Mental health community support needs don’t stop at 65

To the Editor

We cannot afford to keep ignoring the needs of older people with mental illness in planning services. The development of population-based estimates for resources required to provide community support for people with mental illness (Siskand et al., 2012) is an important progression in the planning to improve the lives of people with mental illness. However, it is of great concern that estimates are based only on people aged 18–65 years, as the main current recipients of services. It is almost more concerning that those over 65 appear almost not to be considered ‘adults’ given their categorisation as an ‘other age group’. There appears to be an increasing divide in planning for the needs of ‘older people’ with mental illness between those focused on mental health or ‘aged care’. Estimates for the provision of aged care support services are based around the population aged 70 years and over, with the highest proportion of residents in residential aged care (28% in 2010) being 85–89 years old (Australian Institute of Health and Welfare, 2011). Even the welcome mental health-related update to the ‘Aged Care Assessment Program – Operational Guidelines’ (Department of Health and Ageing, 2010) explicitly notes that assessment and approval for aged care services of a person with mental illness is only appropriate ‘if the person has predominately aged care needs and meets the criteria set out in the Aged Care Act’. The majority of people with mental illness over 65 are not ‘frail’ or likely to meet this criteria.

Within 15 years, the number of Australians aged 65 years and over is projected to be over 6 million (Australian Bureau of Statistics, 2008). The most recently published epidemiology of schizophrenia in those aged 60 years and older found the prevalence to be comparable with the general population (Meesters et al., 2012). This age group has been omitted from relevant Australian studies. Of those in residential aged care, 25% have a diagnosis of mental illness other than dementia at entry to care; an additional approximately 20% have a diagnosis of dementia and a further mental illness (Australian Institute of Health and Welfare, 2011). Those with mental illness who avoid early mortality – including those who underwent earlier ‘deinstitutionalisation’ with limited supports – face a realistic fear of avoidable early ‘reinstitutionalisation’. There are few supported alternatives. There are no ‘aged care packages’ targeting the needs of mental illness, mental health community support programs rarely target older people, and only Victoria has significant numbers of ‘community residential’ mental health places – in residential aged care settings.

Planning for the mental health support needs of older people does require grappling with the complex interface with aged care. Avoiding this complexity can only result in an increasing underestimation of total population needs, the perpetual disadvantage for older people with mental illness, or both. Surely, it is time to stop seeing neglect of the needs of older Australians with mental illness as an acceptable ‘limitation’ in planning.