Retirement villages and mental health


Dr Grant Blashki

Hi there, Grant Blashki here, I'm Lead Clinical Advisor at Beyond Blue. And it's my real privilege to speak to you today on the topic of mental health, and how this is impacting on retirement villages, both for the workforce and also for the residents. I work as a GP and I know how important the work that you do in the retirement villages is.

You really contribute an enormous amount to the quality of life of the residence. And as you'll hear, their mental wellbeing is really a key aspect of their quality of life. And there's so much that you can do. Just before we go on, I would like to acknowledge the traditional owners of the land, which we're meeting on obviously, in different places, I pay my respects to their elders past and present, and Aboriginal elders of any other communities who might be participating in this webinar today. So another thing that I'd like to remind you before we start is as managers and staff in retirement villages, never feel that you have to be a psychologist, we're not asking you to be that. But I think to have a bit of knowledge about the common mental health issues, it's a good idea. And you can help your staff and colleagues and also be able to help your residence.

So we're covering a bit of territory today. What is mental health? We'll talk about anxiety, depression, the serious issue of suicide risk, what signs and symptoms to look out for, how mental health impacts on you and your staff in the workplace, how to develop a personal well being plan. And then we'll talk about some particular mental health issues for older people, some of the risk factors, some of the poor issues that suggest poor mental health, what you should do if you're concerned about someone, I really hope that this will assist you. So the first thing to say is, mental health is not one of those black and white things. It's not sort of like people are either mentally healthy or mentally ill. The truth is that there's a continuum and, and much more these days, we talk about mental health continuum. And this fits very much with the World Health Organisation definition of mental health. So the World Health Organisation says mental health is a state of well being in which the individual realises his or her own abilities, can cope with the normal stresses of life can work productively and fruitfully able to make a contribution to his or her community. Now, obviously, people in a retirement village, they may not be working in the strict sense, but being involved in hobbies or projects or things that they're excited about is really important. And so this mental health continuum, you know, up the reading, we have people in crisis. And as we move across our range, they might be struggling a bit yellow, just getting by. And once we get to the green, people who are thriving are really excelling in life. And I guess for all of us, at different times in our lives, we might sit in a different spot on this mental health continuum. So these mental health conditions, anxiety, depression, are very common. In fact, usually you just have to think about your broader family or friendship group. And you'll definitely know some people who've had some issues along the way. 

We know in any one year, around 2 million people in Australia are living with anxiety, around 1 million people are living with depression. And unfortunately, very sadly, on average, more than eight people in Australia each day, take their own lives. About six of these on average are men. So lots of work to do in this very important area. And if we look throughout people's lifetimes, many of us will have our will grapple with a mental health issue sometime during our lives. You know, one in three women and one in five men are likely to experience an anxiety condition at some time in their lives. And when we look at depression, about one in six women, and one in eight men, so this is not something that just happens to someone else. Very, very common, very part of the human experience and no doubt something that affects many of your residents and your some of your colleagues and staff members as well. So what are some of the things that we look out for with anxiety, anxiety conditions, First thing I should say is because of the way the language works, anxiety often gets very trivialised. People say, Oh, I'm a bit anxious that, you know, Richmond is not going to beat Hawthorn, or whatever it is. But actual anxiety conditions are really quite disabling and really give people a lot of grief and the sorts of problems that they have. They might manifest with behaviours, difficulty making decisions, poor concentration, quite a lot of people with anxiety conditions, what self medicate with alcohol. So I see that with a lot of my patients, you know, they've got a social event they're worried about they'll, they'll use alcohol to try and manage their their stress, feelings, this sort of sense of dread, feeling overwhelmed or worried that something bad's going to happen. And very often, in particular, as a GP, we really see this. People have physical symptoms, you know, muscle pains, chest pains, racing hearts, feeling very restless, and chattering the mind for people with anxiety conditions, we've all got that self talk that goes on in the background, but they often will be thinking things like, I think I'm going crazy. I'm very worried people are judging me. I can't control myself, so not much fun. And the thing with the anxiety conditions is it's really important for people to get proper help, because it's one of those areas that we're actually great at managing and we can really help people. Depression is another common mental health condition, it's worth having a bit of sense, what are some of the signs and symptoms, behavioural problems, I can concentrate can get things done at work, withdrawing, you know, might be not answering phone calls, not participating in social events. 

