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Mental health in rural communities: Supporting the needs of adults 50 and over

Mental health in rural communities: Supporting the needs of adults 50 and over

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Mental health in rural communities: Supporting the needs of adults 50 and over

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  1. Mental health in rural communities: Supporting the needs of adults 50 and over Rural Health Services Research Symposium May 18, 2017 Nelly D. Oelke School of Nursing UBC Okanagan

  2. Acknowledgement of Funders • Canadian Institutes for Health Research • Irving K. Barber School of Arts and Sciences, UBCO • South Okanagan Similkameen Research Foundation

  3. Background—Mental health • Cost estimates are $51 billion per year • Mental health is a major concern for Canadians—1 in 5 individuals will have a mental health concern • Stigma continues to be a major concern

  4. Background—Rural • Rural communities face unique social and environmental challenges • Older populations—out migration/in-migration • Lower SES and education levels • Higher rates of chronic physical disease • May have higher rates of mental illness • Decreased access to health care services • High turnover rates in health care providers • Geographic isolation

  5. Background—Adults 50 and over • Mental health for older adults increasing • Over 20% of seniors in Canada report having a mental health concern • Impacted by life changes (e.g., retirement, relocation, death of partner or friends) • Individuals with chronic disease, particularly seniors, are at risk for mental health issues • Less than 50% of older adults receive treatment for their mental health concerns • Mental health is not well addressed in older adults nor in rural communities

  6. South Okanagan and Similkameen Map: Elections Canada, n.d. Available from: http://www.elections.ca/res/cir/maps/mapprov.asp?map=59026&lang=e

  7. Consultations Community Members 50 years+ • Mental health concerns • Osoyoos, Oliver, Okanagan Falls, Keremeos, Hedley, and Princeton Organization Representatives • Provide services and supports for adults 50+

  8. Results • Access to services • Transportation, wait lists • Capacity/perceived lack of services and supports • Limited services and providers • Lack of collaboration among organizations providing services/supports • Poverty • Housing, income, lack of employment, and balancing needs and finances • Stigma • Gender differences, potentially higher in rural communities, and isolation • Purpose and meaning in life • Lack of being cognitively challenged, lack of value, and isolation from family • Community needs • Increased hours, social connection, and life skills

  9. Research Planning Meeting • Two key priority questions identified: • What are best practices for integrated community-based mental health services and supports for rural communities? • What is the current state of interagency collaboration and how do we build on current capacities to provide integrated mental health services and supports for this community?

  10. Understanding Collaboration through Social Network Analysis • 6 focus groups conducted with organization representatives to create netmaps of their connections with individuals/organizations • 15 people participated with over 200 connections to different individuals and organizations • Some individuals/organizations highly connected; others not • Preliminary analysis: • Fragmentation • Service delivery by not-for-profits • Specialization of services • Information sharing • Continuity of care

  11. Best practices review of rural community-based mental health services for adults 50+ • Medline, CINAHL, PsychInfo, and Systematic Revs • 1124 abstracts • Duplicates removed = 669 • 49 articles met inclusion criteria • Quality ratings • Data extraction

  12. Preliminary Analysis

  13. Next steps • SNA • SNA analysis and share results in community meetings • Best Practices Review • Complete integrative review analysis • Conduct interviews with exemplars • Community meetings • Goal is to co-create a model of care that can be tested • Population-based survey • Photo voice study

  14. Conclusions • Mental health is a major concern for this population • Hidden • Many gaps in services and supports • Underserved • Lack of community-based services and supports • Providers were also not well integrated • Increased awareness needed • Stigma • Support access • Innovative approaches • Informed by local perspectives • Unique to rural community • Effective allocation of valuable resources

