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Enhancing Access to Mental Health Care for Chinese Seniors: The Wellness Centre Approach

The Wellness Centre Model at Mount Sinai Hospital aims to improve mental health care access for Chinese seniors through culturally relevant programs in partnership with Hong Fook Mental Health Association. The initiative addresses barriers such as stigma, language differences, and reliance on family for detection of mental health issues. By integrating wellness concepts with traditional therapeutic methods, the Centre creates a destigmatizing environment. This program targets elderly individuals, caregivers, and families’ needs, promoting education, early intervention, and a continuum of culturally competent care.

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Enhancing Access to Mental Health Care for Chinese Seniors: The Wellness Centre Approach

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  1. Wellness CentreModel and Strategic Development Wellness Centre A Mount Sinai Hospital Community Program in partnership with Hong Fook Mental Health Association & Yee Hong Centre for Geriatric Care May 28, 2007 Joel Sadavoy & KC Chan

  2. Conflict of Interest Disclosure • At this point, we have no conflict of interest to disclose in relation to the subject matter of this presentation. Joel Sadavoy & KC Chan

  3. Background Joel Sadavoy & KC Chan

  4. Barriers in Accessing Mental Health Care: • Fears of stigmatization • Lack of knowledge about available resources • Culturally determined attempts to manage problems within the family • Language and Cultural barriers (Sadavoy J, Meier R, Ong AYM. Barriers to access to mental health services for ethnic seniors: the Toronto study. Can J Psychiatry 2004; 49: 192-199.) Joel Sadavoy & KC Chan

  5. Other Barriers: • Lack of alternatives and dominance of drug therapy may discourage members of ethnocultural group to access care (Li, Logan, Yee & Ng, 1999) • Perceptions of symptoms as somatic rather than psychiatric in origin (Ng, 1997; Li, Logan, Yee & Ng, 1999) • Difference in conceptions of mental health (Ng, 1997) • Long waiting list (Lai et.al, 2003; Health Quality Council, 2004) • Failure to detect MH problems by primary care physicians (Health Quality Council, 2004) Joel Sadavoy & KC Chan

  6. Barriers for Chinese Seniors • Transportation • Reliance on families in MH detection, choice of help-seeking and continuation of care • Fear of burden to family and children • Relatively low literacy and educational skills • Misinterpret MH problems as part of process of normal aging Joel Sadavoy & KC Chan

  7. The Use of the Wellness Model to engage the ethnocultural community to access care • Culturally relevant wellness concepts which are both familiar and acceptable to the target community • The Wellness concepts guiding the program closely fit the culturally derived determinants of mental health: • Mental health is closely allied to physical health and exercise • Self-help and the active pursuit of body-mind alternatives foster better mental health and relieve patients from possible stigma • Mental health must be pursued by individuals rather than purely relying on health services/professionals (to be continued) Joel Sadavoy & KC Chan

  8. The Use of the Wellness Model to engage the ethnocultural community to access care (continued) • Culturally relevant wellness programs and activities serve as the interface to a continuum of more individualized mental health services that incorporates conventional psychiatric care • Wellness activities and the environment of the Centre help to destigmatize the process of seeking mental health care Joel Sadavoy & KC Chan

  9. Philosophy • Health is a continuum ranging from optimal health to critically ill & severe functional impairment Wellness Tipping Point Illness/Deterioration Optimal Health Critically Ill & SevereF(x) impairment At risk / Sub-syndromal Early Phase of Illness Joel Sadavoy & KC Chan

  10. The Wellness Centre Philosophy • The Centre is a culturally-competent mental health access point for Chinese seniors and older adults to : • mainstream clinical care and assessment, complemented by non-conventional holistic care options • MH and wellness education that focus on culturally relevant determinants of health Joel Sadavoy & KC Chan

  11. The Wellness Centre Philosophy2 • Focus on early identification and intervention • Familiar, accessible, destigmatizing environment • community-based portal of entry • continuum of care including social & supportive services • clinical and educational outreach • family-orientation model • An academic program incorporating teaching clinical care, education and research Joel Sadavoy & KC Chan

  12. Target Population / Community • Chinese Community (GTA) • Elderly and Older Adults (55+) • Living in the community • Families and Caregivers in need of individualized emotional and educational support for the care of an elderly at home Joel Sadavoy & KC Chan

  13. The Centre’s Engagement Model • To facilitate access through enhancing engagement; the model includes built-in mechanisms to positively address or accommodate: • linguistic and cultural needs; staff bicultural, bilingual • conceptualization of determinants of mental health • individual readiness to accept psychiatric care and drug therapy • Interpretation of their own problems • Input on their own health and wellness needs Joel Sadavoy & KC Chan

