Lilian Thorpe MD, PhD, FRCP
Professor of Psychiatry and Community Health & Epidemiology, University of Saskatchewan
Saskatoon Health Region continues working on developing its seniors' mental health outreach services. We had initially chosen to prioritize our work on outreach to long-term care, and have collaborated with the behavioral support team in streamlining services. We meet weekly to discuss referrals to our service and have developed a standardized referral form. Our regular involvement with long-term care homes has been helpful in creating capacity to care for challenging seniors, who previously had the potential to have longer hospitalizations in acute care facilities, or access care in mental hospitals. Our collaboration with the behavioral support team has helped minimize duplication but also clarified ongoing issues about the admission of younger people to long-term care with the associated challenges this brings with it. The average age in our long-term care facilities has declined over time as we not only have less access to mental hospitals, but chronic care facilities for people with intellectual disabilities have also been closing.
We still do not have dedicated beds for seniors on general psychiatry, which poses a challenge to admission and appropriate care of frail seniors. There is much pressure to discharge frail seniors too quickly, when they still have very high care needs, which are difficult to meet in long-term care. Unfortunately, personal care homes are often too expensive for seniors, and also generally have difficulty managing those with behavioral difficulties. Mental health approved homes manage difficult behaviors better, but do not accept people with major medical problems. This leaves seniors with both physical and mental health issues in a difficult situation.
On a more positive note, we have just had a wonderful visit from Dr. Marie-France Rivard. She kindly donated a day to help us with program planning, teambuilding, and communication of our priorities to senior leadership. We all felt rejuvenated after her visit and have many interesting leads to follow.
We are very grateful to our colleagues in other centers who are helping provide tertiary training to residents of ours who wish to dedicate themselves to geriatric psychiatry. Dr. Marla Davidson is well known to most of you, and was able to spend time after her residency at Dalhousie University. She is now an important part of our clinical and academic team. Dr. Alanna Baillod has been able to spend time during her residency in both Ottawa and Halifax, and will be doing a PGY 6 year in Ottawa starting in July. Another University of Saskatchewan resident, Dr. Julia Kirkham, is currently in Kingston, and prior to that had a very rewarding experience with old-age psychiatry in Australia. We hope to see both Alanna and Julia join our clinical and academic team when their training is complete (but understand that they will have to move where their lives lead them!).