Transcript of OPtiMHise (South Eastern Sydney LHD) - YouTube
[Project title slide: OPtiMHise: Optimising the health and lifestyle factors of consumers accessing the Older People’s Mental Health Service | Dr Kate Mullin & Natalie Narunsky, South Eastern Sydney LHD]
Rod McKay: So, our next presentation is from South East Sydney. And it looks like Kate has drawn the short straw. Is that right?
Dr Kate Mullin: That's right.
Rod McKay: laughs] I'll hand over to you.
Kate Mullin: Here I am… Hello. My name's Kate Mullin and I'm one of the psychiatrists from Prince of Wales Hospital Older Persons Mental Health Team. And you're right – I did draw the short straw as the presenter today. I was nominated as the mouthpiece, but I do want to acknowledge that I did not do the bulk of the work for this project. So, I wanted to acknowledge just people from our team that are here today. So, Daniella, who's our incredible manager, and then we've also got Helen, our CNC [Clinical Nurse Consultant], and Natalie our OT at the back there. They did a lot of work on this project and also the rest of the Older Person's Mental Health Team. This project was run internally – we don't have any funding or declarations and we don't have any research partners in this project.
[Title slide 2]
Okay, so this is our project: the "OPtiMHize Project" to look at "Physical health care for Older People living with Mental Health Conditions." And you'll notice our clever use of OMPH in our title which I think is really one of the strengths of this project as well. That also wasn't my idea but very, very creative. Okay, so this project has origins as well – like many of the other projects – going back to the Physical Health Care Meeting in 2018 or 2019 when Helen, our CNC, and one of our previous OTs, Daniel Gately, were thinking about how we meet the needs of the physical health needs of our particular group of patients. Some of the kind of thoughts that they were having and that we've had since is really around some of the differences in older adults versus adults with mental health problems and whether there is any extra or unique things we should be doing in addition to what's happening for adult services. And certainly, within our kind of area we have some really strong programs around adult physical health – we have the KBIM Program. But really, we wanted to think about expanding that for the specific needs of older people.
Also, one of the other kind of strengths of our population is that almost 100% of the patients in the Older Person's Mental Health Service have a GP. And so, we also really wanted to think about not doubling up on the really good work that GPs are already doing, but also wanting to empower our patients to have their physical health needs met in the same way as people who are not living with mental illness and how we might take those two things into account.
[Slide 2: OPtiMHize: Community based project]
And that's really where this this project was born from and then obviously we wanted to meet the recommendations of this policy up here – the New South Wales Physical Health Care for People Living with Mental Illness (GL2021_006) – really good policy from 2021.
[Slide 3: OPtiMHize Project]
So, this is the project that we undertook. So, we wanted to [1] identify health and lifestyle issues impacting people over the age of 65 living with mental illness. Then we wanted to [2] develop a health screening questionnaire to [3] engage with consumers to complete that questionnaire and then to get feedback from them in real time about that questionnaire to allow us to change it and make it better going forward. Then we wanted to [4] provide consumers/carers with pathways to address any health issues that they identify in the questionnaire. And finally, more broadly we wanted to [5] increase awareness of the findings to our own Mental Health Service Physical Health Committee – so the service-wide committee. So really looking at that pathway along the bottom there – "Health promotion", "Health education" and then the formation of "Health pathways."
[Slide 4: OPtiMHize Project, 2. Identify health and lifestyle issues that impact people over the age of 65]
Okay so, step 1. Identifying the physical health issues. So, as I mentioned before [we] have this excellent document from the Ministry from 2021.
[Slide 5: Physical Health Flags OPMH* consumers]
And those [on slide] were the key issues that we…identified as particularly pertinent to older people. We wanted to make sure we considered those, but we also wanted to think more broadly around also being proactive. So, thinking about things like screening and the importance of that. So, we went to the Red Book for that from the RAGCP and then always keeping in mind our Equally Well National Consensus Statement in the background is a really key driving factor here.
[Slide 6: Physical Health – OPMH consumers]
The other thing we did is we thought clinically about what are the physical health issues that we see coming up with our patients? So, what are we dealing with day-to-day in our clinical practice? And these were some of the issues that were raised. You know, so, especially for us thinking about – as all of us do in older persons mental health – the crossover of kind of "organic" conditions and "organic" drivers for our presentations that can happen both at initial presentation but also along the course of a person's episode of care with Older Persons Mental Health. We also wanted to think about how we engage with both GPs but also other specialists that might be involved in our consumers' care and then also thinking about their physical health consequences of the mental health treatment. So, thinking beyond metabolics for older people. So, thinking about other side effects – anticholinergic side effects, electrolyte disturbances, etc. You can see them listed there [on screen].
