Overall, issues of access relating to age were not commonly mentioned by stakeholders during the consultation process. Subsequently, this was explored more closely in the local consultations.
One issue identified by a few providers was the fact that nursing home residents are essentially excluded, as they are unable to visit the allied health professional for treatment. GPs can contribute to the management of mental health problems of nursing home residents under the EPC Team Care Arrangements: however, "given the complex care needs for such residents, the five allowable MBS allied health services per year are rarely (available to be) used for referral to mental health professionals."31
The Australian General Practice Network (AGPN) recommends that nursing home residents be made eligible for GP Mental Health Treatment Plans to promote access. This suggestion was also made by a small number of psychiatrists and GPs in the online survey. Another group of psychologist practitioners suggested that access could be improved by allocating ATAPs funding for use in nursing homes and for therapists visiting clients in their environment, rather than requiring the client to attend a clinic.32
A number of AHPs working with older people also identified the additional cost of providing in-home visits to older people and consultation with other services involved in care that was not reflected in the MBS item numbers. It was argued that enhanced funding is required for home visits and additional MBS items are required to cover care planning and case conferencing for AHPs, similar to EPC items available to GPs. AHPs working with older people tended to perceive themselves as part of a multi-disciplinary care team and indicated high levels of networking and integration with local aged care teams (e.g. Aged Care Assessment Teams - ACATs), primary care services, home nursing and home and community care (HACC).
The difficulty faced by nursing home residents in accessing mental health care can be considered in light of the large population of older people with significant depressive symptoms.33 AIHW reports from 2006-07 identify an estimated 1,071 mental health related encounters per 1,000 population for persons aged 65 years or more, which is "a much higher rate than any other age group".34
The need for outreach services for older people was also raised in respect to the frailty and/or limited mobility of many older people and for disorders such as phobias where exposure treatments are prescribed. AHPs and GPs discussing the needs of older people indicated that there was a strong evidence base for outreach services to the home environment for older people and that these interventions were effective.
31 Australian General Practice Network, "AGPN calls for Better Access to Mental Health for residents of nursing homes" (2008) Accessed 19 March 2009 from the AGPN website. p 1.
32 It is recommended that Component B of the evaluation: Analysis of Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) Administrative Data examine ATAPS and Better Outcome data to assess whether older people are accessing mental health service by alternative pathways.
33 Beyond Blue "Depression in the Elderly" Synergy No 2, 2004
34 AIHW (2008)