Mental health and aging in New Zealand: mixed-methods analysis of experiences of healthcare from a survey of older adults with mental health conditions

ABSTRACT

Little is known about the experiences of older people who seek mental healthcare in New Zealand. From a survey of 227 older people, we explored the use of mental healthcare services with quantitative and qualitative questions. Mental health needs were not being met in nearly one in five; a similar proportion was not satisfied with services providing mental healthcare. Reasons included long waiting times, lack of continuity of care and cost. Better co-ordination of primary and secondary services and improved accessibility of mental health services for older adults is needed.

KEYWORDS:

• Mental illness
• aging
• New Zealand
• mental health services
• primary healthcare
• survey
• access

Introduction

Mental health conditions in older people are common, estimated to affect 15% of those aged over 60 (World Health Organization 2017). Due to aging populations and improved life expectancy, the number of older people with mental health conditions worldwide is increasing (Knight and Sayegh 2011; World Health Organization 2017; Carpenter et al. 2022). In the UK, the number of people aged 55 and over with a diagnosis of schizophrenia is expected to double over 20 years from 2013 (Clifton et al. 2013); in the US, the number of older people with one or more mental health conditions is projected to double from 2012 to 2030 (Bor 2015). In Aotearoa New Zealand (NZ), the estimated number of people aged 65 and older with diagnosed depression and/or bipolar disorder increased from 79,000 in 2011/2012 to 130,000 in 2020/2021 (Ministry of Health 2022). Mental disorders are one of the leading contributors to burden of disease in older people (Prince et al. 2015) and account for around 7% of years lived with disability in those aged 65–89 (Institute for Health Metrics and Evaluation 2023).

A rising demand for mental health services for older people is evident. The UK and Europe report increasing referrals to inpatient liaison psychiatry teams (Ferrari et al. 2020; Crowther et al. 2021). Over ten years in Australia, primary mental health services for older people increased for psychological therapy, general practice treatments and psychiatric services (Bartholomaeus et al. 2023). In several regions of NZ, older people’s contact with specialist mental health services increased 2.5% annually from 2009 to 2015 (Cunningham et al. 2019).

An increased need for mental health services for older people has an impact on access. Healthcare access can be defined as having five fundamental dimensions: approachability (the ability to perceive), availability (the ability to reach), affordability (the ability to pay), acceptability (the ability to seek) and appropriateness (the ability to engage), which encompasses aspects of quality of care (Levesque et al. 2013). Older people experience barriers to mental healthcare across all these dimensions. For example, mental health symptoms may be misattributed to a ‘normal’ process of aging by patients and health professionals (Cummings and Kropf 2011; Ouchida and Lachs 2015; Wuthrich and Frei 2015) and older people may not seek help due to mental health stigma and ageism (Polacsek et al. 2019; Reynolds et al. 2020) or not perceiving a need (Sareen et al. 2007; Forbes et al. 2017; Knight and Winterbotham 2020; Takase et al. 2022). Older people with mental health conditions are less likely than younger people to be referred to a psychiatrist, psychologist or psychotherapist (Maust et al. 2015; Walters et al. 2018). Cost is a commonly reported barrier to seeking or continuing mental health treatment in older adults (Wuthrich and Frei 2015; Polacsek et al. 2019; Coombs et al. 2021; Rens et al. 2022). Short appointment times, long waiting lists and lack of co-ordination of care are additional barriers (Cummings and Kropf 2011; Polacsek et al. 2019; Schwarz et al. 2022; Takase et al. 2022). Depression in older people is commonly under-recognised and undertreated (Bor 2015; Briggs et al. 2018), even as over-prescribing of anti-depressants put older people at a higher risk of adverse effects, including increased mortality (Read et al. 2016). In the US, it is estimated that 60% of older people with mental health conditions do not receive appropriate care (Adepoju et al. 2018) and people with mental health conditions are more likely to experience barriers to healthcare than those without (Corscadden et al. 2018).

Concerns around access to mental healthcare in NZ prompted a Government Inquiry in 2018 (The Government Inquiry into Mental Health and Addiction 2018), which concluded that many New Zealanders experience poor access to and quality of mental health services. However, the Inquiry did not look specifically at services for older people. In NZ, older people’s secondary mental health services are publicly funded and provide community-based and inpatient specialist help to older people experiencing severe mental health problems. But these services are not uniformly available around the country and the ratio of medical staff to number of community referrals per year ranges from 1:115 to 1:1300 (Cheung et al. 2018). Primary care services provide mental healthcare to those with mild-moderate mental health problems, but these are generally fee-for-service, as are most psychologists and counsellors. Psychiatrists can also be seen in private practice.

