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Chapter 8 Section H: Ageing and mental health conditions

8.H.1: Introduction

Australia’s population is ageing across all groups, including people living with mental health conditions. Increasingly policy makers are acknowledging the growing needs and numbers of older people living with mental health conditions in the community or aged care settings.

The two systems of health and age care are currently poorly integrated. Many older people with mental health and coexisting conditions do not have access to the support and care they need, when and where they need it. Pressure on services is apparent as the population ages and the number of older people with complex mental health conditions increases. This situation is often made more serious by the coexisting physical and cognitive impairments that people experience.

Poor mental health is not a normal part of ageing. However, older people can be more vulnerable to developing mental health conditions as they age, while others grow older with the ongoing exacerbation of mental health conditions that may have developed earlier in their lives.

For people who have struggled with mental health issues across the lifespan, negative social attitudes can increase their feelings of exclusion, poor self-esteem, helplessness and fear. Isolation and depression should not be associated with ageing, or normalised as a natural part of the ageing process. Nevertheless many people experience increased stigma and discrimination as they age.

Mental illness can also be hard to identify in older people, as symptoms may go unreported or physical conditions can overwhelm or mask existing or developing mental health issues.

Frequently, because of the complex mental and physical health needs older people experience, the care and treatment they are provided with is symptom focused. Older person’s psychosocial needs may be neglected in the context of the challenging coexisting difficulties they present with. Investigating the potential for complimentary medical and psychosocial recovery approaches generally tends not to be well promoted with older persons.

Many people with mental health conditions have, or continue to experience, trauma throughout their lives. For some people, trauma has occurred during childhood in the form of physical and emotional abuse or neglect, violence or other mistreatment. When trauma has continued into adulthood, either at home or whilst in mental health facilities or other institutions, the accumulative impacts may well lead to long term mental and physical health difficulties.

Amongst the many things that may re-traumatise a person who has lived experience of trauma, entering any institution such as an aged care facility can trigger past experiences and be re-victimising and retraumatising to an older person. Particularly, for people previously institutionalised and traumatised in residential mental health facilities, the distress, fear, horror and resistance to being ‘placed’ once more into residential care must be acknowledged and respected.

This chapter provides information about:

  • Mental health services for older people
  • Aged care services
  • Access to community services for older people
  • Age discrimination
  • Loneliness and mental health in older people
  • Elder abuse ; and
  • Legal assistance

8.H.2: Mental health services for Older People (OPMH)

In NSW, older people’s mental health services have been proactive in developing a recovery model for the care and treatment.

NSW Older People’s Mental Health (OPMH) services provide public specialist mental health clinical care generally to people aged 65 years and over, or Aboriginal people aged 50 years and older.

OPMH care for care for population groups with specific needs through:

  • multidisciplinary community services
  • acute and non-acute inpatient units/services; and
  • community OPMH partnership services, including residential aged care services, and programs.

OPMH services are delivered by different types of health professionals with skills and expertise in mental health problems affecting older people and frailty associated with old age. This includes specialist old-age psychiatrists, psychologists, nurses, occupational therapists, diversional therapists and social workers.

OPMH services include:

  • specialist mental health assessment
  • care planning
  • short and longer-term clinical management
  • referrals to other key services, health professionals and programs; and
  • collaborative activities to support early intervention and recovery for older people with mental health problems.

OPMH services are also tailored to certain population groups of older people with mental health problems who may have certain needs discussed throughout this chapter, including:

  • older Aboriginal people
  • older people living in rural and remote communities
  • older people from culturally and linguistically diverse backgrounds
  • residents of aged care facilities
  • older people with co-existing mental health and alcohol and other drug issues
  • older people with co-existing mental health problems and intellectual disabilit;
  • older people in the criminal justice system
  • older people who are homeless or at risk of homelessness
  • older people living in severe domestic squalor
  • older lesbian, gay, bisexual, transgender and intersex people; and
  • families and carers.

8.H.2.1: OPMH community-based services

OPMH Community Services are available in each local health district. They are an important part of OPMH services and are central to the provision of coordinated services to older people living with mental health conditions.

