Older adults living with mental illness often face a double stigma in our society – both from aging and from mental illness. They are some of the most invisible and most vulnerable individuals in our communities, and we need to find better ways to support them.
"Sarah" was well-known to many of the senior-serving non-profit organizations in Calgary. Her behaviour became erratic due to a psychotic or schizophrenic episode, and she was evicted from her apartment. From here, her options were limited: find alternate housing (difficult in a low vacancy environment); stay in a motel (expensive); or go to an emergency shelter (often over capacity). With no safe, supportive housing available, homelessness became a real possibility.
Last week, the Older Adult Service Providers of Calgary released a report warning that more older adults could be at risk of homelessness if affordable seniors' housing providers and mental-health service providers don't work together to tackle the growing problem of older adults living with mental illness. The report shows a considerable knowledge gap between these two types of providers and the lack of a co-ordinated effort.
As with the general population, 20 per cent of older adults live with a mental-health issue. In Calgary alone, that equates to more than 21,000 older adults, with between 1,000 and 2,000 living with severe and persistent psychotic disorders, including schizophrenia and delusional disorder. These figures do not take into account individuals between the ages of 45 and 65 who have lived a higher-risk lifestyle and been intermittently homeless. Such individuals age more quickly than the general population, and often present as "functionally geriatric" well before the age of 65.
One of the most surprising findings in the report is the lack of appropriate housing for older adults living with mental illness in Calgary in contrast to Edmonton, where such specific supports are available. There are currently no housing communities in Calgary that are solely dedicated to seniors living with mental illnesses, notable after the closure of the 38-suite Sunnyhill Wellness Centre in 2011, which was dedicated to older adults, primarily with mental-health diagnoses. There are some communities in the city that provide limited services to this population, such as Peter Coyle Place and Bridgeland Manor, which provide housing for hard-to house and formerly homeless seniors.
In Edmonton, older adults living with mental illness have access to numerous dedicated communities, including the 150-bed Villa Caritas, which alone eclipses Calgary's entire capacity. Another 178 dedicated beds are also available in Edmonton. This discrepancy between the two cities is troubling and needs to be addressed by the provincial government. Although a continuing-care facility was recently announced for Calgary for those who need specialized care outside of a hospital setting, it is not senior-specific. More needs to be done – and soon.
In addition to housing supports, the report also found that there are several effective practices that could be put in place to help this population. One of the most promising is known as the 'behavioural supports framework' which focuses on aggression, wandering, physical resistance, agitation and other behaviours of seniors with mental illness, dementia or addiction. The framework focuses on adapting the environment or care to satisfy the individual's needs to prevent or minimize the behaviour.
As the population of older adults is set to double in Alberta over the next 25 years, cases of older adults living with severe mental illness will only increase. More housing and support services dedicated to this population are needed – in Calgary in particular – if we are to avoid an increased number of homeless seniors.
Pat Cashion is the outgoing chair of the Older Adult Service Providers of Calgary; Dr. Lee Tunstall is co-author of the report and an adjunct assistant professor at the University of Calgary and an advisor with EvidenceNetwork.ca.