clinical focus
about being diagnosed with mental
health issues.
The other side of the problem is that
the people in charge of caring for them
professionally might also be less well
trained, so the symptoms are just not
picked up. Sometimes we hear professional
carers say it’s natural to feel depressed
when you’re old. There’s a continuation
of this stereotype that mental health
problems in old age are normal, that it
shouldn’t be diagnosed and treated.
What are the more common mental
health provisions in the aged care
system? Are there psychologists on staff,
and if not, are they readily available?
Optimistic times
Hopes for mandatory
mental health workers in
all aged care facilities.
Sunil Bhar interviewed by Conor Burke
T
he issue of psychotropic drugs has
been front and centre during the
royal commission into aged care,
but not much time has been devoted to the
reason behind their use: mental illness.
Approximately half of all aged care
residents exhibit symptoms consistent
with depression, and typically those who
currently reside in aged care facilities have
low mental health literacy, so identifying
issues can be problematic.
Unfortunately, this issue is often
neglected, as it is assumed that depression
just comes with old age.
Sunil Bhar disagrees. As a professor of
psychology at Swinburne University, Bhar
believes that more should be done to
tackle mental health issues, and a good
28 agedcareinsite.com.au
starting point would be mandated access
to psychological help.
Bhar does see room for optimism,
however, with last year’s federal budget
allocating significant funds to mental
health in aged care.
Bhar joined Aged Care Insite to talk
about this problem and his work in the
mental health space.
ACI: I imagine that for a great many
people in or entering aged care, mental
health was something that was just not
talked about as they grew up. Is there
a problem with undiagnosed mental
health issues in aged care?
SB: There’s a huge problem with
undiagnosed mental health issues in
aged care. Currently, we think that about
50–60 per cent of the people who live
in residential aged care have a major
depressive disorder, but very few are
diagnosed. A lot of people have very
serious mental health problems, yet very
few are diagnosed.
Should we be educating elder Australians
about mental health?
I think the reason for the underdiagnosis
is quite complex. Certainly, the older
people in our society are less literate
about mental health issues. Perhaps
there’s also a continuing stigma
Well, you’ve just opened up a hornet’s
nest right there. Even when mental health
problems are diagnosed, particularly in
residential aged care, there are very few
services to then respond.
At the moment, the frontline service
happens to be psychotropics. It’s usual
for an older resident to be diagnosed and
then prescribed antidepressants. There
are in fact very few non-medication type
therapies readily available and accessible to
this population.
Perhaps the most frequently available
services are those called ‘lifestyle services’.
These are services within care that focus
on the social wellbeing of the resident.
Often it involves arts and crafts, taking
people out on excursions, organising fun
group activities.
The second most common are pastoral
care services, where people are trained to
talk about the spiritual care needs of the
residents. But there’s no specific service to
deal with the mental healthcare needs of
the residents.
There are very few psychologists in
the system, perhaps only a handful of
residential care facilities that employ
their own psychologists or counsellors.
Older people who live in these residential
facilities do not have access under
Medicare to private psychologists, social
workers and so on. It’s very difficult to
provide the right sort of non-medication
service to these residents.
What else should we be doing to reduce
depression? Post royal commission,
do you think psychologists should be
mandated for aged care facilities?
Absolutely mandated. In some of the
other countries we’ve explored, such as
the US, there are very creative ways of
making sure there are some specialists