[Slide 7: Targeted domains of physical health]
So, taking those things into account, we broke them down into kind of these domains. So, these were the domains that we were thinking about. So, we've got in the middle there all the routine things – so, our screening, health checks, vaccinations – and around the outside some of the more specific issues that we decided to address. It's hard to choose what to include. Obviously, there's lots of different things that we could include – this is what we decided to focus on for this one. We also decided to include in there kind of a question about social connectiveness as an important determinant of health in older people as well. So, we looked at that as well.
[Slide 8: OPtiMHize Project, 2. Develop a health screening questionnaire]
[Slide 9: Questionnaire – V1]
Okay so now we went away and developed this questionnaire, and this is what it looked like when we started it. And we delivered this questionnaire in a number of different ways. So, we either asked the person to fill it in themselves or it was assisted by a clinician or a medical student depending on the person's individual needs. And we got some feedback in real time – as we said we wanted – which was: "this questionnaire is really confusing" and "I can't understand it" and "which questions are we meant to do?" and "what are we not meant to do?" So, based on that feedback we changed it and we made it look more like this [refers to slide], which was a little bit easier to follow.
[Slide 10: Questionnaire – V2]
The other one: obviously very attractive because of the boxes and the green colouring, but hard for people to read. So, this one: much more simple and yeah, easier, a bit more user friendly – but obviously that's going to be a bit of a work in progress as well as we come around to reviewing this.
[Slide 11: OPtiMHize Project, 3. Engage with consumers to complete questionnaire and provide feedback for future design]
Okay, thirdly, we wanted to engage with consumers to complete the questionnaire and get feedback. So, as I mentioned, we already had some of that.
[Slide 12: Demographics]
We ended up doing this with 23 participants that were chosen really completely randomly in terms of who was next due for a review. So, people that were coming up for reviews with clinicians in a relatively short time period that we did this. Those were the other requirements listed there that you can see. So, they had to be active patients or consumers of the Older Person's Mental Health Service.
And these were the demographics of people that we included in our sample: here you can see about 2:1 ratio of males to females and around 2:1 ratio of people over the age of 75 to those under the age of 75. We have around 150 open encounters of community consumers, so this is only a small proportion of those and not necessarily representative. And we did also exclude people in residential aged care just for practical reasons really.
[Slide 13: What did we find?]
So, what did we find?
[Slide 14: Primary Care]
So, similar to the rest of our cohort, 100% of these people also did have a regular GP. There was around a 50% rate of polypharmacy – so, more than five medications – and five people said that they would like more information about their medications. We also left a section of our questionnaire open for people to comment on things that they would specifically like followed up and these were some of the issues that people raised when they were just asked about things they would specifically like to follow up with their GP. So, there's a list there [on slide].
[Slide 15: Physical health]
Okay, so we asked a question about physical fitness and so – linking in nicely to some of the other presentations – you can see that the majority of people – the largest proportion of people – said that they were "Not at all" happy with their physical fitness and that they would like to "improve" it. And then it goes on from there, as you can see, and only two consumers were "Very" satisfied with their physical fitness.
[Slide 16: Falls]
The rate of falls was high and worrying. So, 22 of the people we surveyed – or 5 out of 23 – had had a recent fall. So, this is an area we really want to focus on as part of our kind of moving forward – looking at interventions here. We know that the rate of falls is really high in older people generally and one in three people over 65 will have a fall. But you can see that the other kind of issue here is that 14 people "Declined attending a false prevention program". They said they weren't interested. So, that's also something for us to think about – how we market that.
[Slide 17: Pain]
Okay, next we asked about pain. 57% of the people surveyed were "experiencing pain." And you can see – just in the bottom corner there – that most of those people who were experiencing pain had a chronic or long-standing pain for over 12 months. And you can see the pain rating scale there when people rated their pain. So, something for us to think about in terms of partnerships. And also, that 62% of people were taking medication for pain. We didn't specify whether that was any medications with potentially very negative consequences, like opiates. We didn't specify that.
[Slide 18: Routine check ups]
Okay, and here is the rates – or lack of rates – of routine check-ups. So, you could see that over 70% of the consumers had not had a recent hearing check. Over 60% had not had a recent dental check and over 50% had not had a recent visual check. And obviously, we might also be thinking about the financial kind of limitations here because these – you know, especially dental check, is expensive.
