,
home support or, upon direct request by patients/clients, placement
in a facility.
EXECUTIVE SUMMARY
Community outreach mental
health teams constitute
the foundation of mental
health care services at
the secondary care level
vii
Secondary
Specialized preventive, diagnostic and therapeutic care — usually requiring
referral from a primary source. Includes outreach community-based
teams, inpatient elderly mental health care, day hospital services
and outpatient clinics.
Tertiary
Highly specialized services including professional/technical skills,
equipment or facilities — usually requiring refe
r
ral from a secondary
source. Includes inpatient services, university research clinics and rural
and remote community outreach.
Community outpatient/outreach mental health teams, whether hospital
or community-based, and inpatient elderly mental health care constitute
the foundation of the elderly mental health care system at the secondary
care level.
To be effective, an elderly mental health care service should remain closely
connected to psychiatric expertise. This expertise is traditionally found in
the mental health service structure. Effective elderly mental health care also
requires the development of a formalized collaborative relationship with home
and community care.
3
Home and community care provides and/or coordinates
many direct, in-home and residential services for elderly people, many of whom
have complex mental health or behavioural issues. Elderly mental health care
services provide specialized expertise in support of clients with more complex
mental health or behavioural issues and their caregivers in a variety o
fc
are
settings. Defining the organizational relationship should be done locally,
taking into account the needs o
ft
he population, existing resources and the size
and location of the community. The need for a formalized collaborative
relationship is also required with adult mental health and inpatient services.
Footnotes
1
Kimberley L. McEwan, PhD, Martha Donnelly, MD, CCFP, FRCP, Duncan Robertson, MBBS, FRCP, and Clyde
Hertzman, MD, M.Sc, FRCP(1991): Mental Health Problems Among Canada’s Seniors: Demographic and Epidemiologic
Considerations, Ottawa, Health and Welfare Canada.
2
Taken from the British Columbia Psychogeriatric Association's Principles of
P
sychogeriatric Care (available at
http://www.bcpga.bc.ca/).
3
Home and community care. Formerly referred to as continuing care or long term care.
EXECUTIVE SUMMARY
viii
INTRODUCTION
1
Introduction
Purpose
This document was developed to serve as a guide for health authorities
in designing, developing, implementing and evaluating services that maximize
quality o
fl
ife for elderly people who have complex and challenging mental
health problems. It is anticipated these activities will be reflected in health
authorities' planning.
Over the next few years, the Ministry of Health Services, in partnership with
health authorities, will be monitoring changes in the availability and delivery
o
fs
ervices for the elderly with mental health problems using these guidelines
as a reference point.
Reasons for the Development of the Guidelines Document
. Need for quality mental health care services for the elderly to be
available across the province.
. The target population is increasing more rapidly than other
populations in British Columbia.
.
A review o
ft
he seven Best Practices Reports
4
revealed that while
some of the best practices identified for the adult population are
appropriate for the elderly population, consideration o
ft
he service
needs o
ft
he elderly were not specifically addressed by the reports. Brief
reviews o
fe
ach o
ft
he Best Practice documents from the perspective
o
fa
ppropriateness to elderly people appear in Appendix 1.1.
The number of elderly
people is increasing more
rapidly than other age
groups in British Columbia
INTRODUCTION
For the elderly, normal
aging processes often
complicate the
presentation and
treatment of mental
health conditions
. The impact of normal aging often complicates the presentation
and treatment of mental health conditions.
. Elderly people, many with disturbances of cognition or behaviour,
remain in hospital beds longer than required. This delay ultimately
puts pressure on inpatient beds and emergency rooms.
. The limited number of long term care beds requires systems that allow
elderly people with mental health problems to remain at home as long
as possible.
Process Used to Develop the Guidelines Document
This document was developed by Mental Health and Addictions, Ministry
o
fH
ealth Services, British Columbia, with the support of a working group
of individuals who have extensive expertise and experience providing care
for elderly people with mental health disorders.
The document was developed from reviews of the literature and expert
opinion. A vast body of literature exists on aging and the care of elderly
people with various medical, psychiatric, social, economic and other problems.
Some of this literature is written for professional care providers and crosses
many disciplines, but there is much published for the public as well.
Appendix
2.0 provides selective literature reviews. These reviews provide
useful information for the development of services for elderly people with
mental health problems and were incorporated into the recommendations
contained in this document. The focused areas of the literature reviews are:
. inpatient psychogeriatric care;
. educational issues;
. family support and involvement;
2
INTRODUCTION
Consultations were
undertaken with groups
and individuals involved
in mental health issues
3
. rehabilitation and recovery for older people with mental illness;
. environmental milieu (housing);
. quality improvement;
. service and program evaluation; and
. health promotion.
In order to ensure the information and advice provided are realistic and valid,
a consultation process was completed with groups and individuals who possess
knowledge and/or experience in this area. Early drafts were sent out for review
to clinicians in the field, program managers, the Mental Health Advocate, BC
Mental Health Monitoring Coalition, Continuing Care Renewal Implementation
Committee and the Ministers' Advisory Committee on Mental Health. Focus
groups with family members and others were also held in some communities.
The feedback received from all these sources has been considered and used
in the preparation o
ft
his final document.
The document includes: a discussion of the target population, prevalence rates
and best practices, a description of the array o
f required s
ervices, principles
of care and recommendations, service components needed and
n
ine care
elements and approaches to care. The information in the care elements section
provides background and support for the recommendations.
T
his document also draws upon the rich experiential resources of practitioners,
as well as upon published research and evidence-based material. One model
will not fit all situations: better practices develop when client needs are
the focus and innovative, sometimes unique, approaches are developed
to meet those needs. Some o
ft
he approaches developed in communities
and submitted to the steering committee as examples o
f“b
est practices”
in their areas are included in Appendix 3.
INTRODUCTION
The elderly population
is expected to increase
by 121 per cent over
the next 25 years
4
Target Population
The demographic profile of British Columbia's population is entering a stage
in which tremendous increases and changes will be forthcoming over the next
three decades. The current population of e
l
derly people constitutes a low
birth rate cohort: those born before or during the Great Depression. The high
birth rate baby boom generation, born between 1945 and 1960, are now
middle-aged and will be seniors over the next 10 to 25 years. Over the next
25 years, it is estimated the elderly population will increase by 121 per cent,
compared to an increase in the under 19 population o
f1
1 per cent. Mental
health services as they are currently organized and delivered for elderly people
are not meeting the needs o
ft
he population of approximately 540,000
seniors living in British Columbia. If efficient, effective and innovative
approaches to providing care are not developed, the resulting service pressure
will reach crisis proportions for the baby boom generation of about 1,186,000
seniors in 202
6
.
The population targeted by this report is elderly people with mental health
problems. The definition o
ft
he population is as follows:
"Elderly people with mental health problems is a general term used to describe people
over the age of 65 years who have emotional, behavioural or cognitive problems
which interfere with their ability to function independently, which seriously affect their
feelings of well-being, or which adversely affect their relationships with others. These
problems have a variety of biopsychosocial determinants and methods o
ft
reatment
and care. People under the age of 65 who have conditions more commonly seen
in elderly people, such as early dementia, are included in this group."
5
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