A Northern Approach to Supporting Seniors with Mental Illness
Reprinted from "Seniors' Mental Health" issue of Visions Journal, 2002, No. 15, pp.39-40
Older adults with mental health problems face a life with many barriers and problems. Living in the northern half of the country adds extra challenges. The people who call northern BC home have a sense of isolation from the ease of southern climates and southern solutions. The term ‘pioneer’ describes northern seniors well (however they come to be here) as there is a shared identity of independence and self-reliance that runs deep in these hearts. Acquiring a mental health problem does not change this identity. The things that make northern pioneers stand apart from other seniors have shaped the services that Community Mental Health offers to them.
Mental illness in old age has many different faces, and consequently many different ways of assisting these people have evolved. The Elderly Services Team has targeted help to seniors with severe behavioural problems and to the caregiver systems of these seniors. While Alzheimer’s disease is commonly known, in our practice, it is one of the challenges that family doctors and long-term care facilities handle quite well. Our efforts are more needed for other situations.
Northerners across Canada have a tendency to drink harder and smoke more than people living in the south, and this leads us to strokes and the latelife effects of alcoholism and lung disease. Diabetes rates in the North are high. In addition, working in the bush and on the land is dangerous work, and head injuries are also common. Any of these factors can lead to brain damage and subsequent behaviours and thinking problems that make others shun the sufferer. We have come to think of older adults with this range of difficulties as ‘forgotten pioneers.’
Some of the common problems in serving seniors with mental health problems are that the health and social services designed for older adults do not take into account those with no families to assist them, or those whose thinking is poor but whose bodies are relatively healthy. Many of our clients fall into one or both of these groups. Mainstream housing services for seniors are scarce in our towns, and mental health services for younger adults concentrate on rehabilitation, not retirement.
Our clients over the years were having a hard time keeping a roof over their heads, food on the table and remembering when or how to take medicines. The finer points of their illnesses couldn’t even be worried about until these things were handled.
In the mid-1990s, our team spent innumerable hours negotiating on behalf of clients who had been evicted for disorderly conduct, drunkenness, or extreme poor hygiene. We even had a client who lost his housing, slept in a ditch, spent a few nights at a local men’s shelter and subsequently suffered from a delirium and died shortly thereafter.
Another set of challenges was that home support workers had been forbidden to socialize except in the most rudimentary fashion with clients, assisted shopping was seen as too time consuming, and unless being taken to a health service, transportation was not allowed. Consequently many of our clients were left lonely, disconnected from services, and due to the mental disorders could not organize their own shopping, banking or even meals at seniors centres.
Financial problems were possibly the biggest underlying factor in the loss of housing, poor nutrition, and poor connections with the community. Many of the clients were no longer able to organize themselves to pay the rent and purchase groceries. Even though most of these clients were only on basic pensions, they were ineligible for crisis grants from the province because their pension incomes were still higher than the provincial welfare rates.
One of the things we envied were the talents and services of Lee Perkins who worked at CMHA Prince George. She had developed a special set of skills to assist younger consumers. Through negotiation and firm fairness, she taught many young men and women the hard truths about living on small incomes. She also knew how to find resources and key people in organizations to give her clients all available opportunities. For a brief period, Lee worked on our team and taught us to put the bottom line and the creative mind together. While redeveloping her techniques, we learned how stabilizing income could be the key to housing, nutrition and enormous gains in health for cognitively-impaired seniors.
Because Prince George has the qualities of a small town in its connectedness and shared sense of community, Lee and our life skills staff, Maureen, Pat and Linda could turn their personal knowledge of resources into opportunities for our clients by working with service clubs, seniors centres and other community members to build a network of recreation, meal supports and social skill building, all of which enhances our other work. Mental health professionals are scarce resources in the North, and using this approach allows us to stretch our services much wider.
The most visible asset we have created to serve older adults with mental illnesses in Prince George is the supported housing program. Due to the amalgamations of services that took place in 1998, seniors housing became part of the health authority’s responsibilities. We lobbied and received permission to use one block of seniors’ subsidized housing specifically for our clients. This allowed us to cluster home supports, health services like medication administration and symptom monitoring, the social programs and individual financial management into an ‘assisted living’ model. This has led to gains for the 20 people who live there, but also for up to 30 more people we can continue to support in their own homes with the stabilization and enhancements we have learned to provide.
Because we didn’t believe we couldn’t, because we used everything we could find like a farmer uses baling wire, and because we have such a good time doing it, we now have an excellent community-based service which other seniors often ask to join, not being able to see the problems which used to cause these pioneers to be ‘forgotten.’