Mental Illness in Practice
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Mental Illness

What we know

This topic focuses on mental illness or mental health disorders as distinct from the broader concept of mental health and wellbeing issues. Adults with a severe mental illness have been identified as a particularly vulnerable group. Approximately 10-15% of older Australians suffer from a mental illness, yet, it often goes unrecognised, meaning that relatively few older people with mental illness receive specialised treatment. Unrecognised and untreated mental illness in older adults is linked to disability, reduced quality of life, decreased adherence to treatments, other poor health outcomes and restricted use of available services. A variety of health care professionals deliver care and support to older people with mental illness. Timely referral to specialist mental health providers should be considered in cases of severe mental illness to help tailor interventions best suited to the person’s needs.

What can I do?

Use the tips about Having the conversation with older people about anxiety and depression (278kb pdf) from Beyond Blue.

Check out the resources from Beyond Blue to be confident in knowing what to say and why when talking with older people.

If anxiety or distress is related to the perception of imminent death, it may be helpful to describe the process leading to death. This newspaper article may help support discussions about death and dying.
 

In older people receiving palliative care, consider using:

  • Two-Question Screen or the Geriatric Depression Scale (GDS) to screen for depression
  • Rating Anxiety in Dementia scale (RAID), Geriatric Anxiety Inventory (GAI) or the Hospital Anxiety and Depression Scale (HADS) to screen for anxiety.

For people with clinically significant depressive symptoms and cognitive impairment, actively treat depression prior to an assessment of dementia.

Tailor the treatment of a mental illness to the severity of symptoms, the person's clinical condition and their prognosis.

Put in place a Suicide Safety Plan from Beyond Blue for people to use when they are feeling unsafe or suicidal.

Recognise the role of carers and monitor their wellbeing and offer support where possible.
 

Pass on information for carers and families caring for an older person with a mental health condition including the Head to Health website with its sections:

Remember that:

  • Older people with serious mental illness may require assessment and advice from mental health clinicians so that their care can be appropriately adjusted.
  • The person with who has a life-limiting illness coupled with a mental illness may be experiencing extreme loss. They may believe that because of their mental illness they have not lived their life to the fullest and hence are at risk of greater distress than the general population.

If the person you are caring for needs to talk to someone immediately, telephone one of the following:

 

What can I learn?

Read the fact sheets:

Check out the following videos on

Use the resources from the Head to Health website for information on

For more information, check out the

Read Clinical Practice Guidelines and Principles of Care for People with Dementia (757kb pdf) for steps to prevent, recognise and manage depression and anxiety in dementia. These steps relate to depression and anxiety as symptoms and as a mental illness.

To improve knowledge and awareness of the recognition and treatment of mental disorders, use MHPOD, an evidence-based Australian online learning resource for health professionals working in mental health.

 

What can my organisation do?

For more information and ideas about what you can do and where you can go to get help for older people with mental illness, visit the following websites:

Be aware of how Primary Health Networks (PHNs) can deliver psychological treatment services targeting the mental health needs of people living in residential aged care facilities (RACFs) in the Psychological Treatment Services for people with mental illness in Residential Aged Care Facilities (2018) (194kb pdf).
 
Check out the RANZCP guidance which includes advice specific to the care older adults. RANZCP also hosts advice for the general public about mental illness.
 
Develop experienced multidisciplinary teams to work with older people with a mental illness who are approaching the end of their life. A team could include mental health clinicians: psychiatrists, psychologists, mental health social workers and other allied health (occupational therapists, physiotherapists). Useful information includes:

Page updated 08 May 2020