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Breakdown: Canada's mental-health crisis

When mental illness tarnishes your golden years

Members of an older generation struggle to overcome not only their own biases against seeking care for mental disorders, but the lack of services perpetuated by the 'therapeutic nihilism' of a health-care system that sees them as beyond saving. But on Vancouver Island, researchers and support workers are trying to rejuvenate geriatric psychiatry

From Wednesday's Globe and Mail

VICTORIA — When Laura Baldwin, three months pregnant, began washing clean household linen and fussily ironing what didn't need ironing, her husband, Barry, shrugged it off as the elation of pregnancy.

When she began running compulsively on the beach and couldn't sleep, she went to see her doctor. "He also said I was just excited," she recalls.

It was 1969 and Mrs. Baldwin was in fact heading into her first major experience with bipolar disorder. That first event would result in her being hauled into a mental institution by five burly men and heavily medicated to get her to sleep.

Now 73, she has endured 13 such episodes. Each one takes her longer to bounce back. And like many seniors with mental-health issues, she faces mounting challenges to get the care she needs.

Mrs. Baldwin is more likely to get adequate care for her diabetes than for her bipolar disorder, according to a new study by the Centre on Aging at the University of Victoria. The survey of caregivers and service agencies found fragmented and inflexible care for seniors with mental illness or addiction, and inequitable treatment, compared with other seniors' health problems.

Even if the services were there, Mrs. Baldwin's generation often carries a bias against seeking help for mental health.

"This is the first time I've heard her willing to talk about it," said her daughter, Karen Baldwin. "She was too ashamed."

Society has its share of prejudices, too. There are no major "runs for the cure" or gala fundraisers in this field. The very few health-care professionals who understand both geriatric and mental-health care are stretched thin.

"There is a stunning shortfall of specialized services," said Penny MacCourt, president of the B.C. Psychogeriatric Association, a group of nurses, doctors, psychiatrists and other professionals in the field. "This is a marginalized population."

Mrs. Baldwin lives an hour's drive from Victoria, a community well attuned to the needs of seniors. It has Canada's highest concentration of people 80 and older.

And it's a growing cohort. Within the next 10 years in B.C., there will be fewer school-age children than seniors, and Vancouver Island's retirement communities will be the destination for many.

But even here on Vancouver Island, programs and supports for the elderly are largely designed for cognitive impairment or physical frailty, not the complex needs of depression, bipolar disorder, schizophrenia or addictions.

Open a Victoria phonebook and out tumbles a multitude of services catering to the elderly.

There are social clubs and meal deliveries, a bereavement helpline and bathing programs. There's Dial-a-Daughter Solutions Ltd. to make up for distant children, and volunteers who offer cheering visits with a pet.

But finding services that cater to seniors with addictions or mental-health issues is harder. When UVic researchers went looking for them, they could find only five seniors' programs aimed at mental-health issues, and three for seniors' addictions.

There are roughly 130,000 seniors on Vancouver Island, and experts estimate 5 per cent will require care for acute depression or other psychiatric disorders.

Michael Cooper is the head of geriatric psychiatry for the Vancouver Island Health Authority. For the more populous south island region, his unit will get about 1,000 referrals each year for psychiatric disorders.

Others will get care from their family physicians. "And a significant number are not getting recognized and treated," he said. The group with Canada's highest suicide rate per capita is men over 80.

Dr. Cooper has a team of geriatric psychiatrists who attend all the complex-care nursing homes in Victoria to try to identify problems, especially depression. For seniors living on their own, such illnesses are harder to detect.

To reach out, Dr. Cooper enlists people in the community who work with seniors to help spot the signs of mental illness.

Once a month, he sits down in a room full of nurses, physiotherapists, social workers and others to discuss individual cases.

The program is still in its infancy but he'd like to expand it, to overcome the bias he sees in the medical profession against the older mental-health patient.

"I'd like to work with family physicians to overcome what I call therapeutic nihilism," he said. Many need to be persuaded that "we can do something for seniors with mental-health issues."

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In Breakdown, The Globe and Mail documents the enormous, unaddressed cost of mental illness to Canadian individuals, families and society. The series closes with a search for solutions.


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