  14. Scope of Services • Individualized Care • Assessment • Formulation • Therapeutic Intervention • Early Identification / Detection • Education • Wellness and MH • Health promotion Joel Sadavoy & KC Chan

  15. Early Identification /Detection • Improving access • Client-centered engagement taking into account client’s readiness to seek psychiatric care • Focusing on risk factors and stressors rather than the conventional emphasis on meeting diagnostic criteria • Identifying at risk or sub-syndromal population and motivating individuals to start intervention at early stage • Educating front-line staff and volunteers about early signs of Major MH disorders • Systematic MH screening for at-risk or isolated seniors (in process) Joel Sadavoy & KC Chan

  16. Culturally relevant health practices Healthy lifestyle Healthy diet / nutrition Health maintenance methods – exercise Self-help, coping mechanism, and chronic disease self management Alternative / holistic care (include TCM) Conventional medical care pharmacotherapy Psychotherapies /counselling Hospital/ institutional care Supportive care Care coordination The Centre’s Health and Wellness Strategies Joel Sadavoy & KC Chan

  17. Individualized Care – Assessment • Clinical Assessment • Symptoms / Mental Status / Cognitive Capacity • Diagnosis • Functional Assessment • ADL + IADL • Social / Interpersonal • Patient/family’s Perception of Problems and Situation • Evaluation of patient/family’s Beliefs and view of Possibilities Joel Sadavoy & KC Chan

  18. Individualized Care - Formulation • Analysis and incorporation of information from the Wellness/cultural and medical domains of assessment • Formulation shapes the intervention – defines the combination of strategies • Intervention will encompass patients’ agreed direction of wellness Joel Sadavoy & KC Chan

  19. Treatment Plan / Options No Treatment Referred Elsewhere Evidence-based Care + Perception/Belief-based Programs Evidence-based Care Perception/Belief-based Programs Individualized Care - Intervention Joel Sadavoy & KC Chan

  20. Partner 1 Outreach, Wellness Programs, Case mgmt, peer support, caregiver support/training, and Social club Collaborating Community Agency A Collaborating Community Agency B FP GP FP Dept. of Psychiatry, MSH Training,, Education and Research Collaborating Seniors Org. F (Host Agency) Wellness Centre (Assessment, Dx, Rx Consultation & Treatment) Collaborating Senior Org. C (Host Agency) Primary Care attached to WC GP FP FP Shared care & Referral Referral, Consultation & Follow-up Referral, Resource Backup, & Integrated service program FP Partner 2 Case mgmt, Caregiver support Collaborating Community Senior Service Agency E Collaborating Community Senior Service Agency D Joel Sadavoy & KC Chan

  21. Educational Outreach • Psychogeriatic Training and Consultation to front-line workers of community senior services agencies • may offer basic training to volunteers of Friendly Visiting programs – isolated seniors • Invited MH and Wellness Education for other senior organization/service agencies • Caregiver Workshop and group co-organized with Yee Hong Joel Sadavoy & KC Chan

  22. Outreach to At-risk Seniors • Clinical Outreach – Home-visits when necessary, feasible, and meeting clients’ need • Systematic MH screening for at-risk seniors (proposed research/feasibility study)– researchProposal completed (Yee Hong CD groups ) • may extend to clients of Supportive Housing Programs –frail and isolated seniors • may extend to other agencies at subsequent development phrase Joel Sadavoy & KC Chan

  23. Engagement with FPs • Collaborative Mental Health Care Network (CMHCN) established in December 2005 – 1st of its kind targeting FPs serving primarily the Chinese community • Mentored by Joel Sadavoy and Danny Yeung • 12 Chinese physicians registered • Meet regularly for consultation and training • > 1/3 of the doctors’ referrals from FPs from this CMCHN • Closely link with FPs affiliated with Yee Hong Medical Centre • Service brochures and introduction mailed to Chinese FPs • In future, if resources permit, more outreach to and engagement of FP will be done Joel Sadavoy & KC Chan

  24. Programs for Families and Caregivers • Individualized support to Families and Caregivers by WC or YH • Group and self-help support offered by YH • Supportive and wellness programs for families and caregivers can be offered by YH or WC or in collaboration Joel Sadavoy & KC Chan

  25. Partners’ Roles and Contributions • Co-ordinated Intake and Inquiry Response among partners (a template and working protocol was developed in 2005) • Yee Hong: • Referral Services • Family and Caregiver Support • Supportive Care and Wellness Programs • Outreach to isolated seniors • Hong Fook: • Peer Leader Training for seniors • Community MH education to elderly immigrants (in collaboration) Joel Sadavoy & KC Chan

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