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标题：Supporting the mental health needs of adults 50 and over: The importance of integrated community support services
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作者：Nelly Oelke ; Kaela Schill ; Carolyn Szostak 等
期刊名称：International Journal of Integrated Care
电子版ISSN：1568-4156
出版年度：2016
卷号：16
期号：6
DOI：10.5334/ijic.2830
出版社：Utrecht University, Maastricht University, Groningen University
摘要：Introduction : Mental health challenges are increasing for older adults. Over 20% of seniors in Canada report having a mental illness; while many individuals have higher rates of chronic disease, which include mental health challenges as presenting primary conditions and co-morbidities (e.g. depression). Seniors and individuals with chronic physical disease are identified as being vulnerable for mental health issues. Unfortunately mental health in this age group is often not addressed and can significantly impact the costs for individuals, caregivers and the health system. A focus on early detection, prevention, and the promotion of mental well-being is essential. Promoting mental health and well-being can increase protective factors, decrease risk factors, and address social determinants of health. Addressing health concerns, including mental health in rural communities is significantly more challenging. Rural communities face challenges shaped by unique social and environmental factors. These include an aging population, lower socio-economic status, lower education levels, decreased access to health care services and geographic isolation, especially in the winter months. A research study was conducted in three rural/semi-rural communities in southern British Columbia, Canada focusing on mental health in older adults. The aims of this project were three-fold: 1) to identify the needs of adults 50 and over experiencing a mental health concern; 2) to identify current services and supports available and gaps in services and supports; and 3) to identify opportunities for integrated services and supports for these individuals, their caregivers and community-based organizations. Methods : Six consultation sessions were conducted across the three communities. In each community, one session was completed with community members with a mental health concern and another with community organization representatives. Informed consent was received from all participants. Sessions were audio-recorded and field notes were taken. Data were analyzed using a thematic analysis approach. Results : Six interrelated themes were identified: lack of resources; access issues; poverty; stigma; purpose and meaning in life; and factors influencing mental health. Lack of resources included funding, human resources, and services and supports. Specifically identified was the lack of collaboration and communication between health care professionals, paraprofessionals, and community supports. Access issues commonly acknowledged by participants were long wait lists, availability of services and supports, cost of private services, transportation, difficulties in completing paperwork for services, and eligibility criteria for services (e.g., needing to have a diagnosis to obtain a service). Poverty was identified as a major factor for adults 50 and over with a mental health concern. Housing, income, and balancing needs and finances (e.g., medications or food) were commonly cited by participants. Stigma was also identified as a common concern among participants. Stigma was seen to be higher in rural communities, in this age group and among men. Participants also discussed the contribution of lack of purpose and meaning in life, which was particularly evident in this age group. Retirement, children moving away from home, and lack of cognitive challenge all contributed to the feeling of not being valued. Finally, participants discussed factors that influenced mental health in their communities. These included trauma, isolation, stress, and self-medication or substance use due to the lack of available services and supports. Discussion : The needs for adults with mental health concerns in this age group were well articulated by participants. Many gaps in services and supports were identified. The most common concern voiced by all participants was the lack of community-based services and supports. Furthermore, providers were not well integrated and lacked connection to each other. Community-based integrated services and supports were desired and recommended by participants. Conclusion : This study identifies the importance of community-based integrated services and supports for adults 50 and over with a mental health concern in rural communities. This information will be beneficial to decision-makers and policy-makers in the development and delivery of new services and supports for this population.
关键词：mental health ; integration ; community services and support