Patterns of Service Provision in Older People’s Mental Health Care in Australia

Abstract

Australia has a population of around 4 million people aged 65 years and over, many of whom are at risk of developing cognitive decline, mental illness, and/or psychological problems associated with physical illnesses. The aim of this study was to describe the pattern of specialised mental healthcare provision (availability, placement capacity, balance of care and diversity) for this age group in urban and rural health districts in Australia. The Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) tool was used in nine urban and two rural health districts of the thirty-one Primary Health Networks across Australia. For the most part service provision was limited to hospital and outpatient care across all study areas. The latter was mainly restricted to health-related outpatient care, and there was a relative lack of social outpatient care. While both acute and non-acute hospital care were available in urban areas, in rural areas hospital care was limited to acute care. Limited access to comprehensive mental health care, and the uniformity in provision across areas in spite of differences in demographic, socioeconomic and health characteristics raises issues of equity in regard to psychogeriatric care in this country. Comparing patterns of mental health service provision across the age span using the same classification method allows for a better understanding of care provision and gap analysis for evidence-informed policy.

‘Are we opening a can of worms?’: Community‐based occupational therapists' experiences working with clients with unexpected mental health issues

“…A clear referral pathway (which is locally relevant and kept up to date) for people experiencing varying levels of severity and acuity of mental illness is also required, a gap that was identified by participants of this study. A shortage of non-acute mental health services has been documented previously (Fernandez et al, 2017;State of Victoria, 2021;Tabatabaei et al, 2020). In their analysis of mental health-related emergency medicine service presentations, Roggenkamp et al (2018) found that most presentations were for non-urgent mental health conditions, more suitably addressed by alternative, community-based services.…”

“…It is recognised that health professionals other than those in specific role mental health roles contribute to improving mental health (e.g., social workers, case managers; Tabatabaei‐Jafari et al., 2020). Occupational therapists (OTs) are health professionals who work with people with diverse needs across various settings to support optimal engagement and participation in daily life (Roberts et al., 2014; Dahl‐Popolizio et al, 2018).…”

“…It is recognised that health professionals other than those in specific role mental health roles contribute to improving mental health (e.g., social workers, case managers; Tabatabaei-Jafari et al, 2020).…”

Patterns of mental health care provision in urban areas: A comparative analysis for local policy in the ACT

“…Heuristics and expert pattern recognition based on detailed systematic description of the whole system of care may be of greater use than significance of differences and power calculations across local areas. Saunders [ 16 ] discussed the limitations of samples below 100 in healthcare systems research; a problem also described in previous studies [ 59 ]. Analytically, there are three broad strategies that can be taken when approaching the analysis of data with low sample sizes: a) maximise power using techniques specifically equipped for low samples; b) maximise the utility of available data and inference through permutation, resampling, or bootstrap methods; or c) use fuzzy logics for sensitivity analysis or undertake advanced modelling combining the other approaches.…”

Mental health systems modelling for evidence-informed service reform in Australia

“…RTE has been extensively used in mental health planning in Europe and the US (García-Alonso et al, 2022). In Australia DESDE has been used for describing the capacity and the pattern of care for adults (Fernandez et al, 2017), child and adolescents (Salvador-Carulla et al, in press), drug and alcohol (Calabria et al, 2021), rural and remote areas (Salinas-Perez et al, 2020; Van Spijker et al, 2019), and older populations (Tabatabaei-Jafari et al, 2020). Although local atlases of mental healthcare using DESDE have been produced in Australia, the lack of access to linked databases has hampered the development of DEA/RTE studies.…”