Australia: Integrating Mental Health Services at the Primary Care Level

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In many developed countries, the aging populations are on the rise and Australia is no exception. Currently, 13% of Australia’s population is over 65 years and this is projected to grow 19-21% by 2031 and 26% by 2051. The experience of aging can range from a positive, fulfilling one to an anxiety filled, negative experience. In Australia, mental health disorders are highly prevalent among the elderly.

Existing mental health services are provided at the primary care level, with the general practitioner. In 1992, Australia changed its mental health services policy from an institutional to a community-oriented set up. When it comes to health, one’s General Practitioner (GP) is usually the first point of contact for an elderly patient. By integrating mental health services at the primary care level, the Australian government places mental health as a mainstream agenda in the health system.

An example of a model is the case of St. Vincent’s District in the inner city of Sydney. This district had a heterogeneous elderly population, comprising of Holocaust survivors, people who are homeless, or in hostels among others. Less than 1% of the population surveyed went directly to a hospital for mental health services, and a significantly larger proportion went to their GP. Since the elderly have the freedom to choose their GP, they place a high level of trust with these health professionals. The model encouraged collaboration across primary care, community services and specialist services such as geriatric medicine and geriatric psychiatry. An impact evaluation of this program suggested that general practitioners and other primary health care workers became more skilled in assessing and managing elderly mental health, requiring less support. Additionally, there has been better outcomes with regards to maintaining continuity of care.

This model was applauded for not only improving access to mental health services, but also in the collaboration it achieved. However, stigma against mental health issues is a concern. Elderly patients are often victims of the existing stigma around mental health and this is a significant barrier to engaging in dialogue on mental health issues with one’s General Practitioner. Another critique of this program is that care and treatment can be ‘fragmented, piece meal and sometimes non-existent,’ and that there is no nationally consistent protocol.

It is estimated that 10-15% of the elderly population have experienced depression. If one looks specifically at the elderly population in residential care homes, this population has more than twice the rate of the depression, at 35%. Additionally, about 10% have experienced problems with anxiety. Suicide rates among the elderly are also a cause for concern as men over 85 years have the highest likelihood of dying by suicide than any other age group. This age group’s suicide rate  is three times higher than the national rate, at 37.6 deaths per 100,000 people. Some of the key reasons for depression include loss of a partner and deterioration of health.

These figures look grim. Perhaps there is a need for the re-evaluation of this model, looking at health systems factors as well as sociocultural factors affecting access and use of mental health services.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.

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Categories: Australia

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