Cuidigh Linn

Pobal

Mental Health Support Worker: a new role in the community.

Yohanca Diaz Skeete BSc ( Hons), RGN, MSc in Ageing, Health and Environment, Member of Cuidigh Linn Management Board.

The number of older people living independently at home is on the rise. In Ireland the number of people aged 65 and over increased in the period 2006 – 2011 and it is projected that this trend continues rising from 11 % in 2011 to 20 % by 2036 (Central Statistics Office 2006, 2011). Furthermore, Government policy in relation to older people is to support them to live in dignity and independence in their own homes and communities for as long as possible. This policy aspiration recognises that overwhelmingly people want to grow old in their own homes.  It also recognises the dominance of the medical model in Ireland and our over-reliance on in-patient rather than community-based care (Department of Health and Children, 2001).  Concerted efforts are now being made to promote active ageing, greater levels of independence and positive ageing, with an emphasis on increased participation. This key policy goes as far back as the “Care of the Aged Report” (1968) and has been reiterated in “Shaping a Healthier Future” (1994).

Background of the organization and the area where it operates
Cuidigh Linn it is funded by the Department of Social Protection through Pobal and it is a non-for-profit organization, supporting older people living at home providing free visitation / befriending service in the local area amongst other services.
”Health services often being least available to those needing them more” (Hannigan and Allen, 2011, p.4). MurheivnaMor it is an underserved, economically disadvantaged area where crime, unemployment and inadequate housing problems are evident. Many older adults live day by day with unmet health and social needs in this community. Fortunately some of these older adults can count on the support provided by Cuidigh Linn workers.

Identification of the issue
Lately, following referrals from other agencies and visits to some clients, Cuidigh Linn workers have been encountering older people with mental health problems, that hadn’t been identified by any other health professional working in the community setting.

Case study
Cuidigh Linn received a phone call from Dundalk Urban District Council with a referral. Mr X needed a new boiler fitted in his kitchen. Mr X is an older person living alone. Apparently Mr X had been piling up the rubbish in his kitchen floor for quite a while. The contractor refused to fit the boiler when he witnessed the inappropriate living conditions of Mr X. Cuidigh Linn workers carried out an extensive cleaning work and the boiler was fitted later. A referral to the Public Health Nurse and social worker with Mr X case was done. The case was then referred to the Social Worker who allocated some hours of home support to Mr X.
It is of interest to note that this is not an isolated case,Cuidigh Linn has received and continue to receive clients with unmet mental health needs.
Older adults’ perceived needs of diagnosis and treatment of mental ill health differs from those of younger people. Consequently they do not avail of mental health care services. Furthermore, depression and anxiety in older adults are often concomitant with chronic medical conditions leading to a further decline of their well-being and raising the costs of health services use (Garrido et al., 2011). Therefore it is vital to address the unmet health needs of this population in order to enhance their quality of life and reduce mental and health care services costs.

Solution to the problem
Cuidigh Linn workers have been trained in mental health, mental health promotion and mental first aid. They continue their free visitation scheme incorporating their gained knowledge along with mental health promotion in their visits to their clients.
It is a new initiative and the literature review carried out by the author revealed the lack of research around this role in Ireland, but other pilot projects using a community support worker had been evaluated in other countries, showing good outcomes for service users and empowerment for the worker ( Heket al., 2004), (Nixon et al., 2003).

Rationale for the need of this role in the community
Many community mental health nurses are stressed and burnout due to the type of work they do, the nature of the illness of their patients and an increased of the workload (Edwards et al., 2000). Furthermore the public health nurse workload has increased with the primary care teams established since 2007, having an impact on time that had been allocated before to health promotion ( Burke and O’Neill, n.d.).
Cuidigh Linn staff  initiative provides person centred care enabling the clients to make choices about their own care (Centre for Policy on Ageing, 2008) and a holistic approach moving away from the biomedical approach, taking into account the psychosocial, physical and spiritual needs of every individual.
Cuidigh Linn workers are trusted members of their community which it may have an increase on the uptake of the service. The professional language barriers will be inexistent as they are lay people, achieving good communication between them and the clients.
There is an element of patient – carer safety where by the community support worker have been trained and have the knowledge on how to deal with mental health crisis.
It is a cost effective initiative, the support workers will continue to carry on their activities for the same salary.
Lay health workers have been employed in Belfast to assist the health visiting and district nursing teams and they have been very well accepted by clients. “In poor and developing countries lay workers fill the gaps when healthcare professionals are inexistent” (Twinnet al., 1996, pp. 507 – 508).

