The Seniors’ Mental Health Policy Lens Toolkit

 

III. SENIORS’ MENTAL HEALTH POLICY LENS (SMHPL)

INSTRUCTIONS
For explanations of the questions/concepts and questions to consider if applying the Caregiver Policy Lens at the organizational/program levels, click on the corresponding links. At any time, you can click the Calculate and Save Button at the bottom of the page, and your work will be saved. Access Your Previous Selections

You may refer to the Guide to the Application of the Seniors Mental Health Policy Lens in the next section for explanations of the questions and examples of how others have applied them.

PREPARATION
Describe the Policy/Program
Review the purpose and objective of the policy/program to which the SMHPL is being applied.

Consider the Seniors’ Populations Affected by the Policy/Program

Who are the senior populations likely to be most affected by the policy/program/practice? (Think about those who are seniors today as well as those who will be seniors in the future).

Think about these seniors as you respond to each of the SMHPL questions.

APPLY THE SENIORS MENTAL HEALTH POLICY LENS
Beside each question in the SMHPL check Yes, No, or Not Sure, NA (Not Applicable), according to what you believe your policyreflects.

Be sure to keep notes as you go about areas where you require more information and your plans for obtaining it.

I Process Factors

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Although the SMHPL questions are presented as a checklist they are intended to stimulate thinking and support discussion. The implementation of the SMHPL is most valuable when done in collaboration with those affected.
Involving seniors and other relevant stakeholders can add considerable value by:

  • ensuring consideration of the perspectives of all stakeholders affected, especially seniors.
  • developing an understanding of each other’s perspectives
  • finding common ground
  • facilitating a sense of ownership of any changes/initiatives that result
  • establishing credibility within various sectors of the community
  • helping to ensure that the results are accessible and appealing to those affected.

1. Seniors’ Involvement

  1. How are seniors, seniors advocates and
    seniors organizations involved in the design/review of the
    policy/program?
Seniors Involvement

Yes
No
Not Sure
N/A
Are seniors affected by the policy/program involved in the policy analysis/creation?
Are seniors’ organizations and advocacy groups involved/consulted?
Are mechanisms in place for seniors to be consulted and actively involved in the design, implementation, and evaluation of policies and programs that affect them?
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Seniors involvement in decisions affecting them is a central tenet of the SMHPL. They have a wealth of experience to share and are experts in their own lives. Their input is required to ensure that programs and services affecting seniors are informed by seniors and reflect their values.

A coordinator for a municipal leisure centre used the SMHPL to review their programs and determined that they needed to improve accessibility for older adults, particularly those isolated by transportation needs. To strategize how to address accessibility she invited seniors’ organizations, local businesses, voluntary organizations and the city transit corporation to assist. This resulted in a variety of novel services and subsidies to suit individual needs. Seniors were then involved in evaluating the new approaches.

 

  1. Who needs to be involved?

Notes:

2. Collaboration

  1. Are key organizations/Ministries, interest groups or individuals involved?
Stakeholder Involvement

Yes
No
Not Sure
N/A
Has the policy been developed in collaboration with stakeholders who will be affected?
Does the policy/program emphasize partnership and collaboration?
Are relevant organizations (government and non-government, voluntary, private) and Ministries engaged?
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Given the complexity of interwoven factors that can affect seniors mental health and well being (e.g., social isolation), seniors organizations, seniors advocates, various levels of government, Ministries and non-governmental organization may all need to be involved in policy development or analysis.

In one province the MOH applied the SMHPL to drafts of their Chronic Pain and Chronic Disease Prevention and Management Strategies which set out broad key directions and strategies to guide policy, program / services development and funding, and multi-sectoral collaboration. Their experience with the SMHPL led them to re-consider the representativeness of their Advisory Groups, adding seniors’ organizations and community agencies, and to make some significant changes to content. They also added the SMHPL to the provincial implementation plan as an action item for strategies related to older adults.

 

Who else needs to be involved?

II Assessing Policy/Program Content

1. Diversity and Marginalization

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The seniors’ population is heterogeneous and made up of many different groups, some of which are marginalized and vulnerable, and each of which has diverse needs, circumstances, and aspirations. Often seniors belong to more than one group. This section also incorporates some of the determinants of health—see Appendix 2 for more information.

