Cognitive impairment in older people accessing public mental health services across Australia and New Zealand: Implications for clinical practice, workforce development and service provision.

Assessment and management of older people with cognitive impairment, especially those associated with psychiatric symptoms; are recognised as core capabilities of old age psychiatrists. Bi-national collections of HoNOS65+/HoNOS reveal that over 40% of older people entering public mental health services across Australia and New Zealand have a clinically significant rating on the HoNOS65+/HoNOS cognitive problem scale, with rates increasing with age, and significant regional variability. The high rates of cognitive impairment in these data reinforce the need for mental health clinicians working with older people to have the capability to assess people with cognitive impairment.

Trends in access to clinical mental healthcare by very old people in Australia since 'Better Access' commenced in 2006.

ObjectivesTo examine trends in access to mental healthcare by old and very old people since the commencement of Australia's Better Access Initiative in 2006.MethodsDescriptive analysis of changes in access by people aged 75-84 and over 85 using data analysed and published by the AIHW.ResultsSince the introduction of Better Access, rates of access to specialist inpatient and community mental healthcare have reduced for those aged 75 years and older.

What are the evidence bases for developing models of rehabilitation for older people with mental illness in Australia?

Objective: This paper updates clinicians and service leaders on evidence bases relevant to rehabilitation for older Australians with mental illness.

Methods: Narrative review of literature and relevant public domain data supported by reflections on NSW service development.

Results: There is a paucity of high-quality evidence regarding mental health rehabilitation in older people.

Implementing recovery-oriented practice in older people’s mental health services: the NSW experience.

Personal recovery is central to Australian mental health standards, but promoting recovery-oriented practice remains a wicked problem (ie complex, with definitions and appropriate interventions impacted upon by context and values), with limited evidence regarding effective implementation. This case study re-examines a statewide initiative to enhance recovery-oriented practice in older people's mental health services in New South Wales from the perspective of complex adaptive systems. The initiative consisted of three key strategies: (1) statewide collaborative leadership and practice resources; (2) locally determined and led improvement projects; and (3) evaluating, disseminating and sustaining initiative outcomes.

Opinion: psychiatry formal education courses have been lost in transition.

Objective: With reference to relevant literature, this article explores the impact of moving to a competency-based training programme upon psychiatry formal education courses (FECs).

Conclusions: In the context of major changes in psychiatry training, FECs have lost clarity of role, alignment and governance. Strategic decisions made with key stakeholders are required to continue to train psychiatrists best able to meet future community needs.

Older people's mental health in rural areas: Converting policy into service development, service access and a sustainable workforce.

This paper describes the older people's mental health workforce development, policy development and implementation process and quantifies the rural service delivery and access impacts over a 15-year period in New South Wales. It highlights the factors that are considered to be critical to successful rural service development such as commitment to funding parity, investment in strong local service leadership, and development of innovative, locally adapted rural service models. Building on these foundations, the Older People's Mental Health Program in New South Wales was able to address key challenges relating to service access in rural health and develop new, sustainable specialist older people's mental health service networks.

Review and update of the Health of the Nation Outcome Scales for Elderly People (HoNOS65+).

Aims and methodThe Health of the Nation Outcome Scales for Elderly People (HoNOS65+) has been used widely for 20 years, but has not been updated to reflect contemporary clinical practice. The Royal College of Psychiatrists convened an advisory board, with expertise from the UK, Australia and New Zealand, to propose amendments. The aim was to improve rater experience when using the HoNOS65+ glossary by removing ambiguity and inconsistency, rather than a more radical revision.

Survey of aged psychiatry services' support of older Australians with very severe, persistent behavioural symptoms of dementia.

Objective: To map the provision of community, acute, non-acute and residential care-based state-funded mental health services to older people with severe, persistent behavioural symptoms of dementia.

Methods: An electronic survey was completed in 2015 by senior representatives of aged persons' mental health services across Australia's six states.

Results: Jurisdictions varied widely in the number, geographic spread and make-up of aged persons' mental health community teams when adjusted for aged population; their number of acute and non-acute beds, and especially in the provision of specialist residential beds or partnerships with non-government providers.

The art and science of using routine outcome measurement in mental health benchmarking.

Objective: To report and critique the application of routine outcome measurement data when benchmarking Australian mental health services.

Method: The experience of the authors as participants and facilitators of benchmarking activities is augmented by a review of the literature regarding mental health benchmarking in Australia.

Results: Although the published literature is limited, in practice, routine outcome measures, in particular the Health of the National Outcomes Scales (HoNOS) family of measures, are used in a variety of benchmarking activities.

Reclaiming the best of the biopsychosocial model of mental health care and 'recovery' for older people through a 'person-centred' approach.

Aim: The 'biopsychosocial', 'person-centred care' (PCC) and 'recovery' models of care can be seen as distinct and competing paradigms. This paper proposes an integration of these valuable perspectives and suggestions for effective implementation in health services for the elderly.

Method: An overview of PCC and recovery models, and their application for older people with mental health problems, is provided.

Expensive detour or a way forward? The experience of routine outcome measurement in an aged care psychiatry service.

Objective: This paper describes and reflects upon the experience of a small, integrated aged care psychiatry service that has utilized the National Outcomes Casemix Collection (NOCC) routine outcome measurements within clinical practice, service management and evaluation. The goals of the NOCC initiative are reviewed in light of this experience.

Conclusion: Routine outcome measurement has the potential to significantly improve aged care psychiatric service delivery.