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Collaborative Mental Health Care: Meeting the Accessibility Needs of Older Adults with Concurrent Chronic Disorders

Collaborative Mental Health Care: Meeting the Accessibility Needs of Older Adults with Concurrent Chronic Disorders. CCSMH Conference, September 2007. There are no apparent conflicts of interest that may have a direct bearing on the subject matter of this presentation. Presenters.

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Collaborative Mental Health Care: Meeting the Accessibility Needs of Older Adults with Concurrent Chronic Disorders

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  1. Collaborative Mental Health Care: Meeting the Accessibility Needs of Older Adults with Concurrent Chronic Disorders CCSMH Conference, September 2007 There are no apparent conflicts of interest that may have a direct bearing on the subject matter of this presentation

  2. Presenters • Salinda Horgan, Ph.D. • Martha Donnelly, MD, CCFP, FRCP • Ken LeClair, MD, FRCP

  3. Collaborative Care • Delivery of service by two or more stakeholders (including consumers) • Working together in a partnership characterized by • Common goals or purpose • Recognition and respect for strengths and differences • Equitable and effective decision making • Clear and regular communication • To improve access to a comprehensive range of services delivered by the right person, in the right place at the right time. Kates, N

  4. Canadian Collaborative Mental Health Initiative

  5. Framework for Collaborative Mental Health Care

  6. Members of the Seniors Working Group • Ken Le Clair, MD, FRCPC – Kingston • Martha Donnelly, MD, CCFP, FRCPC - Vancouver • Geri Hinton, B.Sc.N, DStJ – Victoria • Sarah Kreiger-Frost, RN, MN - Halifax • Penny McCourt, MSW, Ph.D. - Nanaimo • Salinda Horgan, Ph.D. – Kingston

  7. Seniors Population Definition • Age greater than 65, avg. age 75 (exceptions organic mental disorders). • All psychiatric disorders but with emphasis on: • Dementia with affective and behavioural disorders • Mental health problems associated with medical illness • Complex B/P/S/F/E problems • Families of seniors with mental health problems • Loss of independent functioning in IADLs/ADLs. • Often present first to family physician with physical complaints. • Require comprehensive geriatric assessments.

  8. The Consultation Process – What • Multi-disciplinary Working Group • Literature Review • Qualitative Interviews • Quantitative Survey

  9. The Consultation Process - Who Qualitative interviews: • 6 interviews with family members/consumers. • 7 interviews with services specific to seniors (specialty psycho-geriatric programs, generic mental health programs, primary care clinic, adult day program). • 7 interviews with professional disciplines (family doctors, pharmacy, nursing, social work, cultural development, research). • 2 interviews with policy advisors. Quantitative survey: 26 surveys of specialty and generic mental health programs and policy advisors. Presentations at conferences

  10. Literature Review – Key Learnings • On-site primary care and specialty case manager strategies provide better outcomes for seniors than traditional care (particularly for those experiencing mood disorders). • Consultation with liaison provide better outcomes for seniors than consultation only. • Approaches embedded in a knowledge transfer framework (evidence based guidelines) provide better collaboration between diverse partners.

  11. What do we Need to Know About Seniors? • Seniors experience the stigma associated with advanced age and mental health needs both in the community and within the health system itself. • Many seniors are experiencing mental health issues for the first time. • Many family caregivers are seniors themselves with complex needs.

  12. Accessibility to Collaborative Mental Health Care • Accessibility is the primordial issue affecting the degree to which older adults with complex mental and physical health issues benefit from collaborative care

  13. Personal Factors • Physical Access • Attend health care appointments. • Driving / financial implications. • Affects number of appointments attended. • Resource Awareness • Limited mobility / life-style changes in retirement. • Limited knowledge of external resources. • Affects their knowledge of available services.

  14. Caregiver Factors • Complex Coordination • Coordination of multiple services (special transit, attendant) for one visit. • Caregiver Health • Less likely to attend regular check-ups. • Increased health needs – stress induced. • Caregiver Inclusion • Crucial resource (historical contextual knowledge, communication).

  15. Systemic Factors • Broad Stakeholder Inclusion • Broad spectrum of health and community partners needed to address complex health and social issues. • Socially diverse population. • System Fragmentation • Health conditions are not static (age / functioning). • System – each developmental stage brings new services, new providers and new service locations.

  16. Planning Strategies Think About: • Location of services. • Co-location with services / supports relevant to older adults. • Seeing older adults in their homes. • Mutual caregiver/patient appointments. • Actively involve caregivers in health appointments. • Collaborate with broad range of stakeholders (health, family, community). • Minimizing service fragmentation.

  17. The Health Care Reality It is estimated that between the years 2020 and 2030, 75% of health providers' time will be spent with older people Seller, et al. Gerontology and Geriatrics Education, Vol. 8 3/4, 1988

  18. Seniors Toolkit www.ccmhi.ca

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