A paucity of research about older people with mental health conditions in NZ may be partly due to a lack of nationally consistent routine data collected on all types of mental healthcare used by older adults (Cunningham et al. 2019). Although some data exist for secondary mental healthcare, there are no data on mental healthcare delivered in primary care or from private services. The level of unmet need for older people with mental health conditions is unknown and there have been no qualitative studies of their experiences of service use.

This study addresses these gaps in knowledge about older New Zealanders who use mental health services, by seeking to:

• Understand the amount of unmet need related to mental healthcare

• Assess the accessibility and quality of mental healthcare for older adults and reasons for poor access and quality of care.

Methods

Study population

A nationwide survey was undertaken in February to April 2019. Those eligible to take part were aged 55 and over and self-identified as currently using mental health services, which explicitly included community health services, seeing a counsellor, or seeing a general practitioner for mental health.

Survey development and content

The survey was developed from the questionnaire used in an Australian study of mental health care in older adults (SANE Australia 2013) and included questions from the New Zealand Health, Work and Retirement survey (Phillips 2019). Our questionnaire was also informed by a review of the literature on mental illness and aging, and in consultation with experts in this area, including people with experience of mental illness. The questionnaire was piloted with two people from the target population, who suggested minimal changes.

Sociodemographic questions included age, gender, ethnicity, hours of paid employment per week, location and rurality of residence. Mental health questions included mental health diagnosis, age at first use of mental health services, length of time having used mental health services and which health professionals were being seen for mental health, and whether respondents were taking regular medication for mental health. Questions to assess service quality, safety and accessibility of care included whether respondents could access mental health services in a crisis, satisfaction with treatment for mental health, whether mental health needs were being met, whether mental health services treated them with respect, whether they trusted the mental health services they used and when was the last time that mental health medication was reviewed.

Qualitative questions analysed in this paper were: What do you think of the mental health services you use? Do you have any other comments you wish to make about the topics raised in this survey?

Recruitment and data collection

The survey was predominantly online (using Qualtrics), with paper copies available throughout services in the Wellington and Southland regions, which could be returned via a pre-paid envelope.

The survey was advertised and distributed online and in-person through mental health organisations (including those targeting adults aged 65 and older), and online through the Office for Seniors (a Government agency), and non-government organisations such as Carers New Zealand, Age Concern and older adults’ charities. Advertisements invited people to visit a webpage with a link to the online questionnaire, to contact a toll-free number, or email to receive a written questionnaire, which was then posted out to respondents.

Due to logistic constraints, paper copies were only available in two regions. Approximately, 15 percent of responses were received on paper copies.

Data analysis

Questionnaire responses were transferred from Qualtrics into an anonymised dataset for analysis. Responses from paper copies were manually entered. For the quantitative data, descriptive statistics were produced in Microsoft Excel (version 2209). We used chi square tests to look for differences by age, gender, rurality, region and income adequacy across the four measures of patient experience and access to crisis services. Response rates to individual questions varied. Missing data were treated as missing at random and proportions were calculated using the denominator of those who responded to each question (not the total sample).

Responses to the qualitative questions were collated and separated into themes using NVivo (QSR International Pty Ltd, Release 1.6.1), to explore reasons for results found from the quantitative analysis on service quality and accessibility. A deductive approach to analysis was taken, using Levesque’s framework on access to health care (Levesque et al. 2013) as an initial coding scheme. Given that survey respondents had already recognised a health need and sought care, themes related primarily to the domains of availability (relating primarily to physical accessibility and timeliness of care), affordability (which includes direct, indirect and opportunity costs of healthcare) and appropriateness (with a strong focus on how well healthcare fit with the needs of respondents and quality of care). Initial analysis was undertaken by FI; other members of the research team reviewed the coding framework, checked final themes against the data and agreed on interpretation through discussion. Team members’ expertise and background included public health/epidemiology (FI/RC), mental health research (RC/DP), mixed methods (FI), qualitative research (DP) and lived experience (DP/FI).

Quotes to illustrate each theme were inserted verbatim but corrected for spelling and grammar to aid clarity, with identifiers including age range and gender.

Ethics

Ethics approval was sought and received through the Central Ethics Committee (reference 18/CEN/113).