  • If the policy/program/practice applies to all seniors a review of how the determinants of health and normative events and transitions affect seniors generally, and of seniors’ perspectives about the mental health challenges of aging, should be carried out. (See Appendix 2, Conceptual Framework).
  • If the population of seniors affected is composed of, for example First Nations seniors, seniors who have a mental illness or other vulnerable groups, additional research may be necessary to determine what inequities they may experience or special issues and challenges they face.
  • Assess whether any seniors are likely to experience inequities or negative impacts resulting from their memberships in marginalized groups.

  1. Assess whether any seniors are likely to experience inequities or negative impacts resulting from their memberships in marginalized groups
Does this policy/program avoid negative effects for seniors who are:

Yes
No
Not Sure
N/A
Gay, lesbian or transgendered
Members of an ethnocultural, linguistic, religious, and/or racial minority
Women
Men
Low-income
Mentally ill
Cognitively impaired
First Nations
Physically disabled (e.g., mobility, vision, hearing)
Chronically ill
Institutionalized
Developmentally disabled
Experiencing addictions
Immigrants (as seniors)
Employed (paid or volunteer)
Over the Age of 85
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The SMHPL was used to frame research about the needs of caregivers of older adults with persistent mental illness and addictions. Caregivers and service providers reported that older adults with addictions faced significant stigma, often were poor, suffering from chronic health problems, and faced discrimination in accessing seniors services, health care services and housing. Caregivers and service providers were tainted with the stigma of addictions as well.
The findings from the research were presented to the health authorities involved with recommendation for addressing the inequities.
Mental health is influenced by interacting personal, environmental and societal factors –the determinants of health (i.e., gender, income and social status, quality of social support networks, personal health practices and coping skills, adequacy of the physical and social environments and access to health services), that accumulate as individuals go through life.

The SMHP was applied by a First Nations organization to frame the development of a program to promote healthy aging. It was recognized that First Nations people have a higher prevalence of diabetes and substance dependence, lower incomes, and often poor physical environments when compared to other Canadians. The uniqueness and importance of First Nations’ cultural practices (including food preferences, respect for elders, oral traditions) and spiritual practices were recognized. All of these factors were taken into account to design a mental/health promotion program that built on seniors’ strengths and reduced barriers to participation.

 

Notes

2. Transitions and Challenges

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Age related normative events, critical transitions and other events may pose increased challenges to some seniors’ mental health. The SMHPL can be used to raise awareness about this and to target services to these seniors. For example:

  • A woman living in a rural area and caring for her husband with dementia at home is vulnerable to negative changes in health (physical and mental) and social isolation, both of which may be compounded by limited respite and other resources. If she also has a low income she will not be able to purchase services privately.
  • A man who has lost his wife and with distant relationships with his children (or no children) may become socially isolated and at risk for suicide.
  • Consider whether the seniors likely to be affected by the policy/program are impacted by any of the challenges below. If so, consider whether the potential negative effects are taken into account/addressed.

  1. Consider whether the seniors likely to be affected by the policy/program are impacted by any of the challenges below. If so, consider whether the potential negative effects are taken into account/addressed.
Does the policy/program address any potential negative impacts that the following experiences may have on seniors’ mental health?
Yes
No
Not Sure
N/A
Bereavement
Relocation
Isolation (Social or Geographic) – Rural or Otherwise
Poor health status
Significant impairments in hearing and/or vision
Family status (single, childless)
Inadequate social support networks (weak, dysfunctional)
Inadequate social environment (e.g., deprived, unsafe, conflicted)
Caregiving
Living situation (homeless , alone, long-term care institution,
hospital )
Experiencing ageism
Elder Abuse
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The discharge policies of a general hospital were reviewed with the SMHPL after a recently bereaved elderly man, treated for cardiovascular problems, was discharged to his farm where he lived alone and committed suicide. It was found that this seniors’ social situation was not taken into account at discharge. This resulted in a policy that seniors with risk factors (above) would not be discharged without social work involvement to develop a plan for a supported discharge.

