Nursing home residents denied GP mental health treatment plans and psychological therapy

Tens of thousands of elderly Australians are being denied effective public health treatments because they live in nursing homes, with experts labelling it a “disgrace” and “blatantly discriminatory”.

A Fairfax Media investigation has revealed the mental health of aged-care residents suffers as a result of widespread neglect that legal and health experts attribute in large part to a “ridiculous” Medicare rule.

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Former nurse Ronda Gordon

Under the rule almost all nursing home residents are denied GP mental health treatment plans and associated psychological therapies provided to other Australians under the Better Access Medicare program, because the government deems residents not to be patients “in the community”.

Despite extreme rates of mental illness in nursing homes – with about 82,000 of 176,000 residents estimated to suffer a mental illness (excluding dementia) or significant mental distress – the Turnbull government reaffirmed the regulatory exclusion late last year.

Ronda Gordon, who suffers from a non-progressive motor neurone disease, has been denied Medicare-funded psychology treatments because of a "discriminatory" regulation.
Ronda Gordon, who suffers from a non-progressive motor neurone disease, has been denied Medicare-funded psychology treatments because of a “discriminatory” regulation.CREDIT:BEN SEARCY

“Several thousand” additional older Australians were also being “denied … medically indicated treatments” for other mental illnesses.

When Fairfax Media contacted 20 randomly selected nursing homes to ask if they would fund a depressed resident’s treatment by a psychologist, all said they would not.

Dr Rod McKay of the NSW Institute of Psychiatry.
Dr Rod McKay of the NSW Institute of Psychiatry.CREDIT:JAMES BRICKWOOD

Royal Australian College of GPs president and University of Tasmania clinical professor Bastian Seidel agreed the denial of treatment was “systematic” because “the data is out there” and he called for the removal of the Medicare exclusion.

Researchers have found only about half of all residents with depression receive treatment of any kind, whether from psychologists or other clinicians, and that almost all of those are put on antidepressants by GPs, despite their use in the elderly being linked to serious adverse effects, including falls and fractures.

Illustration: Matt Golding
Illustration: Matt Golding

Stigmatising attitudes and ignorance about mental healthcare have also been found to be widespread among nursing home staff, with unpublished Swinburne University survey data suggesting staff commonly dismiss depressed residents as “attention seeking” and lack basic knowledge about mental illness.

While many residents arrive in homes with depression or other mental disorders, others struggle mentally due to challenges experienced in care, such as chronic pain, disabling and terminal medical conditions, progressive loss of brain function and the loss of social role and sense of identity.

“There are commonly acute adjustment disorders … [involving] bereavement, grief, loss,” said Adelaide older persons GP Johanna Kilmartin, who described the Medicare restriction as ridiculous.

“You lose your family home [for] … one tiny little room … so you’ve lost all your material possessions; you’ve lost your health, because that’s why you’ve moved in; often you’ve lost your spouse as well.

“This is when you need [psychological help] … [but] we’ve got the opposite”.

Nursing home resident Ronda Gordon, 87, from Adelaide, said psychological care would help her deal with having a crippling neuropathic condition and living surrounded by people with dementia.

“It’s very hard to lose your own personal management skills,” she said. “I have lost my independence.

“We still need all the care and attention that people who can walk in here [do].”

A spokesman for the Department of Health said while Commonwealth-funded residents – understood to be all or almost all aged-care residents – were not eligible for Better Access services, the government’s aged-care funding instrument “assesses residents’ care needs, including in relation to depression”.

He said approved homes were required to “facilitate … access” for residents to health practitioners of their choosing and gave as an example “arranging transport”.

But the dean and head of the University of South Australia’s law school Wendy Lacey slammed the “weasel words” of the Aged Care Act’s care “principles”, saying there was “a complete absence of any positive and mandatory legal obligation on the part of facilities to take proactive measures to promote mental health and wellbeing of their residents”.

There was “no legal obligation on the residential care provider to pay” for mental health services, and the “current exemptions” – arising from the Aged Care Act and Medicare regulation – were “a blatant denial of human rights involving discrimination on the basis of age and infirmity”.

Australian Catholic University senior research fellow Tanya Davison, whose research has found that half of all clinical cases of depression received no treatment of any kind, cited funding “that runs out very quickly” as among contributing factors to the “critically low” psychological therapy levels.


Out of the blue: Aged must get the best mental help

Chief executive of peak industry body Aged and Community Services Australia Patricia Sparrow said aged-care providers were “very conscious of the mental health needs of residents and work in partnership with other organisations to ensure the best quality care and services possible”.

She said it was “difficult for aged-care providers to access ongoing specialist services and support for residents with mental health needs” and that her organisation believed the government should make treatments “available to all Australians, including those older Australians living in residential aged care”.

While the government says its funding mechanism assesses depressed residents’ care needs, a Fairfax Media investigation has discovered the homes almost never pay for clinical mental health treatmentsand experts say the government has neither legally compelled nor adequately funded them to do so.

Audits by Sydney and Deakin universities have repeatedly found that fewer than 2 per cent of residents suffering depression have received psychological treatments, such as cognitive-behavioural therapy, that are clinically recommended for most depression experienced in the aged-care setting.

NSW Institute of Psychiatry director of psychiatry and mental health programs Rod McKay said residents were suffering “systemic neglect” underpinned by ageism, and the Medicare exclusion was “a blatantly discriminatory … disgrace”.

“I’d estimate conservatively that over 30,000 nursing home residents experiencing depression, for whom psychological therapy should be available as a first-line treatment option, are being denied access to psychologists and allied mental health professionals,” Dr McKay said.