How it Grew and Why it Works
Reprinted from "Seniors' Mental Health" issue of Visions Journal, 2002, No. 15, pp.40-41
The development of community mental health services for adults over 64 years of age followed the implementation of services for the 19–64 age group. The elderly mental health service beacon was not switched on until the mid to late 1980s, when the Ministry of Health, Mental Health Division launched a program to address the specific mental health service requirements of this group.
In Salmon Arm, our first exposure to the program was through educational workshops, offered to physicians and interested agency staff by geriatric psychiatrists working in provincial mental health facilities like Riverview or Valleyview. These sessions were of limited use from a service point of view, but they did signal the presence of an entire population group that the mental health service had neither the knowledge, skill nor resources to recognize, let alone assess and treat.
The initial model, proposed by the Mental Health Division, called for multidisciplinary teams, which would receive referrals, conduct assessments and provide care-plan recommendations back to the referral source. These Geriatric Assessment Teams (GATs) were the suggested framework for development of the elderly mental health service in the Mental Health Centres.
There were some problems with the implementation of the GAT format, beginning with the funding of the teams. Generally, larger centres received funding before the smaller communities. In Salmon Arm, the physician sessional funds were available at least two years before the first staff funding appeared. That first sessional physician functioned in an assessment capacity, usually within the long-term care facilities and in concert with the Continuing Care assessors. During this initial phase, we began to address the inappropriate, albeit well-intentioned, prescribing practices of attending physicians, who were unaware of the special medication requirements of their elderly patients.
Eventually, in 1993, a staff social worker was hired into the Elderly Service Program, rendering the team two-dimensional, and now on its way to multidisciplinary status. At this point, another problem appeared. The GAT model, as proposed by the Mental Health Division, seemed incomplete. Receiving referrals, conducting assessments and handing the care-plan recommendations back to the referral source, although tidy, left someone else holding the treatment and implementation bag. Frequently, those service providers felt abandoned by the Mental Health Service and wanted more support.
We resolved that dilemma by deciding to provide not only assessment, but treatment and case management services as well. This was in keeping with the Adult Services, which had always assumed that responsibility. In hindsight, it seems incongruent that the Elderly Service would not have offered that full spectrum of service.
The decision was well received by the community, which perceived the Mental Health Centre Elderly Service Program as offering real service where it was needed. Our willingness to respond, however, led us inevitably to our next problem, which was the limit on our ability to respond to requests for service, and the resulting pressure on the two-member team. All of our best intentions and hopes notwithstanding, five long years passed before additional funds were available to make this team truly multidisciplinary. In 1998, a second social worker was hired and in 1999, a nurse joined the team. In 2000, a part-time contract position was expanded to provide full-time case management services to Enderby and Armstrong. Some of these funds came from the first, and so far only, mental health plan funding to come our way.
Most recently, in May 2002, after 2 years of negotiation, the Interior Health Authority transferred 3.14 FTE Elderly Outreach Workers to the ESP from the Home Support Service, clearing the way for daily support service offered in a flexible and responsive way, and freeing us from the rigid hourly scheduling process entailed by Home Support.
The Elderly Service Program has benefited from the collegial and collaborative teamwork in the Mental Health Centre. The Adult Services Program Coordinator offered the ESP an evening nurse position that was clearly more necessary in ESP than in Adult Services. This evening nurse works from 5pm to 9pm on weekdays and 4 hours each on Saturday and Sunday, providing after-hours follow-up and support where and when needed.
The current Program Coordinator of the Elderly Service Program, Dustine Tucker, has provided excellent leadership to this team, which is now able to provide a full spectrum of service to clients in the Shuswap area. In Revelstoke, we do not have the capacity to provide direct service, but we do offer a regular case conference format with Community Health Care assessors and we deliver some educational programs. The ESP consultant physician provides assessments and treatment recommendations.
Why does this program work?
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First, the Mental Health Centre recognized that this population was a neglected group, and embraced the concept of developing a service that catered to their particular needs.
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Second, the service was designed to be helpful and handson, providing not only consultation and assessment recommendations, but treatment and case management, in keeping with the standards established by the Adult Mental Health Service.
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Third, the Elderly Services Program identity was thoughtfully nurtured and clarified as we grew to understand the very special mental health service needs of elderly adults.
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Finally, the ESP was defined as a core program in the Mental Health Centre and was given an appropriate share of new funds as they became available.
These four measures have put the Elderly Services Program where it rightfully deserves to be: on the same playing field as the Adult Mental Health Service, offering the same standard of service.
