One of the most pressing public health challenges facing aging Canadians is the devastating impact of untreated mental health conditions. Almost one in five older adults in Canada experiences symptoms of anxiety or depression annually. While late-life anxiety and depression are common, they are often undiagnosed and, therefore, untreated. Awareness surrounding the serious health effects of social isolation and loneliness in older adults is also increasing with research showing that chronic loneliness can increase the risk of developing dementia by up to 50 per cent and carries a health toll equivalent to smoking 15 cigarettes a day.
For older adults in rural communities, these risks are compounded by a lack of access to mental health services, a gap that leaves too many to suffer in silence. Baycrest is advancing solutions to help older adults, especially those in rural areas, stay connected, receive timely care and thrive.
It is no surprise that residents of remote areas have reduced access to health care and often experience poorer health outcomes. This is one finding in a 2013 Baycrest study evaluating weekly telepsychiatry consultations provided to six communities in northwestern Ontario from 2002 to 2009. In 2000, Baycrest joined North Network, a forerunner of the Ontario Telemedicine Network (OTN) to provide psychiatry services to underserved areas of Ontario. Dr. David Conn, Geriatric Psychiatrist at Baycrest, the Medical Director of Telehealth Services at the time, conducted consultations and helped pave the way for virtual care as we know it today.
Since 2002, Baycrest has been working closely with the Canadian Mental Health Association (CMHA) Fort Frances Branch, which offers community-based geriatric mental health services in the Kenora and Rainy River Districts. Individuals living in the community, hospitals and long-term care homes are referred for virtual psychiatric consultations and receive personalized support every step of the way.
Now available throughout Ontario, Baycrest's Telepsychiatry Service, which has been providing care for over two decades, involves several psychiatrists providing virtual consultations on an outpatient basis to aging adults who may not have access to mental health services or be able to leave their homes to travel to Baycrest.
Before the consultation, CMHA provides a comprehensive and detailed patient brief, enabling physicians to concentrate on connecting with the patient to deliver informed care. The result is a holistic diagnosis and treatment plan that supports continuity of care.
Bringing health care to aging adults allows them to avoid traveling, which can be difficult and expensive. It has also allowed the family to be more involved. Even before 2009, when the program required clients to visit a local studio to access the necessary technology, older adults proved tech-curious and adaptable. “It was like being right in the room with the psychiatrist," one patient reflected, as noted in the evaluation. Another was so comfortable with the virtual experience that, at its conclusion, he instinctively stood up to shake Dr. Conn's hand. Technological advancements have allowed these consultations from a patient's personal device, making access to mental health care even easier.
A significant proportion of Indigenous populations in Ontario reside in rural and remote communities and often face systemic barriers to accessing consistent and culturally appropriate health care services. According to Employment and Social Development Canada, racism, marginalized language, poverty and oppression are some factors that put Indigenous aging adults at a particularly high risk of social isolation. Baycrest's Telepsychiatry Service provides individuals in this growing cohort, one that increased from 4.8 per cent to 7.3 per cent from 2006 to 2016 – trauma-informed care using an interpreter when appropriate, while also including family members.
Maintaining good mental health is vital to overall well-being for everyone, including aging adults. Challenges unique to aging such as multiple chronic illnesses, mobility limitations and social isolation can take a toll on their emotional and psychological health. But what's often overlooked is how significantly mental health influences physical health outcomes. Depression in older adults is underdiagnosed and associated with poorer management of chronic conditions, increased rates of hospitalization and higher mortality.
This is why Baycrest's aim has been not only to provide access to specialized consultation but also to support and train caregivers and socio-health service providers. In the evaluation, educational seminars for health care teams were reported as invaluable for all participants. Some stated that telepsychiatry made it possible for them to expand their repertoire of skills, such as the administration of standardized tests. This has resulted in the team being able to provide more information about the patient when meeting the consultant and in some cases has precluded the need for a referral.
A champion of virtual care programs, Baycrest provides leadership here in Canada and at a global level on the application of telepsychiatry. Dr. Conn consulted Spanish local and regional governments, helping to launch similar services for Spain's aging populations. Alongside the CMHA, Baycrest provides education to the team, helping train new staff and inspiring the next generation of psychiatrists to do the same kind of work.