The Specialist Mental Health Services for Older People Community Model of Care Guideline (2017) defines how mental health community services for older people should be delivered, saying they should be:

  • person-centred
  • recovery-oriented
  • attentive to consumers’ bio-psychosocial needs; and
  • delivered in partnership with consumers, carers, general practitioners and other services and supports.

8.H.2.2: OPMH hospital-based services

Older people’s mental health hospital-based services include both acute inpatient and non-acute inpatient services.

H.2.2.1: OPMH inpatient services

OPMH provide inpatient services when the severity of a person’s mental health condition cannot be provided for in the community, for example either by themselves of with the care of their family.

OPMH will assess the person’s mental and behavioural status, including physical health issues and other broader social issues (such as risk of homelessness, Centrelink payments, etc.), and if necessary provide specialist care, treatment and rehabilitation in a hospital setting.

Inpatient services provide varying levels of care across the spectrum, with acute care for people presenting with very serious conditions to non-acute for people with less serious conditions. These services may be standalone facilities or units within inpatient mental health facilities or within acute care general hospital facilities.

It is an expectation that consumers of these services will improve enough for them to be discharged to a mainstream service or community setting, with additional support from a OPMH Community Service and other community services. Effective care coordination alongside residential and community services are important in ensuring the delivery of these services.

Transitional Behavioural Assessment and Intervention Service Units are short to medium stay transitional/non-acute inpatient units. They provide intensive behavioural assessment and intervention for older people with severe Behavioural and Psychological Symptoms of Dementia.

For more information about dementia, click here.

8.H.2.2.2: Community OPMH partnership services and programs

OPMH community services provide some support for older people with mental health conditions and/or severe and persistently challenging behaviours associated with dementia who live in residential aged care facilities (RACFs). They work in partnership with the aged care providers.

There are three kinds of mental health-residential aged care partnership services:

  • Specialist clinical outreach to generalist RACFs
  • Mental Health-Aged Care Partnership Initiative transition units, which are specialist 8-10 bed units within a larger RACF, with specialist mental health clinical support provided by OPMH services, and
  • Specialist RACFs with expertise of working with older people living with mental health conditions and complex needs, with clinical support by OPMH services.

OPMH has established partnerships with Catholic Healthcare, Mission Australia, Southern Cross Care, RSL Lifecare, Hammond Care and St Vincent de Paul.

These mental health-residential aged care partnership services will likely expand over the next 10 years under the NSW mental health reforms, which include the Pathways to Community Living Initiative and the NSW Older People’s Mental Health Service Plan.

For more information about dementia, click here.

8.H.3: Aged Care

It can be a big decision to move into residential aged care, and some people may experience a sense of loss. You have the right to visit a residential aged care facility before you enter one, and to ask questions about staffing, physical and mental health services, recreation available, etc. This information can help you make a decision when choosing an aged care facility or deciding to change aged care facilities.

The publications “10 Questions” suggest some questions you can ask about what your experience will be like, and appropriate responses. The questions have been written by nurses, doctors and experts with experience in aged care.

Some questions that you can ask about mental health include:

  • What support do you provide for mental health needs?
  • What activities do you provide?
  • Will I be able to move freely around the place?
  • Will my family and friends be involved in my care, and supported?
  • How I can keep links with my local community?

For more questions you can ask aged care facilities before you join them, click here.

8.H.3.1: My Aged Care

The My Aged Care/Care About website has been established by the Australian Government to help you navigate the aged care system. The website is part of the Australian Government’s aged care system, which have been designed to give people more choice, more control and easier access to a full range of aged care services.

Care About includes this website and a national contact centre. Together they can provide you with information on aged care for yourself, a family member, friend or someone you’re caring for.

The contact centre can be contacted by phone on 1800 826 508*.

If you need an Interpreter

If you speak a language other than English, you can phone the Translating and Interpreting Services (TIS) on 131 450. TIS covers more than 100 languages and is available 24 hours a day, seven (7) days a week, for the cost of a local call.

If you have a hearing or speech impairment?

People who are deaf or who have a hearing or speech impairment can contact the National Relay Service and ask them to call TIS for a language interpreter.

*Mobile phone calls to freecall numbers (numbers starting with 1800) and to local call numbers (numbers starting with 13 or 1300) are charged to the caller at the usual mobile rate.