Results

Characteristics of survey respondents

The survey was completed by 227 respondents of whom most were female, aged 65–74, and New Zealand European (Table 1). Most were not in paid employment and two thirds considered their income to be adequate for their needs. From the 203 respondents who provided one or more mental health diagnoses, depression and anxiety were the most common.

Table 1. Characteristics of survey respondents.

Socio-demographics		n	%
Gender	Male	49	24
	Female	157	76
	Other	1	0
Age group	55–64	51	22
	65–74	147	65
	75+	29	13
Ethnicity (total response)	New Zealand European/Other	210	93
	Māori	11	5
	Pasifika	3	1
	Asian	2	1
Hours of paid employment per week	0 h	152	72
	1–9 h	17	8
	10–19 h	18	8
	20 h or more	25	12
Income	Adequate for needs	141	67
	Not adequate for needs	68	33
Rurality of residence	City	115	55
	Small town	63	30
	Rural	30	14
Region of residence	North Island	149	72
	South Island	60	29
Health characteristics
Mental health diagnosis	Depression	159	78
	Anxiety	132	65
	Psychotic disorder	44	22
	PTSD	26	13
	Personality disorder	16	8
	Addiction	12	6
	Neurological disorder (including dementia)	10	5
	Other	21	10

Use and experience of mental health services

Most respondents had accessed mental health services before age 65 years and over half had used mental health services for over 10 years (Table 2).

Table 2. Experiences of mental health services.

Experience
Characteristics of service use		n	%
Age at first use of mental health services	Before age 65 years	176	78
	65 years or older	50	22
Length of time using mental health services	More than 10 years	122	54
	10 years or less	102	46
Health professionals seen for mental health care	General practitioner	184	81
	Only General practitioner	42	19
	Counsellor	76	33
	Psychiatrist	67	30
	Psychologist	62	27
	Mental health nurse	28	12
	Older people’s mental health service	26	11
	Mental health support worker	21	9
	Social worker	14	6
	Occupational therapist	10	4
Service availability
Could access mental health services in a crisis	Yes	112	53
	No	19	9
	Unsure	81	38
Patient experience of service quality
Mental health needs met	Yes	120	57
	No	92	18
	Unsure	53	25
Satisfaction with mental health treatment	Extremely/somewhat satisfied	131	62
	Neither satisfied nor dissatisfied	38	18
	Extremely/somewhat dissatisfied	43	20
I trust mental health services	All of the time	124	62
	A little to a moderate amount of the time	56	29
	Rarely or none of the time	20	10
Mental health services treat me with respect	All of the time	137	68
	A little to a moderate amount of the time	53	26
	Rarely or none of the time	11	5
Safe practice
Regular medication for mental health	Yes	169	80
	No/unsure	42	20
Last review of mental health medication	Within the last year	133	80
	More than a year ago	33	20

General practitioners (GPs) were most often seen for mental health conditions, but usually in combination with another healthcare provider (Table 2). Counsellors, psychiatrists and psychologists were the next most commonly seen providers. Around a third of respondents were seeing only one practitioner for mental health, another third were seeing two and the remainders were seeing three or more. Relatively few (11%) had used an older people’s mental health service.

Nearly one in five respondents did not think their mental health needs were being met, with another quarter being unsure. Nearly half thought they could not access services in a crisis or were not sure. Only 62% were satisfied with their mental health treatment and trusted mental health services all of the time and 68% reported that mental health services always treated them with respect. There were no significant differences in the experiences of health services or perceived accessibility of crisis services by age (those aged 55–64 years compared to those aged 65 or older), gender, rurality or region, but those who reported that their income was inadequate for their needs were significantly less likely to report that mental health needs were met or felt treated with respect or trusted mental health services all of the time.

Eighty percent of respondents said they took regular medication for their mental health, but one-fifth of these had not had their medication reviewed within the last year.

Accessibility of mental health services

The qualitative analysis explored reasons for mental health needs not being met and aspects of service accessibility that contributed to satisfaction or dissatisfaction with care.

Overall, responses were more positive than negative, especially for GPs and psychologists/counsellors, with more ambivalence for secondary care services. However, experiences were variable, which was consistent with the quantitative results on service quality. Differences in access between public and private services were apparent, and are discussed, as relevant, within each theme.