In a work setting, there might be people taking off lots of time and work. And again, relying on alcohol and drugs is common. feelings, pretty obvious here feeling pretty unhappy, and motivated, maybe indecisive, depressed, physical conditions, a lot of people present with more physical symptoms than the obvious psychological symptoms. So they might have stomach problems or trouble sleeping or feeling tired all the time. And again, the self talk that goes on with depression are things like, I'm a failure to my fault, nothing's going to get better. Life's not worth living these sort of things. So let's turn to the workplace for a minute, because I think health sectors and aged care settings, you know, there, they do put quite a lot of stress on the staff. And what we really aim to support at beyond blue are what we call mentally healthy workplaces. So there's some really practical things you can do to try and set up a mentally healthy workplace. And one of the things is, the leadership really sets the time. So being comfortable to talk about mental health conditions, even you know, as a leader, but enough to bear their soul, but be willing to talk about some of their own vulnerabilities, their own challenges. It just sets the tone of, Hey, this is a mentally healthy workplace. And remember, when someone goes off on stress, leave with mental health issues, it's not just that person who's having a hard time but other people are watching how are they treated by the organisation? You know, they marginalised and put aside are they supportive back to work? And remember, you know, one of the best things I say, as a GP helping people with mental health conditions, get back to work, it's one of the best things for their mental health as well. 

So here's a couple of reports, two groups of people we were asking them, what do they think a mentally healthy workplace looks like? One of the things that stressed them at work, what what would they like to see at work? So let's have a look at group one. So no surprises there, the things that stress people role clarity. Now, this is a really important one. So this is where you know the governance the way in which a organisation retirement villages run, so that people actually know what their job is. They know what they're supposed to do. They know what they don't have to do. They know what their workload is. These sorts of things give people a lot more security about what's going on. It's probably one of the best things you can do to reduce mental health problems. So people like to see good culture in their workplace, good leadership, and respect and commitment to the workplace, ongoing training, they sort of things, the other group pretty similar issues. What are the sorts of things that stress them at work poor communication was huge lack of training too many work hours, and the things that they value, a high communication flexibility. So you can get a bit of a sense of what a mentally healthy workplace can look like. Now, I'd like to talk here a bit about work hazards and protective factors. So when we think about hazards, if you think about physical injuries, let's take for example, back pain. And you're thinking about hazards, and you look at a desk and the chairs terrible, and the computers no good. And you think, wow, this is a train wreck waiting to happen, someone who's sitting at that desk all day is definitely going to injure their back. So we know about those sort of hazards. But we don't often focus as much on those sort of psychological hazards of a workplace. But of course, there are many, as some of those will relate to the individual, you know, are they overworked, and they unclear about the clarity of their role to have the skills to deliver what you're asking them to deliver? What's the organisation like? You know, is there good communication? Or is this a place where people really struggle to work out what's going on, is discrimination going on in that workplace? It's a sad fact. But you know, bullying, discrimination still goes on in many workplaces. And it really sets up people for running into mental health trouble. And then there are the occupational risks, so that there are some particular aspects of a job that can cause psychological problems. So it might be that you know, you're dealing with a lot of aggressive customers, or it might be that you're dealing with difficult residents, for example, or that you're out really far because of where the work location is. So there are aspects of the actual job. 

Now, on the other side, there are protective things. So being really clear with people about their role, giving them good job design, giving them flexibility, lots of training, trying to encourage the organisation to not just give lip service, but really embody those things like, you know, strong values of good culture, people feeling like discrimination is not tolerated. And that risks are identified and managed, and supporting people with some of the difficulties that they are managing in their actual job. So one device that we've developed with Beyond Blue, and you can find this on the Beyond Blue website, we actually have a sub work website on the Beyond Blue site called Heads Up. And you can download lots of things that are really useful for a mentally healthy workplace. But one of them I really want to tell you about was the personal well being plan. And it's a good idea to do this even just once a year. Right? There's a there's a template that you write down, why am I going to work? What do I like about my job? One of the things that actually caused me stress, what are some of my warning signs? One of the things I can do to actually look after myself? How can I engage others to help me? And who can I go to for support if I made some of that sounds quite obvious. But I guess putting aside a little bit of time might only be half an hour, just to focus on how you can look after your wellbeing in your job is a really worthwhile investment.