8.H.4: Access to community services for older people with mental health conditions

Generally speaking, the disability and age care systems are separate and distinct service systems and each has its own eligibility criteria.

8.H.4.1: Access to the National Disability Insurance Scheme (NDIS)

The National Disability Insurance Scheme (NDIS) has specific age criteria which applies to people over sixty five (65) years of age. To become an NDIS participant, you must be under sixty five (65) years of age on the day you apply to access the Scheme. People over sixty five (65) will receive support from the aged care system. NDIS participants can choose to purchase supports from aged care providers.

Younger people in residential aged care often have complex support needs that bridge the aged care, disability, health, and housing and community services systems. Residential aged care is designed to provide accommodation, personal and nursing care for older people. However, residential aged care also supports people with high and complex care needs when alternative care is not available. If a person wishes to enter aged care they will required to undergo an assessment by an Aged Care Assessment Team (ACAT).

If you acquired your disability before the age of 65 (or were born with a disability), and are otherwise eligible, you are entitled to receive support from the NDIS.

People with disability who are existing recipients of disability services from the NDIS (or existing recipients of State and Territory disability support systems that are to be transferred to the NDIS) who turn 65 will continue to be eligible for disability-related support services through the NDIS; but will be expected to obtain supplementary age related supports from the aged care system, and may ultimately be required to transfer to the aged care system.

Aboriginal and Torres Strait Islanders with disability become eligible for aged related services at an earlier age than others. For example, Aboriginal and Torres Strait Islanders become eligible for age related Home Care Services at the age of 45 years, and the planning benchmark for Aboriginal and Torres Strait Islanders for Commonwealth age care assessment is 50 years rather than 70 years for the general population.

For more information about aged care services go to the ‘My Aged Care’ website.

To read more about the NDIS and older people follow this link

To read more about your rights and many other aspects of the NDIS, click here

8.H.4.2: Eligibility of older people for mental health services

Older people with mental health conditions are eligible for mental health services on the same basis as other people, whether these are provided by the public sector, the private sector (including through General Practitioner referrals) or through the non-government community based-services sector.

Refusing to provide an older person with access to a service they require, because of their age, is likely to constitute unlawful age discrimination under NSW and Commonwealth law. Of course, it would not be unlawful discrimination for an older person with a mental health condition to be refused access to a mental health service designed for a specific population group, such as young people. Similarly, there are some services and programs that are specifically designed for older people with mental health conditions, and the fact that there are age criteria for access to these services would be unlikely to constitute age discrimination.

For more information about what to do if you, or someone you know with a mental health condition experiences age discrimination click here

8.H.4.3: Mental health not-for-profits

The following not-for-profit organisations mental health organisations have information about mental health and older people:

  • SANE is a not-for-profit organisation and they have released a guide to planning ahead for older people who live with mental health conditions, family and friends. This resource is available from their website.
  • Beyond Blue notes that depression is common throughout the Australian population, and older people are more likely to experience contributing factors such as physical illness or personal loss. For more information, click here.
  • Telecross: a free, daily phone call service provided by Red Cross to check on someone’s well-being when they live alone. The service is available for people who are frail and aged, have a disability, housebound and/or recovering from an illness or accident. If the volunteer call goes unanswered one day, Red Cross will take action to check the person’s wellbeing. To access this service, call the Red Cross on 1300 885 698* or use this contact form.

*Mobile phone calls to freecall numbers (numbers starting with 1800) and to local call numbers (numbers starting with 1300) are charged to the caller at the usual mobile rate.

8.H.5: Age Discrimination and people living with mental health conditions

Older people living with mental health conditions may experience discrimination on the basis of their age or disability, or both. Such discrimination is unlawful in certain areas of life, including in relation to access to goods, services and facilities, employment, education, and clubs and associations.

Age discrimination can happen where someone is treated unfairly because of their age. For example, it is generally against the law for an employer not to employ a qualified person for a job just because of their age.
It is unlawful to treat people less favourably than another person because of their age in areas such as employment, education, accommodation, the provision of goods and services and the administration of Commonwealth laws and programs.

