A 'lifestyle of choice' for the mentally ill
Staff have little trouble filling beds at Annesley House.
As one of the only low-care facilities in the
State dedicated to mentally ill older people, the Leichhardt hostel
fields referrals from as far away as northern New South Wales to
accommodate a section of our ageing population which is all but
forgotten by aged care planners.
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The only hitch in demand is that, when a bed does
become available, prospective clients often have simply fallen off
the radar.
"They just drift in and out of boarding houses
or get locked into a cycle of homelessness," explains Annesley's
operations manager, Colleen Raleigh. "Some of them we never
hear from again."
Annesley, a UnitingCare Ageing facility
converted from a high-care home ten years ago, works closely with
area health services and local GPs to offer specialised care for
its 86 residents. Most were referred as outpatients from the psychogeriatric
unit at Rozelle Hospital or the local St Vincent's homeless shelter.
Take a midnight walk down Norton Street, the hub
of Leichhardt's café district and a stone's throw from Annesley,
and you might see a resident or two spruiking passers-by for spare
change for some smokes.
In their past lives they might have been employed
professionals; others lived with the support of a loving family
when they were younger; but many from this older age group were
among the generation of mentally ill transferred into community-based
boarding houses in the 1970s and 80s when the psychiatric hospitals
in which they had lived most of their lives were systematically
closed.
Annesley steps in where those boarding houses
failed. It provides structured support and supervision to residents,
who must be at least 60 years old and pass checks by an aged care
assessment team to gain admission. It also accepts individual lifestyle
choices, such as regular drinking, smoking, gambling or even street
begging, that might well be frowned upon at other aged care facilities.
It's a balancing act that can have its hiccups.
Many residents have a dual diagnosis, with about two-thirds suffering
from chronic schizophrenia.
Other common disorders include alcohol-related
brain damage, major depression and major anxiety. Staying well means
not just seeing a psychiatrist and taking prescribed medication;
the challenge is to control the mental illness so that its symptoms
do not interfere with everyday life.
Enjoying the support of a local community can
also help.
"The local businesses on Norton Street are
very tolerant," says Ms Raleigh. "If one of the residents
is getting a bit out of hand, they'll give us a call here and we'll
go and pick them up."
Only about ten residents enjoy an active relationship
with family members; a further ten have family written down as contact
points only in case of emergencies; and the rest have no documented
next of kin, save for their case manager either at the Office of
the Protective Commissioner or the Office of the Public Guardian.
But the absence of familial bonds reinforces the
homelike environment at Annesley - because, for residents, their
resident companions together with the 27 rotating staff members
are their family.
"Residents follow the personal lives of staff
very closely," says Ms Raleigh. "If a staff member goes
on maternity leave, they'll come and ask after her baby. The staff
also take on a strong advocacy role on behalf of residents."
Despite the fact that residents at Annesley require
roughly double the amount of personal carer hours required for residents
at other low-care facilities - staff undergo regular training in
behaviour management and mental health issues - there is no additional
Commonwealth funding for offering aged care beds to the mentally
ill.
And before other low-care facilities open their
doors to older people with mental disorders, aged care planners
will have to dislodge the social stigmas attached to the illness.
The former executive care manager for the Sydney
Region, Joanne Toohey, says attempts at placing older people with
mental illnesses at other hostels are often met with a brick wall
of intolerance.
"Hostel residents are very vocal about anyone
with anti-social or challenging behaviours entering their facility,
so it's always hard for someone with a mental illness to fit into
a low-care environment. Often what happens is they end up being
misplaced into a high-care environment because they couldn't be
placed anywhere else."
Ms Toohey believes that each of the regions in
the UnitingCare Ageing network has the capacity to open a dedicated
facility like Annesley (the nearest comparison is Lillian Wells,
a psychogeriatric nursing home in North Parramatta, operated under
the UnitingCare Ageing Western Region).
"A psychogeriatric facility would never have
trouble filling beds, and we'd be providing a much needed service."
Erin Tennant