Timeliness

Long waiting times and difficulty in getting an appointment were common problems. However, this was not uniformly experienced across all mental health services. Timeliness of access could depend on where the individual lived and what services were funded or available in that location. It also depended on when help was needed (e.g. care was more difficult to access at weekends, holidays and after hours) and for what (e.g. addiction services were noted to be lacking).

My KEY worker is not KEY at all. She works part-time and is over booked, often impossible to see within a short time. It's “inconvenient” to have a mental health crisis on a Friday night! Then you're really in for the worst weekend of your life. (55-64,F)

I feel I am one the lucky ones in terms of access to facilities as I live in a city where these services are mostly found. (75+,F)

Variability in timeliness was experienced for primary care, psychologists and counsellors, secondary and crisis care, with some people finding these services responsive and available when needed and others having to wait, often for significant periods of time, even for urgent care. However, secondary services were more often unavailable or had lengthy waiting times, and even when respondents were ‘in the system’, they reported staff not responding to messages or following up.

I am unsure if I would be able to access mental health services in a crisis unless it was my own GP. I have no faith of the mental health service available where I live. (75+,F)

Private mental health care was generally more available, and some people took this option as the only way to be seen in a timely manner.

All [mental health services used] privately funded as it takes too long to get help through public services. (55-64,F)

Financial cost

The direct cost of having to pay for services was frequently reported as an issue. There was an intersection between timeliness and financial cost, as people who could afford to pay for private mental health services were able to gain quicker access to care. This could feel like the difference between life and death.

When I was seriously ill 18 months ago she [my GP] said I needed the services of a psychiatrist. There was a 6–8 week waiting time to see the DHB psychiatrist. I could not survive that long and had to visit a private consultant. That was extremely costly for me and I think there should be more psychiatrists available for lower income people. (75+,F)

Financial cost was also a burden and barrier to seeing psychologists and even primary care. The lack of subsidised and affordable mental health services for older people on lower incomes meant that not everyone was able to access services that might benefit them, or they would have less discretionary income for other things that might help their mental or physical well-being.

I like my psychologist and he is relatively cheap and handy. He has given me excellent cognitive therapy. However, the cost of such help does mean that I have to budget carefully for it and it is not covered by Southern Cross [private health insurer]. Looking into old age and limited income, I recognize that it will be difficult to finance psychological assistance later on. (55-64,F)

They [mental health services] are expensive so I don’t avail myself of the help. (65-74,F)

Continuity of care

Lack of continuity of care interrupted the building of a trusted relationship with health professionals and could be a barrier to progress. This was particularly an issue in publicly funded secondary care services. The desire for continuity, having both choice and consistency over who was seen, was another reason to pay for private care.

The continuity of care is dreadful. Key workers, doctors, receptionists, shrinks, all clinicians!! come and go from my DHB … This has made it increasingly difficult/impossible to trust anyone in a new role as part of my “recovery” (55-64,F)

Relationship quality

Positive experiences of care related to being listened to, treated with kindness, empathy, understanding and respect. People sometimes felt brushed off and not cared for, often in the context of services being too busy or unavailable and short appointment times in primary care. However, many health professionals, particularly GPs, were praised as being supportive and caring.

The two GPs I have attended at the practice I go to have really listened to me, and then helped me with medication … making suggestions as to how I could cope. (65-74,F)

Experiences of relationship quality could vary between public and private mental health services, which highlighted the connections between timely care, continuity of care and establishing trusted relationships. However, this type of care, which connected all of these aspects, might only be available to those who could afford to pay for it.

I see a private psychologist and psychiatrist and I find this treatment way better than the DHB [District Health Board, that funds public healthcare] service I was using. Privately you don’t feel like just another number in the cog of the DHB machine. Very impersonal using DHB services as opposed to private ones. (65-74,F)

Co-ordination between primary and secondary healthcare services

The interface between primary and secondary care often worked well, with referrals and consultations occurring appropriately, but sometimes fell short of expectation and need. This usually related to the mental and physical health needs of the respondent not being considered holistically by either service or a failure to establish responsibility for on-going care.

I get sick and tired of being passed between my GP services and Community Mental Health Services. I wish these two could work together for me as an individual with complex needs. Mental health services want me to take meds that effect my physical health. GP is too scared to challenge mental health about this. (55-64,F)

Emergency department sent me home with no follow up even though I was suicidal and presented them with the cocktail of drugs I had prepared to take. (55-46,F)

This lack of co-ordination could lead to situations where safe practice was compromised, particularly around the prescribing of medication. Several respondents reported adverse drug interactions that may have been avoidable.

