Last week the Royal Commission into Aged Care published its interim report. It was a shocking wake-up call for us all, even for those of us with personal and professional experience of the problems in the sector.
In a damning foreword, it talks about the "cruel and harmful system" that must be changed. It says: "We have found that the aged care system fails to meet the needs of our older, often very vulnerable, citizens. It does not deliver uniformly safe and quality care for older people. It is unkind and uncaring towards them. In too many instances, it simply neglects them."
Imagine. Giving people powerful drugs so they don't annoy you.
At Mental Health Victoria we have particularly welcomed one of its urgent recommendations, one that we called for in our submission to the Royal Commission earlier this year. That is for action to stop the significant over-reliance on what is known as "chemical restraint" in aged care, the use of psychotropic medications to control behavior rather than to be part of a strong mental health treatment plan.
The Royal Commission said it had heard evidence of "widespread overprescribing, often without clear consent, of drugs which sedate residents, rendering them drowsy and unresponsive to visiting family and removing their ability to interact with people". The figures are devastating. It said research involving 150 residential aged care facilities found that 61 per cent of residents were regularly taking psychotropic agents.
Yet the Australian Government's Aged Care Clinical Advisory Panel estimated that psychotropic medication is only clearly justified in about 10 per cent of cases in which they are prescribed in residential aged care.
The Royal Commission quoted one witness as saying chemical restraint is used: "because there are not enough staff, and it is confronting and unsavoury to physically restrain people, people are often sedated so 'they're not annoying you'."
Imagine. Giving people powerful drugs so they don't annoy you. Sadly this points to just the tip of the iceberg for mental health issues in aged care, and we are hoping the Royal Commission will dig even deeper in the coming months as it works towards a final report and recommendations.
To that end we have urged it to hold a dedicated hearing in December to look exclusively at mental health issues, including that:
- men aged 85 and over have the highest suicide death rate in Australia - double the rate of teenagers
- around 15 per cent of older Australians have symptoms of depression and this rate increases to 50 per cent for people living in aged care facilities
- access to mental healthcare is severely rationed for aged care residents versus high use of "chemical restraint"
- aged care staff lack even the most basic mental health awareness training in their qualifications.
We hope it hears our call.
Next year is set to be the start of the most significant reforms to mental health at both state level and nationally since de-institutionalization in the 1990s. After years of advocacy from individuals, families and organisations, we are facing a perfect storm of reform with the convergence of the Victorian Royal Commission and Productivity Commission's inquiries into mental health and the Aged Care Royal Commission.
We are also facing the prospect of a new national partnership on mental health and suicide prevention between the states and the commonwealth in 2020. We need to make sure that all of this reform activity addresses the mental health needs of this very vulnerable group of older Australians living in aged care.
And it must meet the needs of older people living in rural and regional areas, where there are shortages of aged care places, mental health services and mental health professionals of all descriptions.
This week the Royal Commission into Aged Care held three days of hearings in Mudgee in regional New South Wales, gathering important insights into the aged care issues facing older people outside of metropolitan areas. We want to make sure that mental health care is as high on its agenda as the physical needs of residents.
While stigma and stereotypes may tell us otherwise, mental ill health is not a normal part of ageing, yet it is gravely common in residential aged care.
And while its report is shocking to read, we welcome the spotlight the Royal Commission has put on the need for profound changes in aged care in Australia - in all respects of care, including mental health.
Angus Clelland is chief executive of Mental Health Victoria