However, it may not be unlawful to provide a benefit to a particular age group to meet a specific need due to their age. For example, it is not unlawful to provide concessions to older Australians for use of certain services.
For more information about disability discrimination, including what to do if you or someone you know with mental illness experiences discrimination, click here.

8.H.5.1: Complaining about age discrimination

If you think you have been discriminated in education because of your age, you can complain to one of the following organisations:

These bodies both investigate and try to resolve complaints of discrimination including education discrimination. Both have complaints forms available online.

Complaints to the ADB should be made within twelve (12) months of the actions that you believe were unlawful discrimination. Complaints to the AHRC should be made six (6) months of the actions that you believe were unlawful discrimination. You should ask the ADB or AHRC for more information about the time limit that applies for your specific complaint.

The Australian Human Rights Commission can be contacted by:

Phone: 1300 656 419*
(02) 9284 9888
Email: complaintsinfo@humanrights.gov.au
Teletypewriter (TTY): 1800 620 241 (freecall*)
Fax: (02) 9284 9611

Click here for the Commission’s Online complaint form.

For more about the Australian Human Rights Commission’s processes and what happens with discrimination complaints made to the Commission, click here.

Anti-Discrimination NSW can be contacted by:

Sydney office
Postal address: PO Box A2122
SYDNEY SOUTH NSW 1235
Street address: Level 4, 175 Castlereagh Street
SYDNEY NSW 2000
Telephone: (02) 9268 5544
Freecall: 1800 670 812* (for rural and regional NSW only)
Teletypewriter (TTY): (02) 9268 5522
Fax: (02) 9268 5500
E-mail: adbcontact@agd.nsw.gov.au
Website: www.lawlink.nsw.gov.au

Wollongong office
Postal address: PO Box 67
WOLLONGONG NSW 2520
Street address: 84 Crown Street
WOLLONGONG NSW 2500
Telephone: (02) 4267 6200
Freecall: 1800 670 812* (for rural and regional NSW only)
Teletypewriter (TTY): (02) 4267 6267
Fax: (02) 4267 6261

Parramatta office
Street address: Street address: Level 7, 10 Valentine Avenue,
Parramatta, NSW, 2150
Telephone: (02) 9268 5555
Freecall: 1800 670 812* (only within NSW)
Fax: (02) 9268 5500

Click here to go where you can download the Board’s complaint form.

For more about the Anti-Discrimination Board’s processes and what happens with discrimination complaints made to the Board, click here.

If you think you have been discriminated against, you should get legal advice. You can get free legal advice about discrimination from several places. Click here to find out more.

*Mobile phone calls to freecall numbers (numbers starting with 1800) and to local call numbers (numbers starting with 1300) are charged to the caller at the usual mobile rate.

8.H.6: Loneliness and mental health in older people

Loneliness is a distressing feeling of isolation, or the subjective feeling of not receiving as much emotional support and companionship as you feel you need. Loneliness is not the same as being alone.
Research shows that loneliness is common in developed countries, including Australia. Research shows that people over the age of sixty-five (65) may be more likely to experience loneliness.

Loneliness is associated significant negative impacts on mental health, including feelings of depression and hopelessness, self-harm, anxiety regarding social interactions, less enjoyment of relationships, reduced resilience to address daily problems and decreased confidence.

Loneliness has also been shown to be associated with poorer physical health, including more physical health difficulties, poor judgement about health decisions and behaviours, quicker cognitive decline and increased risk of dementia.

Australian government initiatives to address loneliness include:

  • Social Inclusion Agenda, which includes learning, working or otherwise engaged (socially)
  • Funding and support to local councils and community organisations for different programs
  • National Community Visitors Scheme for people in aged care facilities
  • improving participation in volunteering.

Psychologists have found that the following ways to address loneliness:

  • improving social skills;
  • increasing social support;
  • more opportunities for social contact; and
  • addressing unhelpful thoughts about socialising (i.e. with a psychologist) – lonely people may be more attuned to negative points of social interactions, be on the lookout for social threats/potentially embarrassing situations, ruminating on negative social interactions and feeling discouraged from trying again

If you are experiencing loneliness, you can contact the following mental health not-for-profit organisations for more information and assistance, click here.

