1. Collaborative Mental Health Care: Meeting the Accessibility Needs of Older Adults with Concurrent Chronic Disorders CCSMH Conference, September 2007 There are no apparent conflicts of interest that may have a direct bearing on the subject matter of this presentation

2. Presenters  Salinda Horgan, Ph.D.  Martha Donnelly, MD, CCFP, FRCP  Ken LeClair, MD, FRCP

3. Collaborative Care Delivery of service by two or more stakeholders (including consumers) Working together in a partnership characterized by –Common goals or purpose –Recognition and respect for strengths and differences –Equitable and effective decision making –Clear and regular communication To improve access to a comprehensive range of services delivered by the right person, in the right place at the right time. Kates, N

4. Canadian Collaborative Mental Health Initiative

5. Framework for Collaborative Mental Health Care

6. Members of the Seniors Working Group Ken Le Clair, MD, FRCPC – Kingston Martha Donnelly, MD, CCFP, FRCPC - Vancouver Geri Hinton, B.Sc.N, DStJ – Victoria Sarah Kreiger-Frost, RN, MN - Halifax Penny McCourt, MSW, Ph.D. - Nanaimo Salinda Horgan, Ph.D. – Kingston

7. Seniors Population Definition Age greater than 65, avg. age 75 (exceptions organic mental disorders). All psychiatric disorders but with emphasis on: –Dementia with affective and behavioural disorders –Mental health problems associated with medical illness –Complex B/P/S/F/E problems –Families of seniors with mental health problems Loss of independent functioning in IADLs/ADLs. Often present first to family physician with physical complaints. Require comprehensive geriatric assessments.

8. The Consultation Process – What Multi-disciplinary Working Group Literature Review Qualitative Interviews Quantitative Survey

9. The Consultation Process - Who Qualitative interviews: 6 interviews with family members/consumers. 7 interviews with services specific to seniors (specialty psycho-geriatric programs, generic mental health programs, primary care clinic, adult day program). 7 interviews with professional disciplines (family doctors, pharmacy, nursing, social work, cultural development, research). 2 interviews with policy advisors. Quantitative survey: 26 surveys of specialty and generic mental health programs and policy advisors. Presentations at conferences

10. Literature Review – Key Learnings On-site primary care and specialty case manager strategies provide better outcomes for seniors than traditional care (particularly for those experiencing mood disorders). Consultation with liaison provide better outcomes for seniors than consultation only. Approaches embedded in a knowledge transfer framework (evidence based guidelines) provide better collaboration between diverse partners.

11. What do we Need to Know About Seniors? Seniors experience the stigma associated with advanced age and mental health needs both in the community and within the health system itself. Many seniors are experiencing mental health issues for the first time. Many family caregivers are seniors themselves with complex needs.

12. Accessibility to Collaborative Mental Health Care Accessibility is the primordial issue affecting the degree to which older adults with complex mental and physical health issues benefit from collaborative care

13. Personal Factors Physical Access Attend health care appointments. Driving / financial implications. Affects number of appointments attended. Resource Awareness Limited mobility / life-style changes in retirement. Limited knowledge of external resources. Affects their knowledge of available services.

14. Caregiver Factors Complex Coordination Coordination of multiple services (special transit, attendant) for one visit. Caregiver Health Less likely to attend regular check-ups. Increased health needs – stress induced. Caregiver Inclusion Crucial resource (historical contextual knowledge, communication).

15. Systemic Factors B road Stakeholder Inclusion Broad spectrum of health and community partners needed to address complex health and social issues. Socially diverse population. System Fragmentation Health conditions are not static (age / functioning). System – each developmental stage brings new services, new providers and new service locations.

16. Planning Strategies Think About: Location of services. Co-location with services / supports relevant to older adults. Seeing older adults in their homes. Mutual caregiver/patient appointments. Actively involve caregivers in health appointments. Collaborate with broad range of stakeholders (health, family, community). Minimizing service fragmentation.

17. The Health Care Reality It is estimated that between the years 2020 and 2030, 75% of health providers' time will be spent with older people Seller, et al. Gerontology and Geriatrics Education, Vol. 8 3/4, 1988

18. Seniors Toolkit www.ccmhi.ca