 

Notes

3. Accessibility

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Accessibility is about removing any social, cultural, economic or physical barriers to programs so that seniors are aware of them and can choose to use them. Information, communication and adaptations appropriate to the seniors likely to be affected by the policy/program will enable seniors to make the most of their abilities and facilitate access.

  • Brainstorm ways that the policy/program might unintentionally impede seniors’ access—be creative.

One group recognized that their voice messaging system discouraged some seniors from contacting their program so removed it. Another group realized that where they were advertising their program was not reaching many of the seniors eligible for their service. Poor lighting in a leisure centre was recognized as a barrier to seniors with low vision.

 

  1. Does the policy/program remove any handicaps and make appropriate adaptations to accommodate needs and to enable participation.?
Is access facilitated?

Yes
No
Not Sure
N/A
Is accessibility facilitated by sufficient staff/volunteers?
Is eligibility and other relevant information about access presented clearly and simply?
Is pertinent information readily available that is appropriate to the seniors affected? (Taking into account literacy, health literacy, vision / hearing impairments, language)
Are any physical barriers removed for seniors with impairments (mobility, vision , hearing )
Is it affordable?
Are sufficient resources likely to be available in a timely manner?
Is transportation readily available?
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A seniors’ centre, concerned about a lack of participants, applied the SMHPL to their program. They discovered that information about the program (provided in pamphlets) was not reaching many of the seniors in the community who were members of ethnocultural minorities, had low levels of literacy or low vision. They addressed these issues by providing information in different languages and in large print. They also worked with ethnocultural groups to ensure their promotional materials, food and activities were culturally appropriate, and to promote the program to their communities. Together these activities increased participation in their centre.
Use of the SMHPL has guided a rural municipality to recognize the risk of social isolation and related mental/health risks that resulted from lack of affordable and appropriate transportation compounded by geographic location and weather. This resulted in a multi-stakeholder meeting that developed a grant program for innovative solutions to transportation issues.

 

Notes

4. Participation and Relationships

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Seniors value getting involved, staying active and being active in all facets of life (socially, economically, politically); having a meaningful role in daily affairs; enjoying what life has to offer; participating in available programs and services; and being involved and engaged in activities of daily living, and decisions/initiatives in all spheres, not just those specifically oriented to seniors).

 

  1. Does the policy/program promote and support seniors’ relationships and their social participation?
Does the policy/program:

Yes
No
Not Sure
N/A
Remove any barriers (e.g. financial, technological, institutional, attitudinal, etc.) to seniors’ social and civic participation?
Facilitate access to seniors’ social network of family and friends?
Facilitate access to seniors’ community (e.g. cultural; geographic)?
Promote seniors’ inclusion in society?
Reduce loneliness, and/or social and spiritual isolation?
Promote/support a sense of belonging/mattering?
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A seniors centre that implemented the SMHPL discovered that their physical environment (e.g., poor lighting, noise) and lack of reception for new member, inadvertently impeded some seniors (with vision or hearing deficits, and others who felt uncomfortable/shy), from becoming involved at the centre. They made appropriate changes to their space and recruited volunteers to greet new members. The seniors centre has also initiated family teas and a service to read mail and write letters.

 

Notes

5. Self-Determination and Independence

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Seniors value being in control of their own lives, being able to do as much for themselves as possible and making their own choices (e.g., decisions on daily matters; being responsible, to the extent possible and practical, for things that affect them; having freedom to make decisions about how they will live their lives). Interdependence (enjoying access to a support system) is also important to enable freedom of choice and self determination. Facilitating an environment in which seniors are provided with the required information, options and supports to make real choices can enhance independence and self-determination.

 

  1. Does the policy/program/practice promote and support seniors’ self-determination and Independence?
Does the policy/program:

Yes
No
Not Sure
N/A
Provide opportunities to make choices?
Provide seniors with information and time to enable them to make informed choices about the risks they are willing to take and live with?
Provide support (encouragement, resources) to facilitate decision making?
Promote coping skills/strengths?
Build on the capacity of seniors and adjust to different circumstances?
Enable seniors to make the most of their abilities? (Compensate for mobility issues, sensory changes, etc)
Promote and support options and informed choices for seniors in all aspects of their lives? (Consider whether a full continuum of options is available)
Promote resiliency?
Does it promote Recovery and hope?
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Using the SMHPL to review a geriatric mental health service led to discussion of how health professionals, although well intended, “prescribe” what is appropriate care and treatment. This led to incorporating questions about coping skills and strengths into the assessment and the care plan.

