5TH ANNIVERSARY NATIONAL MENTAL HEALTH AWARDS
Category: Partnership
Honourable Mention: CANADIAN COALITION
FOR SENIORS’ MENTAL HEALTH Toronto, Ont.
ccsmh.ca
A PATH TO RECOVERY FOR SENIORS LIVING WITH A MENTAL ILLNESS
BACKGROUND
Life may be transformed in myriad and profound ways as people grow older. Changes can include employment status, societal and family roles and relationships, physical abilities, housing and health needs; all of which can be considered typical transitions associated with aging. Mental illness cannot.
Seniors comprise Canada’s fastest-growing demographic group (one in four people will be over the age of 65 by 2026). As in the general Canadian population, one in five seniors over the age of 65 experiences a mental health issue or mental illness in their lifetime. Some 60-80 per cent of seniors in long-term care facilities have some form of mental health concern. One in 10 seniors experiences clinically significant depression and one in four of these people experiences severe depression.
Suicide rates are higher among people over the age of 65 than for any other age group.
Addressing the critical and specific mental health needs of seniors requires collaborative efforts on a national scale, and national guidelines for those who care for seniors.
OVERVIEW
The Canadian Coalition for Seniors’ Mental Health (CCSMH) was established during a 2002 National Symposium on “Gaps in Mental Health Services for Seniors’ in Long-term Care” hosted by the
Canadian Academy of Geriatric Psychiatry. Participants from more than 65 organizations from across Canada, including national and provincial associations, policy makers, consumers, service providers, educators, researchers and representatives from private industry attended, and identified the need to advocate for and promote seniors’ mental health.
Two co-chairs from the Canadian Academy of Geriatric Psychiatry lead a steering committee
comprising 14 organizations representing healthcare providers, consumers, family and caregivers and policy makers, including: Alzheimer Society of Canada; Canadian Academy of Geriatric Psychiatry;
Canadian Association of Social Workers; Canadian Caregiver Coalition; Canadian Geriatrics Society;
Canadian Healthcare Association; Canadian Mental Health Association; Canadian Nurses Association;
Canadian Pensions Concerned; Canadian Psychological Association; Canadian Society of Consultant Pharmacists; College of Family Physicians of Canada; and Public Health Agency of Canada (advisory only).
With a mission to promote the mental health of seniors by connecting people, ideas and resources, and with funding from the Public Health Agency of Canada’s Population Health Fund, the Coalition
took the lead in developing evidence-based recommendations for best-practice guidelines in
specific areas. In 2006, the Coalition released the CCSMH National Guidelines. Canada’s first national, interdisciplinary, evidence-based guidelines focus on four key areas of seniors’ mental health: the assessment and treatment of delirium; the assessment and treatment of depression; the assessment and treatment of mental health issues in long-term care homes (with a focus on mood and
behaviour); and the assessment of suicide risk and prevention of suicide.
Seven pilot projects implemented elements of the guidelines in a variety of settings across Canada.
To communicate the guidelines most effectively and literally put the information into people’s hands, four different “pocket cards” were created, each offering summaries and recommendations from the four guidelines. The suicide prevention card, for example, focuses on the risk factors and warning signs for suicide in late life, as well as recommendations for assessing and managing those potential risk factors. User-friendly education guides for seniors and their families have also been developed consistent with the guidelines’ focus.
“We wanted to improve the assessment and treatment of common mental health problems in late life,” explains CCSMH Executive Director Kimberley Wilson. “Even more so, we want to raise the level of understanding and awareness of these mental health issues. We really have incredible partners who produce these tools and resources, and lend us their expertise, typically with no reimbursement.
They do it because they care and they want to contribute to the landscape. The only reason we have existed is because we have such strong partners across the country.”
Since the Coalition’s founding, significant financial support has come from the Public Health Agency of Canada, as well as from the Canadian Institutes of Health Research (Betty Havens Award for Knowledge Translation in Aging). A donation from the RBC Foundation was also instrumental in the dissemination process.
CHALLENGES AND OPPORTUNITIES
From the beginning, the Coalition needed to confront two issues: a great deal of stigma surrounding mental health issues in general, and the myths and lack of information surrounding seniors’ mental health in particular.
Shortly after the guidelines were developed, the group heard from a large group of people, many of them clinicians, saying that although they wanted the information the guidelines offered, they were unlikely to read the entire lengthy document. To address this challenge, the Coalition sought a way to communicate vital mental health information for seniors in a condensed and convenient manner.
