Pressure on mental health care

Report deplores inadequate services for troubled people branded with a `use-by date’
Elderly people with severe mental illness are often warehoused in dingy hostels and boarding houses and overdrugged with “industrial-strength” doses of superseded medicines, according to a survey.

The report by SANE Australia, ‘Senior Service?’, says negative attitudes towards older people with a mental illness are still prevalent in some health services.

The report says: “It is as though older people are approaching their `use-by’ date and are not worth investing resources in.”

The report was based on a national survey of 45 organisations and professionals involved in mental health care for the aged. It concluded that Victoria needed to improve medical care and social support for older psychiatric patients, as well as provide more community housing in which they are supervised by staff with mental health training.

SANE’S executive director, Ms Barbara Hocking, said people with psychiatric disabilities were living longer because of better treatment. Their baby boomer cohort is greying along with the rest of the population, and many need more help as their elderly parents die or become too frail to continue caring for them at home.

“It’s been called the second wave of homelessness, these people coming through in their 40s or 50s whose families have traditionally cared for them very well, without great support and at enormous cost to themselves,” she said.

Ms Hocking said she recently spoke to a woman anxious about what would become of her mentally ill nephew. His mother was in her 80s and had recently had a stroke, and the auntie could not take him in because she was the sole carer of her brain-injured daughter.

“When these parents can’t continue any more, their children tend to drop out of care and support altogether and move from one boarding house to another,” Ms Hocking said.

“They end up in hostels (for the homeless) like Ozanam House.”

Many are at risk of violence. “They may share boarding houses with young men with drug or alcohol abuse problems who can be quite aggressive.”
Survey respondents reported that many elderly people had not had their medication reviewed in decades and were on heavy doses of older medicines that, while effective, often had stigmatising side-effects such as eye-rolling and involuntary movements.

This added to their loneliness and isolation.

“If people who don’t understand mental illness see someone gyrating like that, they tend to recoil from them,” the report says.

The state Health Minister, Mr Rob Knowles, said Victoria was ahead of other states in its psychiatric services for the aged and that more people were receiving treatment and support, “but we can’t run away from the reality that there are still unmet

Mr Knowles said pilot programs were using mental health nurses to teach psychiatric skills to managers of special accommodation housing, and a taskforce was examining how to help older psychiatric patients connect with services.

Alone, vulnerable and lacking support Karen Kissane   “Max” has bipolar disorder (manic-depression) and takes lithium. He is well known in his local area as a colorful eccentric who rides his bike everywhere. Now that he is older, his blood lithium level is more unstable.

Last summer, during a heatwave, he was out on his bike in the middle of the day and became dehydrated.

He fell off his bike and was taken by ambulance to a general hospital and was found to be lithium toxic. He spent two months in a psychiatric hospital while his bipolar disorder was re-stabilised.

This could have been avoided if the supervisors at his accommodation house had known about the risks of dehydration with lithium therapy, had told him not to go out on the day, and had warned his GP that his lithium levels needed checking.

* “Eleanor” has had a limited education because schizophrenia has given her psychotic episodes since she was 15. She was abandoned by her struggling rural family in the 1940s and spent 20 years in a country mental institution.

When she was treated with the first anti-psychotic medications in the 1960s, she was discharged into the community. During the next 30 years she was re-admitted to hospitals 15 times, staying for up to 18 months.

Doctors and nurses kept reporting in Eleanor’s records that she could not manage in mainstream society and would turn up at emergency departments all over Melbourne at all times of day or night, desperate to be admitted. Now 75, she has no relationship with anyone apart from her case worker and refuses to stay in the accommodation offered to her. She is preyed upon by strangers for her pension money and other favors.

* “Stan” came to Australia to work on a hydro-electric scheme. Always a loner, he had jumped at the chance to leave his alienated family in eastern Europe. He was a heavy drinker and had his first episode of mental illness in the 1960s, when he was in his early 40s. In one alcoholic haze, he committed a serious crime and was jailed, but has not drunk since his release. He moves home often because of his paranoid delusions about other residents and staff, especially when he is becoming ill again. Because of this, and because management at accommodation houses changes often and those in charge have no training in mental health, the signs that Stan is becoming ill are frequently missed. Fine-tuning his medication at an early stage would avoid renewed breakdowns with re-hospitalisations and would help him to stay in one place and develop a sense of belonging.

These stories of older people with chronic, severe mental illness who do not have trained, home-based supervision, come from Dr Kathryn Hall, head of aged psychiatry at the Caulfield General Medical Centre.

First published in The Age.