Some people felt they were being discharged from public specialist services to their GP prematurely or without considering the impacts of mental health treatment on physical health (e.g. weight gain caused by some medications). This also related to issues of continuity and timely, available care. Seeking private secondary care could remedy these concerns. Again, this was only an option for those who could afford it; others had no choice even if they might prefer to see a psychiatrist instead of or as well as a GP.

I feel I should have a psychiatrist review my mental health and my medication and not just my GP. (65-74,F)

Discussion

This study of adults aged 55 and over included people with a range of mental health diagnoses and treatment histories, accessing a variety of services for mental healthcare. Depression and anxiety were the most commonly reported diagnoses, consistent with prevalence estimates of mental health conditions in older people (Volkert et al. 2013; Andreas et al. 2017).

Experiences of mental healthcare

Despite many respondents reporting positive experiences, one in five were dissatisfied with mental health services. This was similar to results from a NZ mental health consumer survey in 2016, where 80% of respondents (of all ages) were satisfied with publicly funded mental health services (Ministry of Health 2016). From our survey, only 68% felt respected by mental health services all of the time, somewhat higher than that found in a 2020 NZ mental health consumer survey (59%, also including all ages) (Health Quality and Safety Commission New Zealand 2020) but much lower than reported in adult patient experience surveys of overall healthcare in NZ (including those with and without mental health disorders). From the August 2022 primary care and inpatient experience surveys, 90–95% of patients felt that health professionals treated them with respect (Health Quality and Safety Commission New Zealand 2022). This gap may be a function of differential care provided to people with mental health disorders at any age, or due to differences in service delivery from mental healthcare. It could also result from a bias in our survey sample, which requires further research. However, it is notable that in the general population surveys, older respondents tended to report more positive experiences of care (Health Quality and Safety Commission New Zealand 2022). Our survey indicates that poor experience associated with mental health conditions continues into older age.

Another contributing factor to poorer patient experiences of mental health services was income adequacy. Lower income is known to be associated with lower patient satisfaction with health services (Chen et al. 2019; Okunrintemi et al. 2019) but the underlying reasons for this are likely to be a combination of health system factors (e.g. fewer, busier or less resourced services in areas of socioeconomic deprivation), clinician and patient factors (Okunrintemi et al. 2019). However, improving the financial security of older adults with mental health conditions is likely to have a positive impact on wellbeing (Golberstein 2015; Ervin et al. 2021).

Although most respondents took regular mental health medication, one in five had not had their medication reviewed in the last year, which could contribute to adverse effects. It is recommended that older people have regular medication review, weighing up benefits and harms, including whether and how medications can be safely discontinued (Department of Health 2001; National Institute for Health and Care Excellence (NICE), 2015).

Unmet need and accessibility of mental healthcare

From this survey, nearly one in five respondents did not think their mental health needs were being met, and another quarter was unsure. Similarly, nearly half were either unsure or thought they could not access services in a crisis. This is consistent with the Government Inquiry into Mental Health and Addictions (The Government Inquiry into Mental Health and Addiction 2018), which found that mental healthcare services were considered difficult to access, of poor quality for some and that many people felt unable to access services in a crisis.

International research also documents high levels of unmet mental health need. From a population survey in Belgium, only half of those who were clinically assessed as having mental health needs had accessed mental healthcare (Rens et al. 2022). In the UK, 46% of older people in contact with adult psychiatric services had a self-assessed unmet psychiatric need, but this was 33% for those accessing specialist older adult mental health services (Abdul-Hamid et al. 2015).

Few models of care are specifically designed for older adults with mental illness (Bartels et al. 2014). In our survey, relatively few respondents (11%) had used older people’s mental health services, and the latest survey of Psychiatry of Old Age services in NZ raised concerns over a lack of dedicated services to those aged 65 and older with long-standing mental health or addiction issues (Cheung et al. 2018). Without increased and targeted funding to these types of services in the face of a growing population of older people, even fewer of those with chronic, severe or complex mental health needs will be able to access appropriate mental health services. The same can be said for primary mental healthcare services for older people with mild-moderate mental health conditions (Bartholomaeus et al., 2023). There needs to be consideration of how changing models of care for mental health and addiction issues are being implemented in response to the Government Inquiry, and how these will work, and be funded, for older people.