This led to the simple, low-tech “pocket cards.”
Like many organizations that operate on a shoe-string budget, ongoing uncertainty about funding has required the group to re-evaluate some of its workload and, at one point, to consider closing its doors. “We stay alive through enthusiasm and demand,” Wilson notes, adding that the group’s members believe so strongly in their cause, that even though there was no funding to continue after the guidelines were completed, the project committee continue to work. “For now, there is no funding for this project, but it continues to live on momentum.”
“It comes back to the roots of why people got involved,” explains Dr. Ken Le Clair, Coalition Co-Chair.
“The development of these guidelines was all volunteer enthusiasm. Through the process, there were relationships established across provinces and local communities. These leaders wanted to continue in a meaningful way.”
INNOVATION
The CCSMH is “probably the only national network in aging and mental health that exists,” Le Clair says. “It’s about surfacing and identifying and supporting the development and delivery of knowledge of highlighting the issues of mental health, and pointing to areas of improvement and good
supportive care.”
While guidelines for seniors’ mental health have been developed in the past, these were typically discipline-centred. Something specific was needed for all Canadians, not just those who cared for seniors in a hospital environment. Recognizing that the people who work with seniors come from many different disciplines, and include families, the CCSMH guidelines also reached out to front-line workers, mental health professionals and educators in health education programs at universities and colleges.
The Coalition emphasizes a knowledge dissemination strategy to ensure the guidelines are widely known and implemented. “[The guidelines] are not owned by CCSMH. They are owned by leaders in the field, by the people who used them,” Le Clair explains.
Initiatives like the pocket cards [see Challenges and Opportunities for more information] were an innovative approach to getting information out in the most accessible manner. Offering additional resources online ensures the Coalition continues to make an impact, while keeping costs to a minimum.
MAKING AN IMPACT
Throughout the project duration, more than 15,000 hard copies of the CCSMH National Guidelines have been distributed across Canada and an additional 11,000 copies have been downloaded from the website from more than 40 countries. More than 50,000 pocket cards have been distributed, and there continues to be a heavy demand for them.
“I never expected the kind of enthusiasm, the kind of impact and the utilization of these guidelines that I have seen locally or provincially,” Le Clair says. “It is beyond what I expected. What it did was change the stigma associated with seniors’ mental health and galvanized people so they knew that these disorders were not normal.”
Despite its current funding challenges, the Coalition can continue to offer access to the guidelines and other tools and resources through its website.
LEARNINGS AND INSIGHTS
The Coalition recognized that seniors’ care involves many people from many disciplines, and that creating national guidelines required national representation. “We have a broad, diverse stakeholder membership. It is one of the most important things contributing to the success of this project,” Wilson says.
While in recent years the public profile of mental illness has begun to come out of the shadows and mental health issues are discussed more openly — including increased media coverage and corporate sponsorships for a variety of mental health initiatives — seniors’ mental health still languishes behind and is not always viewed as a priority.
THE FUTURE
Funding concerns continue to weigh heavily on the Coalition, which will look to increase
collaborations to not only survive as an organization, but to continue to provide the support and education needed to help seniors experiencing a mental health problem or mental illness.
The Coalition would like to know more about the impact of its efforts, specifically how many people are actually putting the information to good use. They would like to know, for example, how many of the pocket cards are actually make it into somebody’s pocket and change the way care is delivered.
Given the growing need for information, its wide dissemination and the positive response from the communities, the Coalition has progressed to the point where it can no longer rely solely on its website as a means of communicating to a vast audience. “The digital divide is changing,” Le Clair notes. “I think we are now in a place where really we need to start to think about how we use social media, rather than static online resources.”
He cites as an example of a possible template for the CCSMH, the Canadian Dementia Resource and Knowledge Exchange (CDRAKE) website (www.dementiaknowledgebroker.ca), a project which he co-chairs. The site provides the opportunity for people to ask questions, share answers, connect to feeds and blogs, and interact through Twitter and Facebook. The group also archives conversations to serve as references for future inquires.
Despite raising a great deal of awareness about four critical aspects of seniors’ mental health, the CCSMH would welcome the opportunity to explore other common mental health issues for seniors.
“In a perfect world, if we were given additional funding we would add to our suite of guidelines and resources, and explore other key topics in seniors’ mental health,” Wilson explains.
By Séamus Smyth and Cathy Nickel Mental Health Commission of Canada