8.H.7: Elder Abuse

Elder abuse is any behaviour in a relationship where there is an expectation of trust which causes harm or distress to an older person. This harm could be caused by people you trust, such as a spouse, partner or family member, a friend or neighbour, or people you rely on for services. Abuse can be financial, physical, psychological, sexual, spiritual or facilitated by technology. Denial of access to medical care would be considered elder abuse.
Some examples of financial abuse, include:

  • Someone who is your Enduring Power of Attorney (EPOA) failing to act in your best interest. It could mean the EPOA is using your money for their own benefit. To find out more about EPOAs, click here.
  • Family members or other trusted people may financially abuse you by pressuring you into giving or guaranteeing a loan or signing over property without allowing you to obtain independent legal and financial advice.
  • Granny flat arrangements can sometimes lead to financial abuse, especially when they are entered into without legal advice and proper documentation (for example, where you contributed financially but your name is not on the title).

Abuse can often go unnoticed by outsiders and even other family members, especially if you are becoming frail or declining mentally.

Some people experiencing elder abuse can find it very difficult to report a family member, especially if that person is their child and they feel responsible for their child’s behaviour.

If you or anyone you know are currently feeling unsafe, it is best to call the police on 000 for immediate assistance. If it not urgent and you believe you may be experiencing elder abuse, please contact one of the organisations listed here.

8.H.8: Legal assistance

The following organisations provide assistance to older people:

  • Ageing and Disability Abuse Helpline is free and confidential service that provides information, advice and referral for people who experience, witness or suspect the abuse of older people. Call the Elder Abuse Helpline on 1800 628 221*.
  • Senior Rights Service is a community organisation that provides free and confidential telephone advice, aged care advocacy and support, legal advice and rights-based education forums to seniors in NSW. They also provide legal advice on retirement village tenancy. Call 1800 424 079* from 8:00am to 8:00pm Monday to Friday, or 8:00am to 2:00pm on Saturday
  • Older Persons Advocacy Network is a community organisation that provides independent information, education and advocacy for issues that may arise in aged care, including elder abuse. They do not provide legal advice. Call them on 1800 237 981*, 6:00am – 10:00pm, seven (7) days a week; and
  • Elder Abuse Service, Legal Aid NSW provides legal services to people living on the Central Coast aged over sixty five (65) years (or aged over 50 if Aboriginal) and is at risk of or experiencing elder abuse. Call on 02 4324 5611 from 9:00am to 5:00pm Monday to Friday, or email: elderservice@legalaid.nsw.gov.au

*Mobile phone calls to freecall numbers (numbers starting with 1800) and to local call numbers (numbers starting with 13 or 1300) are charged to the caller at the usual mobile rate.

8.H.8.1: Wills, Power of Attorney and Guardianship

There are several ways you can plan ahead to ensure your values, beliefs and preferences are made known and guide decision-making at a future time when you cannot make or communicate your decisions. For example, you may want to make legal arrangements such as a Will, Power of Attorney and Enduring Guardianship.

A Will is a legal document that sets out how you want the things you own to be distributed when you die. It can include your jewellery, or other objects that are important to you, money and property. If you die without a Will (intestate), your estate will be given away according to a pre-determined formula, with certain family members receiving a defined percentage of your assets even if this is different to what you wanted.

A Power of Attorney is a legal document appointing a person or organisation of your choice, to manage your financial and legal affairs while you are alive. You must be over eighteen (18) years aged and have the capacity to understand the nature and effect of the appointment to appoint an attorney. For information about Financial management and Power of Attorney, click here.

An Enduring Guardian can make decisions for you in areas such as accommodation, health and services, if you lose the capacity to make your own decisions at some time in the future. An Enduring Guardian cannot make decisions about your money or assets. You can make an Enduring Power of Attorney to appoint someone to manage your financial affairs. For information about Guardianship, click here.

It is recommended that you consider these issues at an early stage and while you are able to make decisions (have capacity). If you do not have planning ahead documents prepared when they are required, a court or tribunal may need to appoint someone to make decisions for you. The opportunity to choose who you would like to act on your behalf will be lost.

For more information about these documents, click here. Factsheets are available in a number of languages.

Updated July 20, 2020