Battling The Tragic End
Calgary has a 10-year plan to end homelessness.
Among them are the aged and evicted, needing mental health care
Sujata Devadas, January 13, 2016
Calgary has a 10-year plan to end homelessness. Among the homeless, quite a significant number are senior citizens with mental health problems and behavioral disorders. Above the age of 65 is labeled a ‘senior’ citizen. But younger adults can also be functionally geriatric. Eviction and homelessness is the harrowing result. Devoid of shelter, suffering from dementia, delirium or depression, their quality of life is gravely at risk - more so, given the climate variability in Calgary.
Still others are burdened by psychotic disorders, schizophrenia, bipolar disorder, obsessive compulsive disorder and borderline personality disorder. Anxiety attacks too make them very vulnerable. Depending on the region, rates of seniors diagnosed with mental health issues range from 44% to 80%, or even 90%.
Treatment and Recovery
Several institutions and programs exist in Calgary to help them with medical care, intervention and support. Some are specific to seniors, others cover functionally geriatric younger adults as well.
Missing in Calgary is the lack of an outpatient geriatric psychiatry service. Assessments to determine whether a person has the cognitive ability to understand information, make choices or take decisions are done at Bridgeland Seniors Health Centre by the RCAT(The Regional Capacity Assessment Team).
Acute and sub-acute care
Rockyview General Hospital has 20 acute care beds to serve all southern Alberta. For some time now, it has been operating over its current capacity. The Geriatric Mental Health Community and Consulting Program provides its services through 29 long-term care facilities, 3 transition units and 13 designated assisted living facilities. One long-term care facility, Rouleau Manor at Holy Cross Centre with a capacity of 77 beds, closed after the 2013 flooding. 15 psychiatrists and 42 clinicians, offering treatment through this program, dealt with over 2000 referrals in 2013. The proportion of the functionally geriatric is ever rising.
The impact of 2013 floods in Calgary brought the Seniors Community Collaborative Outreach Team(SCCOT) into being, with the focus of addressing the health and safety of elderly citizens in Calgary. To accomplish comprehensive medical care, they have access to mental health clinicians as well.
A psychogeriatric patient exiting acute care has access to transition services available at Hamilton House (8 beds) and Roberts House (9 beds) - giving them a little more time to adjust and gain behavioral stability before resuming normal life. Not many seniors use it. The number of beds are low, and patients may be wait-listed before they reap benefits from this service. Apart from this, a brief follow-up and case management for about 90 days is provided to recently discharged psychogeriatric patients from Unit 48 Acute Inpatient Service as well as from Rockyview General Hospital and Glenmore Carewest Mental Health and Recovery Unit, if their consultant psychiatrist refers them to the Geriatric Mental Health OutreachTeam.
Geriatric Mental Health Rehabilitation and Recovery Unit in Calgary, equipped with 20 beds, offers short-stay facilities and treatment at the sub-acute level.
Addictions pose another problem. A telephone service (403 943 1500, Ext. 2) provides information and support for addicts as also for those battling mental illness. Addiction victims can receive help from Substance Abuse in Later Life (SAILL) that uses the Harm Reduction model to effect amelioration.
Victims of anxiety or depression add to the growing concern for senior citizens and their well-being. The AHS Bridgeland Seniors’ Health site operates a program for helping these distraught individuals.
Mobile support for seniors experiencing mental illness and complex behaviors is provided by BES, Behaviour Education Support system.
Aging before 65
Functionally geriatric, but below 65, the Peter Lougheed Centre offers intensive short-term intervention for mental health issues. Follow-up is given to patients exiting hospital care, and family and community resources are mobilized for their aid. The Assertive Community Treatment (ACT) Program is also not limited to the geriatric age group. It helps individuals who are unable to accomplish personal care, and require assistance with medical care, legal, financial or housing concerns.