 

Critique
If this initiative is implemented, mental health support workers should be linked in with the multi-disciplinary mental health team. Up to date, there is communication between them but a lack of team work. “Clarity of objectives, level of participation, commitment to quality and support for new ideas is associated with better mental health, job satisfaction and increased team effectiveness” ( Borrillet al., 2000b as in De Burca, 2010, p10.).
Some hostility could stemmed from the training that mental health support workers had received as other community worker could think that their role could be replace in the future by these workers ( Heket al., 2004, p.242.)

The path to follow
The Programme for Government 2011 (Universal Primary Care) Health Services support the idea of improving access to modern mental health services in the community and announced that annually will ring fence 35 million euros to develop community mental health teams.
On the other hand “A vision for change” reiterates directing mental health services into the community proposing a multi-disciplinary / holistic approach and inviting organisations in the community to take the lead with new initiatives as illustrated in fig. 1 below.
Figure 1.
Outcomes

  1. Older people living in the community will received holistic, person centred, multidisciplinary approach enhancing their quality of life and a better recovery.
  2. To raise awareness in the local community about mental health and less service users experiencing stigma and or discrimination due to their mental health problems.
  3. To reduce the utilisation of secondary services (cost effective initiative).
  4. Building team-work between mental health support workers and the multi-disciplinary mental health team and other organisations and agencies.
  5. Cuidigh Linn workers are raising the standards of the organisation and the standard of care for older people with mental health problems in the local community. There is an element of empowerment and knowledge gained through the process for staff.
  6. Moving away from old ways of care and embracing innovative ways of care in the community regarding mental health. This initiative could be proven best practice but it has to be implemented, assessed and evaluated.

The way to go
Capacity building is “The development of sustainable skills, structures, resources and commitment to health improvement to prolong and multiply health gains many times over” (NSW Health Department, 2001).
Mental health professionals and policy makers should be in favour of innovative ways of service delivery enhancing better outcomes and quality of life for service users in the community (Edwards et al.,2000), (Rhoades, 2000), (Waitzkinet al., 2011). Further research in the role of the mental health support worker and to what type of worker could most effectively provide care at home for older people with mental health problems it is paramount (Heket al.,2004).
Recommendation
Cuidigh Linn workers are providing an innovative service for older people in an underserved community. For all the reasons mentioned above, it is vital that this organization continues advocating and providing care for vulnerable older people.
References
Australia, NSW Health Department.(2001). A framework for building capacity to improve health.Gladesville: Better Health Centre.
Burke, t. and O’Neill, C. (n.d.). Community nurses working in piloted primary care teams: Irish Republic. British Journal of Community Nursing,Vol 15, No 8.
Central Statistics Office (2006) and (2011) [online] available: www.cso.ie   [accessed 21 October 2012].
Centre for Policy on Ageing (2008) available at www.cpa.org.uk accessed on 21 October 2012.
De Burca, S. (2010). Community mental health teams: Determinants of effectiveness in an Irish context.Summary Report, Health System Research Centre, Limerick, Ireland.
Edwards et al., (2000). Stress and burnout in community mental health nursing: a review of the literature. Journal of Psychiatric and Mental Health Nursing,Vol 7, pp. 7-14.
Heket al., (2004). Cross-boundary working: a generic worker for older people in the community.British Journal of Community Nursing, Vol 9, No 6.
Ireland, Department of Health and Children. (1994). “Shaping a healthier future”.  Dublin: Stationary Office.
Ireland, Department of Health and Children. (2001). Quality and fairness: a health system for you. Dublin: Stationery Office.
Ireland, Department of Health and Children. (2006). “A vision for change”: Report of the expert group on mental health policy. Dublin: Stationery office.Ireland, Department of Health and Children. (1994). “Shaping a healthier future”. Dublin: Stationery office.
National Council on Ageing and Older People. (1968). Care of the aged report, [online], available: http://www.ncaop.ie/publications  [accessed on 21, November, 2012].
Nixon et al., (2003). Managing mental health in primary care: a partnership approach. Primary Care Mental Health, Vol 1, No 81-8.
Programme for Government (2011) Health Section / Universal Primary Care page 7 available at ww.taoiseach.gov.ie/Home/Publications accessed on 21 October 2012.
Rhoades, D. (2000). The homeshare model: caring for individuals with serious mental illness. Journal of Mental Health Counselling.Vol 22, No 1, p.59.
Twinn et al., (1996). Community health care nursing: Principles for practice. Reed educational and professional publishing ltd, Oxford, United Kingdom.
Waitzkin et al., (2011).Promotoras as mental health practitioners in primary care: a multi-method study of an intervention to address contextual sources of depression. Journal Community Health, Vol 36, pp. 316-331.

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