How to improve the organisation of Mental Healthcare for older adults in Belgium?

TABLE OF CONTENTS .1 -- LIST OF FIGURES 6 -- LIST OF TABLES .9 -- SCIENTIFIC REPORT 16 -- 1 INTRODUCTION .16 -- 1.1 BACKGROUND 16 -- 1.1.1 Historical overview of the organisation of mental healthcare in Belgium and the place of older adults 16 -- 1.1.2 Definitions 22 -- 1.1.3 Emerging demographic changes .23 -- 1.1.4 Specific concepts attached to older people 23 -- 1.1.5 Mental health problems in older people in Belgium 24 -- 1.1.6 Specific dimensions of mental health in the older people 31 -- 1.2 OBJECTIVE 32 -- 1.3 METHODS 32 -- 2 LITERATURE REVIEW: CONCEPTS & MODELS APPLICABLE FOR MENTAL HEALTHCARE IN THE ELDERLY AND ITS EFFECTIVENESS .33 -- 2.1 METHODOLOGY 33 -- 2.1.1 Databases and search terms .33 -- 2.1.2 Search strategy and date limits .34 -- 2.1.3 Results of the literature search .35 -- 2.2 GENERAL MODELS & PRIMARY CARE 35 -- 2.2.1 The C.A.R.I.T.A.S. principles .35 -- 2.2.2 The Chronic Care Model (CCM) 36 -- 2.2.3 Integrated people-centered health services 38 -- 2.2.4 Mental healthcare for older adults in primary care settings 39 -- 2.3 IMPLEMENTATION STRATEGIES TO ORGANISE MENTAL HEALTHCARE IN OLDER ADULTS 40 -- 2.3.1 The stepped Care Model 40 -- 2.3.2 Indicated prevention 40 -- 2.3.3 Watch and Wait strategy 40 -- 2.3.4 Collaborative Care model .41 -- 2.4 STUDIED IMPLEMENTATION STRATEGIES AND THEIR EFFECTIVENESS 41 -- 2.4.1 Implementation strategies to organise care for depression in the elderly 44 -- 2.4.2 Implementation strategies to organise care for suicidal ideation in the elderly 52 -- 2.4.3 Implementation strategies to organise care for alcohol abuse in the older adults 53 -- 2.4.4 Implementation strategies to organise care for older long-term or severe psychiatric patients 53 -- 2.4.5 Implementation strategies to organise care for mental health problems in older persons with Alzheimer disease 54 -- 2.4.6 Implementation strategies to organise care for mental health problems in older minority populations 54 -- 2.5 ADDITIONAL REMARKS ON IMPLEMENTATION 55 -- 3 PERCEPTION OF THE SERVICE SUPPLY FOR MENTAL HEALTHCARE IN OLDER ADULTS IN BELGIUM .56 -- 3.1 OBJECTIVES AND METHODS 56 -- 3.2 RESULTS 58 -- 3.2.1 Perceptions of the current MHC system 60 -- 3.2.2 Perception of the need for a specific system for older adults, compared to other patients 74 -- 3.2.3 Suggested improvements 75 -- 3.3 KEY MESSAGES 77 -- 4 INTERNATIONAL COMPARISON: ANALYSIS OF MENTAL HEALTHCARE ORGANIZATION FOR THE OLDER PEOPLE .79 -- 4.1 INTRODUCTION .79 -- 4.2 METHOD .79 -- 4.2.1 Selection of countries .79 -- 4.2.2 Methodology of data collection .79 -- 4.3 ENGLAND 80 -- 4.3.1 Healthcare system in general 80 -- 4.3.2 Organisation of mental healthcare 80 -- 4.3.3 Demographics on elderly population 81 -- 4.3.4 Burden of mental health in older people from UK 82 -- 4.3.5 Mental Healthcare system for the older people 82 -- 4.3.6 Funding .83 -- 4.3.7 Description of some case studies 84 -- 4.4 FRANCE 88 -- 4.4.1 Healthcare system in general 88 -- 4.4.2 Demographics on elderly population 89 -- 4.4.3 Healthcare system for the older people 89 -- 4.4.4 Burden of mental health disorders in French older people .90 -- 4.4.5 Organisation of mental healthcare 90 -- 4.4.6 Mental healthcare system for older people .91 -- 4.4.7 Funding .92 -- 4.4.8 Description of some case studies 93 -- 4.5 THE NETHERLANDS 96 -- 4.5.1 Healthcare system in general 96 -- 4.5.2 Demographics on elderly population 97 -- 4.5.3 Healthcare system for the older people 97 -- 4.5.4 Burden of mental health disorders in the Netherlands 98 -- 4.5.5 Organisation of mental healthcare 98 -- 4.5.6 Burden of mental health disorders in older people 100 -- 4.5.7 Mental healthcare system for the older people 101 -- 4.5.8 Funding 102 -- 4.5.9 Description of some case studies 102 -- 4.6 CANADA 105 -- 4.6.1 Healthcare system in general 105 -- 4.6.2 Demographics on elderly population 105 -- 4.6.3 Healthcare system for older people 105 -- 4.6.4 Burden of mental health disorders in Canada 107 -- 4.6.5 Organisation of mental healthcare 107 -- 4.6.6 Burden of mental health disorders in older people 108 -- 4.6.7 Mental healthcare system for older people 109 -- 4.6.8 Funding 110 -- 4.6.9 Description of some case studies 111 -- 4.7 INTERNATIONAL COMPARISON AND TRANSVERSAL ANALYSIS OF MENTAL HEALTHCARE ORGANIZATION FOR THE ELDERLY BETWEEN FOUR FOREIGN COUNTRIES: ENGLAND, -- FRANCE, THE NETHERLANDS AND CANADA: 113 -- 4.7.1 Official priorities: 113 -- 4.7.2 Comparison of key recommendations for older adults’’ mental health services organisation: 115 -- 4.7.3 Approaches to mental healthcare and mental health services for older people 116 -- 4.7.4 Barriers to implementation of elderly services of mental healthcare 125 -- 4.7.5 Potential ways to overcome these barriers 126 -- 5 DESCRIPTION OF THE BELGIAN SITUATION 129 -- 5.1 AIM AND METHODS 130 -- 5.2 THE BELGIAN MENTAL HEALTHCARE SYSTEM TODAY AND THE ELDERLY 131 -- 5.2.1 In-hospital settings 131 -- 5.2.2 Residential settings 147 -- 5.2.3 Non-residential settings 152 -- 5.2.4 Mental healthcare initiatives with a focus on older adults 161 -- 5.3 ANALYSIS OF PREVIOUS KCE REPORTS 168 -- 5.3.1 Method 168 -- 5.3.2 Search results 168 -- 6 CONCLUSIONS AND RECOMMENDATIONS 171 -- REFERENCES 172

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