Tuesday, July 21, 2009

Groups with particular needs under the Mental Health Act - Older clients

Older clients: The NSW Mental Health Act 2007 contains no specific provisions for the care and treatment of older people, though psychological disorders occur and recur in older people as well. It may therefore be necessary to use the powers of the Act to involuntarily detain an older person or place them on a Community Order in certain circumstances. Older men, for example, have the highest rate of suicide in our community. Thus an older person with a depressive illness who is at risk of self-harm may require involuntary treatment. Persisting conditions (such as schizophrenia and bipolar affective disorder) also recur in older people. Conditions such as dementia and delirium, which occur more often in older than younger people, can cause difficulties in the application of the Mental Health Act. Illnesses causing dementia, such as Alzheimer's disease, are not recognised as "mental illnesses" as defined by the Mental Health Act. However, a person suffering from dementia may experience auditory hallucinations, delusions or a serious disorder of mood. This person then has symptoms that are recognised by the Act. If the person is at risk of "serious harm", they may come within the definition of a "mentally ill" person. In addition, the presence of several disorders and diseases at the same time is a common feature of illness in old age. The co-morbid presence of dementia and another mental illness does not preclude the use of the Mental Health Act. At the time of the initial assessment it may not be possible to know whether an older person is suffering from dementia, delirium or another mental illness (such as late onset schizophrenia). Urgent admission for assessment may be necessary and is possible on the basis that the person is a "mentally disordered" person. If the diagnosis subsequently is one of delirium or dementia alone, the Guardianship Act (if necessary) may be used. A clear understanding of the relationship between the Guardianship Act and the Mental Health Act is crucial for those persons working with older clients. There are many social and medical factors associated with old age that add to the complexity of diagnosis and effective treatment for this group. It is, therefore, particularly important that a thorough assessment be conducted in consultation with those who have expertise in this area. Specialised psychogeriatric services are available in the Wingecarribee (as in many areas of NSW), and the Aged Care Assessment Team (ACAT) is located at the Bowral Community Health Centre. One worker in the Bowral ACAT has the role of coordinating the assessment and treatment of older persons with mental health issues. Visiting Consultants are available for pre-arranged assessments in the community health centre or the older person's residence. The Bowral Mental Health Service works collaboratively with the Older Persons Mental Health initiative of NSW Health. In the next post the cultural issues of non-English speaking persons under the Mental Health Act will be described.

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