setting new standards for mental health care in long-term care facilities
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plans to implement better mental health support in long-term care aim to improve the quality of life for residents.
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a newly launched standard of care, known as the national standard of canada for mental health and well-being in long-term care and assisted living settings (csa z2004), aims to change the way people living in these facilities access the mental health supports they need.
developed by the canadian standard association (csa group), the new standard will set a precedent to address the issues faced by as many as 76 per cent of residents in long-term care (ltc) living with mental health disorders or dementia.
currently, physical health and well-being are at the forefront of care in ltc settings, and while necessary, it doesn’t address the gap in accessing mental health support for the people who need it.
after identifying the dire need for mental health care, the goal of the csa z2004 is to “move beyond institutional models of care to one that embraces person-centred care to promote mental health and well-being of residents by focusing on psychosocial needs, emotional needs, and mental health in a compassionate way.”
ltc facilities and mental health statistics
people living in mental health care facilities often struggle with the change. going from the comfort of one’s own home to a strange and new place, especially in the face of a health issue on top of it, can be emotionally taxing.
dr. julia kirkham, associate professor of geriatric psychiatry and chair of the technical subcommittee leading the development of csa z2004, has worked tirelessly with others in the medical community to ensure that those living with mental health conditions don’t get left behind in ltc settings.
she and others working on implementing the new standard across the country also aim to address the fears related to the change and the ways in which those anxieties can worsen mental health and well-being.
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“people are not worrying that they’re going to have a fall and break their hip. what people worry about, what people tell me, and what personally i would be afraid of too is that you’re going to be miserable, that you’re going to be isolated, that you’re going to have no quality of life, and you’re going to be unhappy,” she said. “that’s what people are concerned and afraid of when it comes to considering a move somewhere like this.”
according to research, as many as 40 per cent of people living in ltc facilities have some type of psychiatric disorder, with 10 per cent living with major depression. close to half of all residents also contend with depressive symptoms, and the prevalence of other disorders, including schizophrenia and bipolar disorder, is also high.
while it could be easy to say that the significant life change drives those conditions in ltc, the situation is not that cut and dry.
dr. kirkham believes that two factors play to the high prevalence of mood disorders in people living in these types of facilities.
“the usual reason that the rates are very high in these settings is that these are the conditions that lead someone to require this level of care, particularly in long-term care,” she said during a briefing session. “but that’s not to say that there isn’t a contribution from living in long-term care or assisted living. i think there are many places that i’ve worked in that do a wonderful job of making it a home-like environment and supporting people’s mental health and quality of life. but for many people, the transition to living in long-term care and assisted living, though it might be required, is an extremely stressful time, as you can imagine.”
she continued, “many people have to move from what was their home or long-term community. they may be isolated by their problems with mobility, not being able to leave, or other factors, and so you can imagine that the stress for people that are associated with being newly or longer-term in an assisted living or long-term care environment can increase the risk for mental health symptoms like depression or anxiety. so, for some people, the setting itself may be the cause, but for a majority of people, that’s not the case and that rates are high because of the reasons that they’ve wound up living there.”
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the csa z2004 and why it’s important
the new standard was developed with several goals in mind. the first is to guide those who implement services, programs, education, training, policies, procedures, and practices in a way that fosters better support for people living with mental health disorders in ltc settings while reducing the risk of people without these disorders developing them.
they also aim to address the physical environmental considerations that are geared toward the promotion of improving mental health and well-being and provide person-centred care that is inclusive of all people living in assisted living or ltc facilities.
those developing and implementing the standard across the country want people to look at mental health in these facilities as a continuum rather than a black-or-white situation.
“in this standard, we see mental health existing along a continuum. so, there’s a dated view of mental health as either you have a mental health condition or you don’t, and we do not see it that way,” said dr. kirkham.
“we see this as mental health on a continuum, so everyone is at risk of a mental health condition. obviously, people who have historically had a problem are at higher risk, but particularly in long-term care and assisted living, this represents a time of very high risk for mental health conditions or symptoms for everybody who’s living there.”
the new standard is designed to work alongside others that have been implemented to ensure the best overall quality of life for those living in ltc facilities or assisted living settings. other standards, including csa z8004:2022 and can/hso 21001:2023, are also in place to provide adequate care in different areas, such as the safety of the physical environment and guidelines for delivering high-quality ltc services.
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while the issues faced in ltc and assisted living settings have always existed, the covid-19 pandemic amplified matters that may have flown under the radar before it occurred.
“there’s been a lot of activity in this area since the pandemic, and all of the issues that were identified during that time … neither of these standards focus directly on mental health neither cover assisted living settings either, so that is the gap that’s addressed in this new standard, and these are meant to be complementary.”
steps for a better future for those in ltc and assisted living settings
the change toward making mental health services and care more equitable and accessible in ltc and assisted-living settings is a long time coming. now that the csa group team has begun making changes, workers, administrators, residents, and their families can all benefit.
“historically, mental health has not been prioritized in these settings, and physical health and safety have taken precedence, and that’s important. we’re not saying that it isn’t, but we’re saying that it’s time to shift toward a place where we prioritize mental health and wellbeing in these places in the same way that we prioritize physical health,” said dr. kirkham.
“we need to move beyond this institutional model of care, this reactive model, to one that embraces person-centred care, and we’re thinking about promoting mental health and well-being, so not just treating a mental health problem but for all residents, we’re thinking about mental health as something we want to promote and be good in these places. and that includes both mental health but also psychosocial or emotional needs.”
as for what’s next, since the standards are voluntary, conversations continue to be needed to ensure that policymakers, private and public ltc facilities, assisted living organizations, and those who work in these places are all on board with making the necessary changes.
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if they can accomplish that, the results for residents will be significant in terms of mental health and quality of life.
“as a healthcare provider, my vision would be that everybody in these places has access to mental health support and treatment and in the bigger picture that these are not places that people have these concerns and fears that they do now,” said dr. kirkham.
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