[Slide 19: Vaccination / Screening]
And this was our results for vaccination and screening. So, this is the people that require screening – so, people that have not had screening – or people that require a vaccination. So, obviously there's one person who hasn't accepted the COVID vaccination. But you can see we did have a really – like I'm sure all of the services – really big push to support consumers (who wanted it) to access COVID vaccination, including our clinicians taking people to vaccination appointments if they need transport, etc. in the first two. But there's a little bit less when it comes to the fourth shot – or the second booster. You can also see low rates, or either low rates or low knowledge of rates, around the Pneumococcal and the Shingles vaccine. So, we were unsure if people definitely hadn't had it or if they just didn't know that they had had it. And then you can see the screening at the top there. So, those numbers are a bit less because, remember, only half – or eight – of the consumers were under the age of 74, which is the age of cut off for those screenings.
[Slide 20: My Aged Care Services]
Okay, and then we also, as I mentioned, wanted to include something around people's kind of social well-being and whether people felt they needed increased support in the community to improve their social engagement or to have help being more independent in the community. And we were thinking about ways of linking people into My Aged Care to support that. And so, a little over 20% of people said that they would be interested in having assistance from My Aged Care to remain independent and a little over 10% around having support for social engagement.
All right. So, what did we then do once we had completed that – saying that we wanted to be in partnership with consumers and GPs?
[Slide 21: email excerpt]
Well, we wrote back to the consumers and to the GPs, summarizing what they had identified as health needs that they would like addressed. And so, you can see the formats of the two different letters that we sent back there.
[Slide 22: Feedback]
And then we asked for feedback. So, we asked for feedback on the questionnaire that we did with consumers and then we asked for feedback from the GPs around the letter that we had sent. So, you can see we got feedback from one GP who said it was "not useful." So, unfortunately, fair enough. And then we did get feedback from consumers around if they felt the questionnaire was useful and actually, overwhelmingly, they did find it useful. So, that's positive. So, some comments were that they enjoyed speaking about this. However, some negatives were that spending all of this time asking answering these questions is taking away from my time to talk about my mental health. So, that's I think genuine and fair feedback in a time when you know access to clinicians is – you know we have to be a realistic – it is time limited. And it was a reasonably long questionnaire. So, that's the balance.
[Slide 23: OPtiMHize Project, 4. Provide consumers and carers with accessible pathways to address identified health issues]
Okay, and then looking at providing consumers and carers with pathways to address these identified issues. So, that's here.
[Slide 24: Promoting Pathways]
So, you'll see this excellent slide that was compiled by Natalie that looks at how we might go about breaking these things down and then trying to create a toolkit that we can use to provide necessary pieces of information and direction to consumers around how they could have these health needs met. Whether it might be with support from Older Person's Mental Health, from GP, from family, independently, from other involved providers – looking at how to direct people about where to go and how to find these things. So, this is you know really kind of great starting point for that – looking at what resources are out there and how we can make links for people to those. Because I think there are lots of different places available to get these needs met and linking our consumers up with those options, I think, is going to be really helpful.
[Slide 25: service and programs examples]
So, these are just some of the services and programs that are listed there that we would be thinking about.
[Slide 26: Stepping On with Recovery]
I mentioned before that falls – [we'll] be continuing to focus on that. We already do run through Older Person's Mental Health at Prince of Wales, A Stepping On program with Recovery. So, most of the Stepping On programs are run through Medical Services. This is run through the Mental Health Service and it's an incredibly popular program for people that agree to attend. Really great program in terms of looking at providing knowledge and information around falls prevention and practical steps for people to help reduce falls. So, we're going to be continuing to run this program and our next one starts on the 20th of October. I had lots of positive feedback around this from consumers.
[Slide 27: OPtiMHize Project, 5. Increase awareness of findings to MHS physical health committee]
Okay, and then finally we wanted to increase awareness back to our Mental Health Service. And so, we have to consider: okay, what are the key messages that we want to take back there?
[Slide 28: Key messages]
So, I guess firstly that older people are affected by both chronic medical conditions and the interplay of age-related conditions that includes, sensory impairment, functional impairment, increased adverse effects of medication and frailty. All of the consumers that participated in this identified at least one health concern that they felt hadn't been addressed or that they wanted to address. And we know that screening tools and provision of healthcare pathways can help address modifiable key physical health issues to empower consumers to enhance their overall wellbeing and quality of life.
Thanks.
[Applause. End]