Survey respondents reported on multiple barriers to accessing mental healthcare. Long waiting times and unavailability of public services led some to pay for private services, but this was unaffordable for others. This potentially affected a large proportion of the survey sample, as a third of respondents perceived their income as inadequate for their needs and most were not in employment. Hence, although secondary mental health services are publicly funded, it was unavailability that created the barrier to access. In other research, financial cost of private services coupled with inaccessibility of public services was also found to be a deterrent to seeking help for mental health issues in older people (Polacsek et al. 2019; Schwarz et al. 2022). In addition, primary healthcare, including for mental healthcare, is not free in NZ, creating another cost barrier, both for people seeking help for mild-moderate mental health issues and those with more severe issues who need referral to secondary services. These cost barriers to primary healthcare and private secondary mental healthcare may mean that mental health issues have to become severe before people are eligible for funded care, and these presentations may have been preventable with timely and affordable early intervention.

The lack of services in regions outside a main centre has also been noted as a barrier (Polacsek et al. 2019; Schwarz et al. 2022) and mental health workforce shortages hamper the ability of mental health services to provide timely and effective care (Ministry of Health 2018; Tampi 2019). Another issue is that private mental healthcare services are not generally equipped for crisis intervention, so even those able to afford private care may find it difficult to access help in an emergency.

Co-ordination of care between primary and secondary healthcare services for older people is not only important for treating and managing mental health (Reynolds et al. 2020; Takase et al. 2022) but also physical health needs (de Carvalho et al. 2017). Siloed healthcare that lacks an holistic patient-centred approach will contribute to unmet needs (Schwarz et al. 2022) and poorer quality of services (Tampi 2019).

Ongoing monitoring of the accessibility of mental healthcare services for older people is needed, through consistent national data collection of mental health service use and patient experience (in both primary and secondary care) (Cunningham et al. 2019).

Strengths and limitations

This was the first nationwide survey of older adults in NZ who use mental health services. The combination of quantitative and qualitative questions allowed us to gain a broad overview of patient experiences of mental health services and explore the reasons for these experiences in more detail. Survey respondents were predominantly female and NZ European, so that our qualitative analysis relied primarily on females. Higher response rates to research questionnaires by females have been noted elsewhere (Becker 2022). A low response by Māori and non-NZ Europeans may relate to digital exclusion (Grimes and White 2019; Department of Internal Affairs 2020) and meant we could not analyse results by ethnicity and our findings may not represent the experiences of non-European New Zealanders. We recommend further research with these groups, especially older Māori, using methods that are likely to increase engagement.

An online survey is the most practical and cost-effective way of reaching large numbers of people and allows people to answer in a setting of their own choosing, remain anonymous, and self-identify as being interested in the issue. Online surveys are becoming a more accepted method to undertake mental health research and have regularly been conducted with people with experience of mental illness in NZ (Health Quality and Safety Commission New Zealand 2020, 2022). However, not all older people have access to or are comfortable with using the internet. We sought to overcome this barrier by making paper copies of the questionnaire available, that could be returned by pre-paid post. Unfortunately this was only feasible in our local area and one other.

The survey sample was relatively small although comparable to the national mental health consumer survey in 2019 (n = 228), which had a target population of all adults using mental health services (Health Quality and Safety Commission New Zealand 2020). A similar Australian survey had difficulty recruiting people aged 65 plus, achieving 111 responses (SANE Australia 2013).

Since this survey recruited people using mental health services, most people were aware of services, although a few were unaware of mental health services specific to older people. This may be different in a general population of older people, who may have unrecognised and undiagnosed mental health conditions. Our survey did not aim to obtain a representative sample of older people with experience of mental illness as we lacked a sampling frame to achieve this but our sample allowed us to gain an understanding of barriers to access that are likely to be relevant to many.

Conclusion

This survey of older adults who use mental healthcare services highlights the issues with accessibility and quality of such services in NZ. The experiences reported by respondents can be used to inform service improvement and focus attention on the need for services that are able to cater for an aging population. Services need to cope not only with a growing demand, but to provide mental health services that are appropriate for the needs of older people, that value respectful and integrated care, and that are widely available and affordable so that inequalities in outcomes for people with mental health conditions are not exacerbated.

Acknowledgements

Abigail Freeland assisted with data collection and creation of dataset for quantitative analysis. This manuscript was written in accordance with the Standards for Reporting Qualitative Research guidelines.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the New Zealand Lotteries Grant Board under Grant R-LHR-2017-69627.