  15. Questions? For more information please contact: nelly.oelke@ubc.ca

  16. References • Mental Health Commission of Canada. (2016). Mental Health Commission of Canada - Strategic Plan 2017-2022, Ottawa, ON. Retrieved September 24, 2016, from http://www.mentalhealthcommission.ca/sites/default/files/2016-06/mhcc_strategic_plan_2017_2022_eng.pdf. • Trautmann, S., Rehm, J., & Wittchen, H-U. (2016). The economic costs of mental disorders Do our societies react appropriately to the burden of mental disorders? EMBO reports. 17(9), 1245-1249. • Canadian Coalition for Seniors’ Mental Health. (2006). The CCSMH National Guidelines for Seniors' Mental Health Project. Retrieved May 17, 2016, from http://www.ccsmh.ca/en/natlGuidelines/initiative.cfm. • Bartsch, D. A. & Rodgers, V. K. (2009). Senior Reach Outcomes in Comparison With the Spokane Gatekeeper. Care Program Management Journals, 10(3), 82-88. DOI: 10.1891/1521-0987.10.3.82 • Van Citters, A. D. & Bartels, S. J. (2004). A Systematic Review of the Effectiveness of Community-Based Mental Health Outreach Services for Older Adults. Psychiatric Services, 55(11), 1237-1249. • Charney, D. S., Reynolds, C. F., III, & Lewis, L., Lebowitz, B. D., Sunderland, T., Alexopoulos, G. S., et al. (2003). Depression and Bipolar Support Alliance consensus statement on the unmet needs in diagnosis and treatment of mood disorders in late life. Archives of General Psychiatry, 60, 664-672. • Rauscher, A. B., Ardiles, P. & Griffin, S. (2013): Building mental health promotion capacity in health care: results from Phase I of a workforce development project, International Journal of Mental Health Promotion. doi:10.1080/14623730.2013.770320. • Healthy Aging and Wellness Working Group of the Federal/Provincial/Territorial (F/P/T) Committee of Officials (Seniors). (n.d.). Age-Friendly Rural and Remote Communities: A Guide. Retrieved May 17, 2016, from http://www.phac-aspc.gc.ca/seniors-aines/alt-formats/pdf/publications/public/healthy-sante/age_friendly_rural/AFRRC_en.pdf • Dandy, K. & Bollman, R. D. (2008). Seniors in Rural Canada. Rural and Small Town Canada Analysis Bulletin, 7(8), 1-56. Retrieved October 15, 2016, from http://www.statcan.gc.ca/pub/21-006-x/21-006-x2007008-eng.pdf.

  17. 10. Moazzami, B. (2015). Fewer & older: The population and demographic dilemma in rural British Columbia. Ottawa, ON: Government of Canada Strengthening Rural Canada Initiative. Retrieved October 14, 2016, from http://strengtheningruralcanada.ca/file/Fewer-Older-The-Population-and-Demographic-Dilemma-in-Rural-British-Columbia1.pdf. 11. Provincial Health Services Authority. (2016). BC Community Health Profiles. Retrieved October 1, 2016, from http://communityhealth.phsa.ca/HealthProfiles. 12. Hart, L. G., Larson, E., & Lishner, D. (2005). Rural Definitions for Health Policy and Research. American Journal of Public Health, 95(7), 1149-1155. 13. Wong, S. & Regan, S. (2009). Patient perspectives on primary health care in rural communities: effects of geography on access, continuity and efficiency. Rural and Remote Health 9, 1142. 14.Riva, M., Bambra, C., Curtis, S., & Gauvin, L. (2011). Collective resources or local social inequalities? Examining the social determinants of mental health in rural areas. Eur J Public Health. 21(2), 197-203. doi: 10.1093/eurpub/ckq064 15.Desmeules, M., Pong, R., Lagace, C., Heng, D. Manuel, D., Pitblado, R., et al. (2006). How Healthy Are Rural Canadians? An Assessment of Their Health Status and Health Determinants. Ottawa, ON: Canadian Institute for Health Information. 16.Zanjani, F., Kruger, T., Murray, D. (2012). Evaluation of the Mental Healthiness Aging Initiative: community program to promote awareness about mental health and aging issues. Community Ment Health J. 48(2), 193-201. doi: 10.1007/s10597-011-9373-1 17.Weinhold, I. & Gurtner, S. (2014). Understanding shortages of sufficient health care in rural areas. Health Policy. 118(2), 201-14. doi: 10.1016/j.healthpol.2014.07.018 • Aoun, S. & Johnson, L. (2002). Men’s Health Promotion by General Practitioners in a Workplace Setting. Australian Journal of Rural Health. 10(6), 268–272. doi: 10.1046/j.1440-1584.2002.00492.x • Goncalves. D. C., Coelho, C. M., & Byrne, G. J. (2014). The use of healthcare services for mental health problems by middle-aged and older adults. Archives of Gerontology and Geriatrics 59, 393–397. • Interior Health. (2013). Local Area Health Profile South Okanagan. Kelowna, BC: Author.