Guidelines for Comprehensive Mental Health Services for Older Adults in Canada

Purpose

These Guidelines are intended to support the planning, development, and implementation of a mental health service system that can respond adequately to the needs of its senior population. They are meant to guide systems planners, government, policy makers, and program managers in planning, developing, and ensuring a comprehensive, integrated, principle-based and evidence-informed approach to meeting the mental health needs of seniors. A comprehensive and integrated mental health system is most likely to be responsive to the varied needs of older persons, be more efficient and reduce both duplication and gaps in services.

They are focused on service systems specific to adults aged 65 and older, recognizing that there will be exceptions to this age cut-off. For example, some individuals in their 50s or early 60s may benefit from a comprehensive geriatric assessment when they age prematurely due to complex, multiple, and chronic health problems (as can occur with homelessness), developmental delay or early onset Alzheimer disease. However, specific, age-appropriate services also need to be developed for these younger adults, as their needs cannot be met adequately in the system of care currently available or planned for seniors. Although the Guidelines may inform service providers making innovations in their own practice or engaging in creating a better system of care, they are not intended to provide clinical guidance. Further, the recommendations made are congruent with Accreditation Canada Standards for Mental Health.

The comprehensive and integrated model proposed in these Guidelines is meant to serve both seniors living with a mental health problem or illness and those at risk of developing one. Further, for the purposes of this document, mental illnesses include Alzheimer’s disease and age-related dementias, serious and persistent mental illnesses complicated by aging issues, and mental illnesses that occur for the first time in old age.

Additionally, these Guidelines support the development of the Mental Health Commission of Canada’s Mental Health Strategy for Canada, and are meant to be consistent with its goals for achieving the best possible mental health and well-being for everyone, as outlined in its 2009 document Towards Recovery and Well‑being: A Framework for a Mental Health Strategy for Canada: Seniors Care Guidelines.

• People of all ages living with mental health problems and illnesses are actively engaged and supported in their journey of recovery and well-being.
• Mental health is promoted and mental problems and illness are prevented wherever possible.
• The mental health system responds to the diverse needs of all people in Canada.
• The role of families in promoting well-being and providing care is recognized, and their needs are supported.
• People have equitable and timely access to appropriate and effective programs, treatments, services, and supports that are seamlessly integrated around their needs.
• Actions are informed by best evidence based on multiple sources of knowledge, outcomes are measured, and research is advanced.
• People living with mental health problems and illness are fully included as valued members of society.

The MHCC goals were developed through a broad consultation with Canadians who have lived experience of mental health problems and illnesses, their families and caregivers, service providers, and planners.

DEVELOPMENT OF THE GUIDELINES

The development of the Guidelines was overseen by representatives from the Mental Health Commission’s Seniors Advisory Committee, Science Advisory Committee and Mental Health Commission staff. Between June 2009 and January 2011 the project team engaged stakeholders (older adults with lived experience, caregivers, service providers, program planners, policy makers and educators) from across the country to build an understanding of the changes required to create a comprehensive, transformed mental health system that supports older adults and their caregivers on their journey towards recovery and well-being. In addition to the information gathered from stakeholders, a review of academic literature and government documents (international, national and provincial) was completed. Based on this evidence review, a model was developed to depict an integrated and comprehensive mental health service system for older adults. To ground this service system model in the broader mental health and health systems, supporting evidence was used to create recommendations for decision makers.

To develop the benchmarks, a summary of existing capacity benchmarks for various jurisdictions was produced (based on benchmarks for seniors’ mental health services described in Canadian and international planning documents), and reviewed for relevance by key stakeholders across Canada.

Summary of Recommendations

Detailed recommendations and supporting evidence are provided throughout the Guidelines.

Below is a high-level summary of the overarching key recommendations.

1. Those planning a comprehensive integrated mental health system must understand the diversity amongst seniors, must understand the local context and resources, and must consider the need to modify existing practices and relationships to achieve a transformed system.
2. Policies, programs and services that affect seniors should be assessed with the Seniors Mental Health Policy Lens (MacCourt, 2008) to ensure that they reflect the guiding principles and values outlined in these Guidelines. (The Seniors Mental Health Policy Lens, informed by evidence, is an analytical framework for determining the degree to which planned and current policies promote and support the mental health of seniors.)
3. Mental health promotion should be embedded in all policies, programs, and services for all older adults (including those with mental illness) and their caregivers, and encompass anti stigma strategies, public awareness, education, and training.
4. Older adults, caregivers, service providers and the public should be informed about the importance of early identification of symptoms of mental illness, prevention strategies and the hope for recovery and well-being.
5. A transformed mental health system is recovery oriented, supports caregivers and provides information to the public and service providers about the journey towards recovery (hope, choice, empowerment) and well-being for older adults living with mental illnesses.
6. The specific components of an integrated mental health service system for older adults may vary according to local context and resources, but all service systems should provide access to the following range of services for the entire senior population: community-based support services, primary care services, general mental health services and specialized seniors mental health services (including specialized community and outreach services to residential care facilities as well as specialized geriatric psychiatry inpatient services). Most importantly, there should be clear mechanisms in place to facilitate collaboration and access between services in order to achieve a comprehensive, efficient system that is integrated and more responsive to the needs of older persons, and focuses on recovery, well-being, and choice for older adults and their caregivers.
7. Benchmarks should be used to review existing services and staffing levels and guide future allocation and deployment of resources, taking into account the size of the population, existing gaps in services and bottlenecks, as well as the priorities of the community.
8. To facilitate a comprehensive mental health service system, cultural safety and diversity must be embedded in structures, programs, policies and services.
9. Caregivers must be considered active partners in the journey towards recovery and well-being, and their roles must be supported and valued in programs, policies and services.
10. Transformation of a mental health service system must include training, education and support for caregivers and health care providers to increase their capacity to respond to the mental health needs of seniors.