Complex mental health issues within in-home aged care

Findings from the Australian Institute of Health and Welfare (AIHW) show that, on average, 57.7% of all people aged 65 and over were recorded with a mental health condition on their aged care eligibility assessment or their residential aged care funding assessment. AIHW also found that mental distress and mental health conditions are common in late life, with men aged 85 years and older recording the highest age-specific suicide rate of any age group.

In addition to these figures, Silverchain Group has heard anecdotes from aged care workers about the challenges they face supporting older people with mental health conditions. The most common condition older people face is depression. Care workers have also noticed a rise in older people experiencing complex mental health conditions, including schizophrenia, drug and alcohol disorders, bipolar disorder,  and personality disorders. 

Silverchain Group also heard that many care workers feel unprepared or lack the skills and knowledge to effectively provide safe care to older people. To add to this, the Royal Commission into Aged Care Quality and Safety unearthed that the mental health needs of older people are not being adequately addressed across the sector. Further, the Commission recognised that most care workers are not sufficiently skilled or trained to identify and support people living with mental health conditions.

What does this mean for care workers in the aged care sector? Well, first, more training is needed to plug in these knowledge gaps. And second, a better understanding of complex mental health conditions should lead to more effective support for older people.
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How training can help

Addressing these workforce capability gaps requires targeted training that raises awareness of complex mental health conditions and teaches care workers what support looks like. However, it’s important that aged care workers receive the right kind of training.

Research indicates a gap in the market for community support mental health training, with the majority of online training being highly clinical and often targeting GPs, counsellors, or other mental health professionals. Aged care workers need training tailored to them and the unique nature of their role.

One example is our Mental Health Library, which provides practical strategies to recognise signs of mental distress, build resilience, and foster a supportive environment. Learners can even choose to complete training on specific conditions, such as PTSD, bipolar disorder, and schizophrenia—covering symptoms, warning signs/changes in behaviour, and how to provide support to each person’s unique needs and experiences.

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Deeper understanding = better support outcomes

Better support can come from increased understanding of what mental health may look like in older people, so that person-centred approaches are always taken.

A crucial part is understanding the differences between mental health, cognitive health, and general ageing conditions:
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• Mental health refers to emotional, psychological, and social wellbeing, with conditions such as depression, anxiety, bipolar disorder, schizophrenia, and substance use disorders falling into this category.
• Cognitive health relates to brain function, including memory, thinking, and reasoning. Dementia and delirium fall into this category.
• General ageing can involve more physiological changes, such as an “older” appearance or cardiovascular issues, e.g. higher blood pressure.

Let’s look at the three D’s: dementia, delirium, and depression. These three conditions can be independent or comorbid, meaning that a person may have only one of these conditions, or they may have all three. 
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• Dementia is a chronic, progressive, and usually irreversible condition, characterised by memory loss and cognitive decline.
• Delirium is usually a temporary condition that can be reversed by treating the underlying cause. It is characterised by a rapid onset, disorganised thinking, confusion, delusions and hallucinations, and sudden changes in mood.
• Depression is a condition that can be either temporary or chronic, usually characterised by a low or depressed mood, loss of interest or pleasure in usual activities, and apathy. It may or may not respond well to treatment, depending on the individual.

By recognising the differences in how we categorise health conditions and how they may overlap, aged care workers can provide safer, more effective, person-centred care.

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Moving forward

Supporting older people can be challenging; supporting older people with complex mental health conditions is even more so. But with the right training and support, aged care workers can confidently provide the care older people need, rather than having those needs overlooked or misunderstood.