The ISD mission
In spite of all these institutions and programs currently operative in Calgary to treat, alleviate and support affected older adults at various levels and aspects of care, the report commissioned by Older Adult Council of Calgary (OACC) on ‘Effective practices on collaboration between affordable seniors’ housing providers and mental health service providers’ presented by Dr.Lee Tunstall and Dr.Susan McIntyre in 2014 is an eye-opener to the formidable task of integrating service delivery (ISD) faced by concerned policy makers, caregivers and social work practitioners, clinicians, psychiatrists and psychologists:
Seniors facing geriatric issues and mental health issues are underserved by the community at large.
Agencies for seniors need to be much better informed about mental health disorders in older adults and trained to assist elderly residents so afflicted. Similarly, mental health treatment centers need to have a greater awareness of geriatric issues.
Supportive specialized mental health housing for this segment of population is woefully inadequate.
Dr.Tunstall is an independent consultant based in Calgary, Alberta with a PhD from Cambridge University. She is a member of the Canadian Academy of Independent Scholars and the Professional Writers' Association of Canada. She works with various non-profit organizations, many in the seniors' sector.
Dr.McIntyre holds a PhD in Socio-Legal Studies from University of Sheffield - a strong community advocate. She has evaluated organizations and held membership on numerous committees and task forces involving justice, social services, health services, homelessness and education including one on Sexual Exploitation and Trafficking with The Whitehouse.
Susan Brooke is a Community Impact Planner at the United Way of Calgary and Area for 5 years. She stewards funds that United Way receives from the community and engages the community in the senior and immigrant sectors to identify gaps, reduce barriers and help create greater community impact in addressing underlying causes of social issues. She has taken an earnest note of future options and alternatives outlined in it.
Walter N Luetz is a social welfare policy maker, a gerontologist with expertise in long-term care and service delivery for the disabled. He believes the need of the hour is to link health and social care providers, to make wraparound services affordable -coordinate their services and integrate the services network - therefore mitigating the deleterious effects of mental health or addiction challenges in aging Calgarians, even though full integration is not ideal for all circumstances.
Integrated Care and Service Delivery
Tunstall and McIntyre’s report spotlights attention on effective programs and best practices in different Canadian provinces as well as with various models in Australia that align most closely with the Behavioural Supports Framework - a philosophy of care emerging in Canada as the most competent and skillful in caregiving.The most important component of this approach is person-centred care that takes the individual’s environmental context - gender, family, marital status, culture and ethnicity - into account.
This must then be supplemented by an integrated psychogeriatric case management where the manager is “a member of a network of integrated, community-based clinical services and supports” says the report.
One of the emerging successful approaches mentioned by interviewees was the SCCOT initiative. Other effective programs in integrated care include:
CHOICE (Comprehensive Home Option for Integrated Care of the Elderly) in Edmonton, operated and managed in partnership with Alberta Health Services (AHS) for seniors with long-term mental health issues. Calgary’s equivalent is Comprehensive Community Care Program(C3) at Carewest Sacree.
PRISMA in Quebec - an integrated care program for the frail, elderly and disabled population that focuses on improving continuity and efficiency of its services.
St.Joseph’s Care Group in Thunder Bay, LOFT Dunn’s/Spencer project in Toronto, and Psychogeriatric Resource Consultants(PRC) - all in Ontario.
Supportive housing to back up this integrated service delivery could gain from studying the living arrangements in Cool-Aid Society in Victoria, British Colombia; LOFT’s Stepping Stone Project and LOFT Senior Supportive Housing in Toronto, Ontario; SHIP - Supportive Housing in Peel, Ontario; and Assisted Living Services for High-Risk Seniors run by the government of Ontario.
The model of integrated care for mental health service in later life described above is currently just a proposed conceptual model without any evidence-based research. Suffice it to say that it has rarely been attained in its fullest form.
Creating such a customized model for the rising number of seniors with mental illness in Calgary with a harm reduction perspective is hopefully oriented to succeed.