So let's talk a little bit about older Australians, keeping in mind the residents that you're often supporting in the retirement villages, what are some of the mental health issues that play out for them? What we do know first of all, when we look at the prevalence of mental health conditions, that 10 to 15% of older people do experience depression. Another 10% anxiety in residential aged care is really quite high rates of depression. 35%. And I think an important concept to keep in mind is that having depression and anxiety are not a normal part of ageing. So we do have a bit of ageism in the community, unfortunately, and some people will go well, they're old, that approach because they're depressed. They haven't got much going on in their life. And that's an attitude that we really need to challenge because we can pick out depression and anxiety early, we can manage it really well, to really improve people's quality of life.

So it is very important to be aware of these symptoms, not to ignore them. As I said, you don't need to be a psychologist. But even if you can pick up that someone's having a hard time, link them with someone that can help them. That can be a really valuable thing. You can do it. Some other risk factors in particular for older Australians, physical problems such as heart disease, stroke, Alzheimer's disease, chronic pain can be very exhausting, and mentally challenging thing for people to manage side effects from medication. Some of the medicines will cause depression or anxiety being admitted to a hospital is very stressful, and big changes in living arrangements. I'd add to that list that certainly, when this video is being made in 2020, that COVID has been a big pressure on older Australians. A lot of isolation, a lot of fear. And, you know, it's been a really tough time, separation from family and, and so these are things to be aware of. Other things that older people are often experiencing a lot of losses in their lives - it might be relationships, a sense of independence, working income, their self worth, and mobility being able to get around independently, social isolation can be a big problem. And note also that some of the anniversaries, it might be the anniversary of when they lost the partner, or, you know, some sort of anniversary like that can be a particularly hard time for them.

So just some ideas about the signs in older people have anxiety conditions, as I mentioned, it can be anything along the spectrum, from physical complaints. So obviously, with an older person, it's important they go along to a GP, check there's not a physical cause that might be causing a heart rate to go up or feeling faint, that needs to be checked properly. But they it can manifest with a lot of physical symptoms, this is something we try and sort out often as GPs. Feeling overwhelmed, self talk, very anxious, and behaviours, again, withdrawing from participation. Similarly, with depression, the physical feeling thinking and behaviour changes, you can have a look at some of these. But I think I've focused particularly on withdrawal, slowing down neglect of self care, in our lack of grooming, people really looking like they're not looking after themselves not getting proper meals, not paying attention to themselves, these sorts of things.

The first thing is to check on your pal, so you're going okay? And you might say something like, gee, it's been a pretty tough year. How are you going? Or you might make an observation, you might say, Listen, I've noticed you haven't been out of here, your apartment for two weeks is everything going? Okay? Or I've noticed that you were doing the garden there, and you seem to have let it go, is everything all right? So pick your time, but you might just open the conversation. If they're happy to talk, try not to interrupt you have to jump in with a solution.

Obviously be confidential about anything they talk to you about. And then what you can do is you can say, look, thanks a lot for telling me that maybe you could go and get some assistance. Now there's lots of places you can go for help. You could ring the beyondblue support service. So we've got a 24 hour phone line, you could call, you could get them to go along to their GP and you might not be aware but GPs can do this thing called a GP mental health plan. And then the person is entitled to Medicare subsidised consultations with with psychologists. That's pretty good! So there's quite a lot of services out there. But I think one of the best things you can do might be to just open the conversation, encourage them to go and speak to their GP or to give Beyond Blue a call.

So there's other things that you can do in the first place to sort of prevent mental health conditions. We know there's a lot we can do to build people's emotional wellbeing. Exercise, physical activity is fantastic, some form of relaxation. They might get involved in some hobbies, music, art, social activities. We know that people who are more socially connected, have better mental health and interestingly better physical health as well. Or they might be wanting to turn their mind to studying something new or learning a new skill.

So I think as managers and staff in retirement villages, there's so much you can do to help to bring people together, introducing residents to local activities in the area. Sometimes there's quite a few grants available for ongoing programs. And be aware in the in the background that you've got Beyond Blue. If you're worried about someone or encourage them to go along to the GP and do a mental health plan, so I wish you great success with your role in the retirement villages - you play a really important role in our community and help an enormous number of people and we wish you well.