IDENTIFYING THE BARRIERS TO MENTAL HEALTH INTERVENTION IN THE HOMEBOUND OLDER ADULT

Abstract

Homebound older adults (HOA) are at high risk for depression and anxiety, resulting from concerns about health, functional mobility limitations, and social isolation. HOAs underutilize professional treatment in part due to their belief system, limited knowledge, and stigma surrounding mental health services. Home care caseworkers use of anecdotal screening over standardized tools may contribute to under-detection and under-utilization of mental health services in HOA population. Our investigation compared the detection efficacy of two methods for mental health screening: anecdotal vs standardized. Subsequently, to obtain insight into the barriers and facilitators for mental health detection and service utilization, HOAs (n =6) and caseworkers (n =5) based in social service organizations took part in two separate focus groups. In 10.5 months, 34 HOAs agreed to be screened using anecdotal and standardized tools. Of the 34 participants screened for further mental health services, the anecdotal method identified 21 compared with 23 by the standardized tools. The percent agreement between anecdotal and standardized assessment improved from the first 6 months of the study (n =16/24; 66.67%) to the last months of the study (n = 9/10; 90%). Qualitative findings revealed trust establishment, and lack of knowledge as common themes. Data informed the development of two educational materials: best practice recommendations for home care agencies and an emotional well-being fact sheet for clients. This research contributes to literature on introducing mental health services in the HOA population residing in a large metropolitan region who receive services from a non-profit home care agency.