 

Notes

6. Respect and Dignity

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Seniors value being treated with respect, regardless of the situation, and having a sense of self-esteem e.g., having a sense of self-worth; being accepted as one is, regardless of age, health status, etc.; being appreciated for life accomplishments; being respected for continuing role and contributions to family, friends, community and society; being treated as a worthy human being and a full member of society.

 

  1. Does the policy/program reflect respect for seniors and support their dignity?
Does the policy/program:

Yes
No
Not Sure
N/A
Promote seniors’ self- esteem?
Support seniors’ dignity?
Respect privacy and confidentiality?
Demonstrate respect for seniors?
Acknowledge the uniqueness of each individual?
Portray seniors’ positively?
Respect the values of seniors?
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A complex care facility used the SMHPL to frame a training program for staff that focussed on respect for person-hood, how to identify/promote residents’ strengths and coping patterns, and building relationships.

The BC Ministry of Health has undertaken two initiatives that reflect the values and principles embedded in the SMHPL. Officials have worked with seniors organizations and other partners to find ways to showcase seniors in the 2010 Olympic and Paralympic Winter Games. This initiative is intended to increase awareness that seniors are encouraged and supported to volunteer, leading to associated health benefits that result from enhanced social integration and a greater sense of value in society. The Premier’s Council on Aging (made up of seniors) is another example of facilitating seniors’ involvement and input into policies and programs affecting them

In a review of the care of older adults in a general hospital the SMHPL revealed a number of practices that compromised seniors’ dignity, such as: sharing rooms with people of the opposite sex; staff talking over seniors, calling them by their first name without asking, and not responding quickly to toileting needs. A policy was created to address these issues.

 

Notes

7. Fairness and Equity

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Seniors value fairness and equity. They would like their needs considered equally to those of other Canadians (e.g., having equitable access socially, economically, politically) to available resources and services; not being discriminated against on the basis of age; and being treated and dealt with in a way that maximizes their inclusion in society.

 

  1. Is the policy/program fair to seniors in the context of the public good?
Is the policy/program fair?
Yes
No
Not Sure
N/A
Is the policy/program fair to those affected by it?
Are the procedures and criteria inherent in the policy fair and reasonable?
Does it consider individual versus collective needs?
Does it take into account the full costs and benefits of supporting the aspirations of seniors?
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Seniors by and large would like to remain in their own homes as long as possible but may be challenged by such factors as low income, physical and cognitive limitations, and challenges in accessing the community. By being able to remain in their homes seniors are more likely to remain involved with their social support network and in their communities, both protective factors for mental health. The SMHPL was used to review federal programs directed at seniors and found three federal policies/programs ( HASI, RRAP-Disabilities Program and Veterans Independence Program) that supported seniors’ preferences to remain at home.
.
In a review of nursing home policies it was noted that there was no policy in place to balance the needs of older adults with disturbing and challenging behaviours, with the negative impact their behaviours were having on the mental health of other residents. There was pressure on the nursing home to discharge the challenging residents. An based clinical practice guideline was developed to ensure that “least intrusive” interventions (e.g., modify the social and physical environment) were implemented prior to consideration of relocation. At the same time, measures were put in place for the ongoing assessment of disturbance to other residents and staff, and were factored into the guidelines.

 

Notes

8. Security

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Seniors value a sense of security which can be accomplished by having adequate income as one ages and having access to a safe and supportive living environment (e.g., financial security to meet daily needs; physical security (including living conditions, sense of protection from crime, etc.); access to family and friends; sense of close personal and social bonds; and support.
A senior who lives in a deteriorating urban environment may feel too unsafe to venture outside of home, increasing the risk of social isolation. Seniors who may have experienced discrimination (e.g., racism, homophobia) or who are frail and/or have impaired mobility may feel especially threatened.

