Integrating mental health support in home and community care: acceptability and feasibility of a holistic mental health conversations initiative

Background: The mental health needs of community-dwelling older adults often go unidentified or unaddressed in health care systems designed to prioritize physical health concerns and facility-based care and treatment. Pervasive societal stigmas related to aging and mental health further exacerbate these unmet needs by creating conversation barriers among providers, older adults and caregivers.

 

The Mental Health Conversations Initiative (MHCI) is a non-diagnostic, discipline-agnostic, multi-component intervention to promote integration of evidence-informed conversations about mental health into routine home and community care interactions. Rooted in the Mental Health Continuum Model for Aging Canadians, the MHCI includes education and training to destigmatize mental health and increase awareness of holistic mental health needs, and provides evidence-informed tools and resources to support holistic mental health conversations, self-reflection and monitoring. The MHCI was co-designed with input from 1000+ older adults, caregivers, and health and social care providers, with representation from every province and territory in Canada. This project aims to explore the acceptability and feasibility of implementing the MHCI within home and community care organisations in Canada.

 

Approach: Eleven home and community care organisations in urban and rural settings across three Canadian provinces pilot tested the MHCI. Home and community care providers completed education (i.e., asynchronous online individual learning modules and synchronous group training) and used the MHCI to engage older adult clients in mental health conversations for 8 weeks. Surveys and interviews explored the initiative’s acceptability based on the Theoretical Framework of Acceptability, and implementation based on the Consolidated Framework for Implementation Research. A pan-Canadian working group of 18 experts-by-experience (e.g., older adults, providers, health organization leaders, caregivers, researchers) was consulted throughout the project to support development of data collection instruments and plan knowledge mobilization activities.

 

Results: Participating older adults (n = 53) included men and women living in rural and urban areas, with over half experiencing moderate to poor mental well-being at the time of recruitment. Most participating care providers (n = 73) were women who had been working in home and community care for over 5 years as personal support workers or continuing care assistants.

 

Preliminary findings indicated the MHCI had good acceptability among care providers prior to implementation. Care providers felt the training increased their confidence and understanding of the initiative, and expressed desire for more examples of how to use the tools to integrate mental health conversations into routine care interactions in future training. Qualitative interviews with providers and older adults are being conducted to explore acceptability and use of the initiative and identify implementation barriers and facilitators. Data analysis will be completed by March 2025.

 

Implications: Preliminary results indicate the MHCI is an acceptable approach to enhancing integration of mental health support within home and community care. Intentional engagement of organizations in multiple geographic settings supports transferability of findings to diverse organizational, sectoral and international contexts. Spread and scale of this initiative as an innovative strategy to build multi-sector mental health capacity and enhance availability of mental health support for older adults across Canada will be explored in future research.