Introduction to the Best Practices
Document
In 1998, an ad hoc committee of practitioners and Ministry
of Health staff involved with issues of aging and mental
health of older people came together to develop the Best
Practices document. Members of the working group
reviewed the literature, undertook consultations and focus
groups with caregivers, family members, professional service
providers and community members at large in order to learn
and to ensure that the information in the document was
realistic and valid. The document was repeatedly
edited and changed to incorporate feedback from reviewers
of early drafts, and the final version was published by
the Ministry of Health and circulated to all Health Authorities
in British Columbia in 2002.
The
Elderly Mental Health Care Working Group members were:
Co-Chairs:
Martha Donnelly, MD, CCFP, FRCP
Penny MacCourt, MSW, PhD.
Members:
Juanita Barrett, RN, MBA, CHE
Elizabeth Lockhart, PhD.
David Maxwell, MSW
Holly Tuokko, PhD
The Executive Summary follows.
To
see the full document, go to: http://www.health.gov.bc.ca/library/publications/year/2002/MHA_elderly_mentalhealth_guidelines.pdf
Executive
Summary
The purpose of this document is to serve as a guide for
health authorities in designing, developing, implementing
and evaluating services that maximize quality of life 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 of 11 per cent. 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 2026. Studies show the prevalence
of mental health problems affecting elderly people is between
17 and 30 per cent: McEwan, et al (1991), suggested 25
per cent as a reasonable figure.
The Principles
of Elderly Mental Health Care and
nine key elements, considered vital to the provision
of mental health care for the elderly, provided the core
principles and assumptions upon which the recommendations
made in this document were founded.
The Principles
of Elderly 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.
The key elements considered vital to the provision of
mental 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.
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
referral 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 of care settings. Defining the organizational relationship
should be done locally, taking into account the needs of
the 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.
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