What are mental health and wellbeing?
Mental health and wellbeing are important components of overall health. They impact how we feel, think, behave, respond to stress, and relate to others. Both mental health and wellbeing are determined by a combination of physical, psychological, emotional, social, and cultural factors such as being financially secure and having supportive relationships with others. [1, 2]
The term ‘mental health’ is often used to refer to the absence or presence of a mental health condition. Mental health conditions (also called mental disorders or mental illnesses) include disorders such as depression and anxiety. [3] While it is natural to feel low or sad at times, people with depression usually experience these feelings for longer and with greater intensity. [4] An anxiety disorder may be present when people have excessive feelings of anxiety or fear that impact their daily life. [5]
A strong sense of wellbeing contributes to good mental health. [6] Wellbeing is the condition of flourishing and thriving in life. It is associated with feelings of self-esteem, having control and a purpose in life, a sense of belonging, coping abilities and resilience. [6]
The mental health and wellbeing of older Australians
Mental health and wellbeing are important at all stages of life. [7] Generally, mental health conditions are less common in older adulthood than earlier in life. [8] However, there are certain factors which may increase the chances of experiencing mental health issues or lower feelings of wellbeing later in life. Older adults may experience major life events that impact their mental health, for example, physical illness, loss of a partner, or a change in their living arrangements. [3] Older people who are carers, people living with dementia, and those experiencing hospitalisations are particularly vulnerable to mental health conditions. [8] The impacts of grief can often resemble depression, and people may develop depression following a significant loss. [9] As older people are more likely to experience significant personal loss, they may be more likely to develop depression. In Australia, between 10 and 15 per cent of older adults have depression and approximately 10 per cent have anxiety overall. [3] The high rate of suicide in older Australian men is of particular concern [10], as is the large proportion of older adults experiencing a sense of loneliness. [11]
The mental health of people in Australian residential aged care
Mental health conditions are more common among people living in residential aged care than older people living in the community. [12] Recent research has reported that approximately 57 per cent of people living in residential aged care in Australia have at least one mental health condition. [13] Depression and anxiety are the most prevalent, with depression present in between 35 and 49 per cent [3, 8, 14], and anxiety in approximately 19 per cent of people living in residential aged care. [15] The co-existence of dementia and mental health conditions is also common, with clinically significant symptoms of depression in approximately 25 per cent of people living with dementia, and 14 per cent for anxiety. [16]
Access to mental health services for older Australians
There are several issues when it comes to the provision of and access to appropriate and effective mental health care for older Australians. [17] First, older adults are the age group least likely to seek out help for their mental health. [1] This may be due to the misconception that low mood or depression is a normal part of ageing [17] or due to a lack of mental health services specialising in care for older people. [18] However, untreated mental health conditions are associated with worsening overall health, more admissions to hospitals, and an earlier transition to residential aged care. [18]
Secondly, access to mental health services differs depending on the setting in which older people live. For those living at home, mental health services are accessible through a general practitioner and allied health services with a Medicare-subsidised Mental Health Treatment Plan. Until quite recently, however, access to these same services has been unavailable to those living in government-subsidised aged care facilities. [19] The rates of people living with dementia accessing mental health services from within this setting are even lower. [19]
Submissions to the Royal Commission into Aged Care Quality and Safety by mental health organisations suggest other reasons for the inadequate mental health care received by aged care residents. These include a lack of workforce training and expertise in detecting mental health problems [20, 21] and the need to encourage more mental health professionals to work with complex older adults, especially those with cognitive impairments. [20] Since the Royal Commission, the Commonwealth Government has provided short-term funding (four years only) to Australia’s Primary Health Networks so that they might commission mental health support services specifically for people living in residential aged care. The eligibility criteria for services were also expanded temporarily in 2020 in response to the COVID-19 crisis in aged care. [19]