Mental Health Commission of Canada Seniors Guidelines – Executive Summary

Background & Development of the Guidelines

The Canadian population is aging, a process that is currently undergoing a rapid acceleration as the baby boom generation moves into older age, and is also influenced by increased life expectancy and decreased fertility (Carstairs & Keon, 2009). If left unaddressed, this trend will have far-reaching social, economic, and political impacts, including an increasing number of seniors who are at risk of experiencing mental health problems. These Guidelines present an opportunity to address concerns with the current health and mental health system from the perspective of older adults and provide recommendations for moving toward a transformed mental health system that supports older adults in their journey towards recovery and well-being.

The development of these 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 mental health system for older adults. 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, a model was developed to depict an integrated and comprehensive mental health service system for older adults.

Guideline content

The full document has been organized into three separate parts. Each section includes evidence-based recommendations highlighted in grey boxes. View the full Guidelines.

Part I: Framing the Context – Key Factors to Consider in Planning a Comprehensive Integrated Mental Health System for Seniors

Part I sets the context and explores the key factors that should be considered when planning a mental health service system for older adults. Of particular note are the guiding values and principles that underpin all of the recommendations and content of this document. Part I also include recommendations about the determinants of mental health, mental health promotion and prevention, and early identification of mental health problems.

Part II: An Integrated Model for Mental Health Services in Late Life

Part II focuses on the services required to support adults in later life. This includes the model for mental health services in later life and descriptions of the functions of each resource. Additionally, Part II offers staffing benchmarks for specialized seniors’ mental health services and a discussion on how to apply the benchmarks.

Part III: Facilitators of a Comprehensive Mental Health Service System

And finally, Part III discusses the mechanisms that facilitate a comprehensive mental health service system. This includes recommendations about cultural safety, diversity, the role of caregivers, and service delivery models.

Summary of recommendations

Detailed recommendations and supporting evidence are provided throughout the Guidelines. Below is a summary of 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.
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.

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.