Reprinted from "Seniors' Mental Health" issue of Visions Journal, 2002, No. 15, p.43
A psychiatric geriatric emergency is an event with a psychiatric/behavioural component, involving an elderly individual, requiring a rapid response to ensure the safety of the individual and others, that can’t be managed initially in the current environment.1 The Geriatric Crisis Service exists to fill gaps in the emergency and crisis services to the psychogeriatric population through improved communication with the client and caregiver. This service was initiated in the late 1980s, operated seven days a week and was staffed by two nurses, one full-time and one part-time. The program expanded; now there are two full-time nurses.
The Geriatric Crisis Service provides support to frail seniors in psychiatric crisis and their formal and informal caregivers. This enables them to engage appropriately with community resources. The support provided includes emergency assessment; assistance with accessing hospitals if needed; links to community services; short-term follow-up; client advocacy; education of clients, family and facility staff; consultation and assistance from the mental health teams when available. This clientcentred service is offered with the least restrictive approach to care, driven by the principles of safety, expediency, and clear communication based on the values of respect and autonomy.
To decrease the time in which clients are in distress from a crisis through outreach support and/ or referral to appropriate resources.
To facilitate hospitalization and wherever possible, prevent hospitalization or decrease time spent in hospital.
To help sustain the well-being and highest level of functioning for our clients and their caregivers.
To act as a link between community resources which currently provide services to older adults.
The GCS is a unique program because it is positioned within the organization between Mental Health Emergency Services and the Geriatric Service. It specializes in offering service to a population of older adults presenting with a potential or existing psychogeriatric diagnosis, who are experiencing a crisis or emergency. The clients served are usually over the age of 65, with concurrent psychiatric and medical conditions. The average age of clients is around 85 years.
The Geriatric Crisis Nurses perform assessments at client homes, at care facilities and by telephone. Referrals come from geriatric mental health teams, police, physicians, care facilities, hospital emergencies, health units, Public Trustee, home support agencies, families, apartment managers, Seniors Well-Aware Programs, concerned friends and neighbours. Referrals are made to mental health teams, health units, mental health residential service, Venture, family doctors, and hospitals.
About the authorDiane is one of two nurses that work with the Geriatric Mental Health Emergency Services team of Vancouver Community Mental Health Services. She works with her colleague Terry Doherty
Romilly, L. (1995). The report on geriatric mental health emergencies: A review of emergency services for the Vancouver/ Richmond psychogeriatric population. Romilly Enterprises, p. 3