Living History – Delivering an Older Persons Mental Health

Service to the indigenous population of Palm Island.

David JohnstonClinical Nurse Consultant

Townsville North Queensland

Palm Island

Location

• 57 km north of Townsville

• 46 km east of Ingham• 224 km south of Cairns

Palm Island

Palm Island

BWGCOLMAN

• The indigenous settlement was established in 1918.

• Being one of the last settlements created under the Aboriginals Protection and Restriction of the Sale of Opium Act of 1897.

Palm Island

• Used to confine “problem cases and uncontrollable aboriginals” from other reserves.

• Over the next 20 years the population increased to 1600, with people from 40 different groups.

• Aboriginal language was banned.

Palm Island

• In 1985 the State relinquished control of the Island passing title to the Community Council in the form of a DOGIT (Deed of Grant in Trust).

• However the government removed much of the infrastructure, including houses, shops, a timber mill, a dock and farming equipment.

Palm Island

• In 2006, the population was estimated at 2000, with 88% unemployment.

• In 2007, Palm was missed by the ABS census.

• Island completed own census in July 2010.

Palm Island2010 Population Survey

Total population

No. per

Survey

%age People Not Counted

(10%)

Grand Total

Total persons 2,765 276 3,042

Males 1,403 50.7% 140 1543Females 1,362 49.3% 136 1498

Indigenous persons

2,695 97.3% 270 2,965

Non Indigenous 70 2.7% 7 77

Palm Island2010 Population Survey

Population Growth – 1921 to 2010

Palm Island2010 Population Survey

2010 Age Composition2006 Age Composition

Palm Island2010 Population Survey

Comparison of Age Composition 2006 Vs 2010

Palm Island

2009

• Joyce Palmer Hospital• Generic Mental Health

Team• Consultant Psychiatrist

2/52• No Gerontology

Service• GP Service

Palm IslandTownsville Older Persons Mental Health

Service (OPMHS)

Townsville Older Persons Mental Health Service (OPMHS)

• Team Leader• Clinical Nurse

Consultants • Clinical Nurse • Occupational Therapist • Indigenous Mental

Health Worker• Administration Officer• Clinical Director –

Consultant Psychiatrist • Psychiatric Registrar

Townsville Older Persons Mental Health Service (OPMHS)

Team Role and Function.

• Integrated Multidisciplinary Mental Health Team. Primarily Consultation and Liaison, some Short-term engagement.

• Clinical assessment and management recommendations.

• Planned therapeutic interventions.

• Liaison with other stakeholders such as ACAT, GPs, NGOs, RACFs.

• Membership in area and state-wide reference groups –developing models.

Townsville Older Persons Mental Health Service (OPMHS)

Eligibility Criteria.

Service primarily aimed at people over the age of 65, [No age restrictions for indigenous people] with:

• A mental illness which has arisen for the first time.

• Consultation for patients with a pre-existing mental illness complicated by age related co-morbidities.

• Older persons with a mental illness who do not meet the above criteria should continue to receive treatment from existing MH services.

Palm IslandSandy Boyd Hostel

Palm Island

Sandy Boyd Hostel

• 15 bed facility.• Nursing cover 24/7.• Federally funded.• Majority of care

assistants are relatives of the clients.

Palm Island

Palm Island

Commonly used tools for cognitive assessments

• Mini Mental State Examination (MMSE)• Frontal Assessment Battery (FAB)• Allens Cognitive Levels Screen• Rowland Universal Dementia Assessment

Scale (RUDAS)• ADAS – Cog Examination• Repeatable Battery for the Assessment of

Neuropsychological Status (RBANS)

Palm Island

Palm Island

• Kimberley Indigenous Cognitive Assessment (KICA) was developed by Dr Dina LoGiudice (Geriatrician) Kate Smith (Occupational Therapist)

• Validated in 2005 within the older Indigenous people of the Kimberley

• It includes both client assessment and carer reports.

Palm Island

Areas of Assessment

• Medical• Alcohol• Smoking History• Cognition• Behavioural Symptoms • Psychological Symptoms• Activities of Daily Living

Palm Island

Palm Island

Post Assessment

• Cognitive enhancers• PBS

• Further Assessment!!!• Clinician Interview

Based Impressionof Change (CIBIC)

Questions