 

  1. Does the policy/program facilitate seniors’ psychological, physical and economic security?
Does the policy/program:

Yes
No
Not Sure
N/A
Provide the security of being able to plan for the future (appropriate housing and services, death)?
Provide a sense of safety?
Facilitate a sense of belonging?
Reduce the risks of crime, disease or injury?
Facilitate physical security?
Facilitate economic security?
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A seniors’ advocacy group recognized that the way seniors were being portrayed in the media and by politicians (i.e., as robbing the young through their pensions, as a health care burden, as “bed blockers”), was ageist and stigmatizing. Using the SMHPL as a guide they developed a strategy to involve seniors in a campaign to educate advertisers, government and their elected representatives about the impact of negative stereotypes on seniors’ mental health and well being.

 

Notes


9. Protection and Risk Management

Although self-determination is important to seniors so is the security of knowing that when needed, assistance is available.

  1. Does the policy/program provide seniors with the security of knowing that when needed, assistance is available?
Does the policy/program:

Yes
No
Not Sure
N/A
Facilitate appropriate interventions to protect seniors when warranted?
Provide for the timely and effective management and communication of risks?
Provide for the reduction of risks to seniors’ health, security and well-being?
Ensure that the least intrusive measure is taken? (given the risks)
Ensure that the preferences of seniors are taken into account as much as possible?
Respect and protect seniors’ legal rights?
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A seniors’ mental health program applied the SMHPL to their eligibility, intake and referral policies. They found that their waitlist practice and the time lag for making the initial assessment and communicating the results to other health care professionals was too lengthy and contributed to increased risks to some clients as interventions/ resources were delayed. They streamlined their processes, developed a professional intake, triage and crisis response, and developed a proposal for additional staff.

 

Notes

10. Evidence-Informed

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Policies and programs should be informed by pertinent legal and regulatory frameworks, standards, guidelines, “best” or leading practices and research evidence. The Seniors Mental Health Policy Lens is only one form of analysis by which a policy is assessed—other sources of information and tools of analysis and reviews should also be considered when applying the Seniors Mental Health Policy Lens and in analyzing results.

 

Is the policy/program informed by evidence?

Yes
No
Not Sure
N/A
Is it based on current evidence and/or best practices?
Can it be evaluated for process and outcome?
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In a review of policies related to tenancy in supportive housing it was found that provincial Landlord Tenant policies and residential care standards did not apply, leaving a policy vacuum around the issue of evictions.
A Home Support agency applied the SMHPL to an examination of admission and exit criteria for supportive housing. They determined that they needed to first review the legal requirements related to supportive housing and then to factor them into their policy analysis.

 

Notes:


III CREATING AN ACTION PLAN

1. Summate the columns- How are we doing? Where can we improve?

Final Totals


Yes


No


Not Sure


N/A

0


0


0


0

YES > NO? You are well on your way to a positive policy/program practice. But look for some ways it could be improved. Go back and determine if there are any changes that will yet increase the number of “Yes” responses.

NO > YES?
Your policy/program practice should be re-examined for content and overall intent. Many needs, wants, and concerns of seniors are not being met. A good source of input is from seniors themselves- ask them!

NOT SURE > Either YES or NO
You need to gather more information before proceeding with your policy/program practice. This will ensure it more comprehensive and holistic.

NOT APPLICABLE > Either YES or NO
Go back and critically examine your policy. Are there really this many categories that do not apply to your policy /program/practice? Or do much of the policy/ program/ practice not apply to the needs, wants, and concerns of those for whom it is intended?

2. Review your answers. Note strengths of the policy/program:

3. Identify the individual areas that require improvement and ways that potential negative effects could be addressed or off-set. Note who needs to be involved to address this process, and what information needs to be gathered. Set target dates.

Issues Identified:

Actions/Information Needed:

Who Needs To Be Involved?

Target Date:


4. Make a Recommendation

Answer yes or no to whether the policy should be accepted, or accepted as revised, whether there is a need for more information, or if revision is required.

Does the policy/program:

Yes
No
Accepted
Accepted as revised
Need more information to decide from whom and where
Needs revision

5. Revise the policy, and re-apply the lens, starting at the beginning. Repeat until the (revised) policy is recommended for acceptance.

Print the SMHPL

 

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