Older adults access to mental health and social care services during COVID-19 restrictions in Western Australia

doi:10.21203/rs.3.rs-2109561/v1

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Research Article

Older adults access to mental health and social care services during COVID-19 restrictions in Western Australia

https://doi.org/10.21203/rs.3.rs-2109561/v1

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published 02 Nov, 2022

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Objective: This study aimed to understand the impact of COVID-19 on access to mental health and social services among older adults in Western Australia.

Method: A cross-sectional study was conducted with 194 adults aged ≥70 years or ≥60 years with chronic conditions. A questionnaire co-developed by a consumer reference group was used to collect data on social networks and service access. Frequency analyses were used to assess quantitative data. Qualitative data were assessed using thematic analyses.

Results: 62.7% of participants reported being not at all/slightly affected by COVID-19; 40.7% reported having three/four people to chat with. 76.3% of participants did not access mental health or social services during the 2020 COVID-19 restrictions. The remaining 23.7% mostly accessed mental health-related services, with GPs the most common source of support. 18.0% of the total sample reported choosing not to access services even though they would have liked to.

Conclusions: Most older adults in this sample did not access mental health or social care services. 18.0% of all participants felt they needed services but did not access them. This suggests there were some unmet needs within the community. Strengthening social networks may help protect older adults against psychosocial declines during and post-COVID-19.

attitudes

barriers

COVID-19

health service utilisation

older adults

What is already known about this topic?

• Older adults are at an increased risk of social isolation, loneliness, and mental health declines during COVID-19

• COVID-19 has brought a substantial need for, and disruption to, mental health and social care services locally and globally

• Services have had to change the way they deliver care, which has presented challenges in providing mental health and social support to older adults

What this topic adds?

• Most older adults did not access mental health or social care services during the 2020 COVID-19 lockdown

• The greatest barriers to access were the belief that I ‘should be able to cope on my own’ and a preference for face-to-face care

• Local governments and community organisations play a key role in strengthening social networks and protecting older adults’ psychosocial wellbeing during and post-COVID-19

Older adults are at a high risk of severe morbidity and mortality due to COVID-19. Pooled data from 16 countries indicate 86.2% of COVID-19-related deaths were among people aged 65 years and older (Yanez et al., 2020). To protect older adults from contracting COVID-19, governments worldwide have posed restrictions such as lockdowns, curfews, social distancing, and isolation measures. Further, they advised people aged 70 years and older and those with chronic conditions to stay at home and avoid contact with others (Armitage & Nellums, 2020; Healthdirect, 2021).

Social isolation, resulting from such restrictions, is known to have adverse consequences for older adults’ physical, mental, and psychosocial health (Yeung et al., 2020). Prolonged social isolation is commonly linked to loneliness, and has been associated with higher rates of cardiovascular disease, poorer immune functioning, increased psychological distress, and greater risk of developing dementia (Wu, 2020). During COVID-19 restrictions, high rates of anxiety, depression, and sleep disturbances have been observed in older adults, and one in eight older people reported they were lonely ‘very often’ (Bailey et al., 2021; Sepúlveda-Loyola et al., 2020). It is predicted that detrimental mental health effects of COVID-19 will be enduring, thus it is paramount to understand how services can better meet the mental health and social needs of older adults (Veldhuis et al., 2021).

COVID-19 has brought a substantial need for, and disruption to, mental health and social services (Giebel et al., 2021). Services have been required to adapt to different modes of delivery and provide alternate forms of support, including telephone and online formats (OECD, 2021). This has posed challenges in providing mental health care to older people, who already experience inequalities in accessing mental health treatment (The Royal College of Psychiatrists, 2018).

Staff perspectives on delivering mental health care to older adults during COVID-19 suggest loneliness and limited access to support from family, friends, and usual services (e.g., primary health care, social care) are relevant problems (Ashcroft et al., 2021; Bhome et al., 2021). However, less attention has been paid to service delivery from the perspectives of older adults themselves, and preferences in the type of mental health and social support remain unclear. It is important to understand service delivery from the perspectives of potential and current service users, to ensure services are appropriate, and meet the needs of those they intend to serve.

In Australia, rates of service use declined in the 2020–2021 period compared with the year prior, and mental health service use showed the greatest declines (Australian Bureau of Statistics, 2021). Cost was often cited as a reason for not seeking help (Australian Bureau of Statistics, 2021). In Western Australia (WA), although the spread of COVID-19 has been limited compared with other states and countries, service use has still been impacted (Callis et al., 2020), and continues to be affected since the easing of interstate and international borders in March 2022.

Given the challenges faced in service provision during COVID-19, it is important to understand older adults’ patterns of service use during the pandemic, to identify effective ways to support older adults’ psychosocial needs. This is particularly important as the mental health impact of COVID-19 is expected to be long-lasting and future epidemics/pandemics are anticipated (Marani et al., 2021; Veldhuis et al., 2021). Research in this area may help to better equip our mental health and social care services for future crises, as well as potentially mobilise initiatives to improve the health and wellbeing of our ageing society post-pandemic.

The aim of the present study was to understand the impact of the COVID-19 pandemic on access to mental health and social care services among older adults in WA. We chose the period in which Western Australians have been most affected by COVID-19 restrictions to investigate service use: the mid-March 2020 to early June 2020 period. During this time, social and work restrictions were posed, and older adults were encouraged to stay at home to reduce the risk of infection. As such, we refer to COVID-19 restrictions and stay at home orders as lockdowns for older adults. The research questions for this study are: What are older adults’ experiences with mental health and social care services during COVID-19? What are common barriers and facilitators to accessing mental health and social care services during the 2020 COVID-19 lockdown among older adults in WA? What are current and future implications of the COVID-19 pandemic on mental health and social care services among older adults in WA?

Study Design

The current study employed an online survey design. Cross-sectional data were collected online using Qualtrics research services and convenience sampling from health centres and community groups. Data collection took place April-August 2021.

Participants

Adults 70 years and older, or 60 years and older with chronic medical conditions were recruited. Participants were excluded if they did not reside in WA, if they had a diagnosis of dementia, including Alzheimer’s disease, or if they did not meet the age and/or health criteria. Such screening questions were included at the beginning of the online survey to determine eligibility. Participants who did not meet the criteria were automatically excluded by the survey program. Participants provided informed written consent prior to commencement of the study via a check box at the beginning of the online survey.

Measures

Questionnaire Development

A questionnaire co-developed by a consumer reference group and the research team was used to collect data. The consumer reference group comprised eight older adults living in WA. The research team included a general practitioner with primary care knowledge, a registered psychologist, two epidemiologists, and researchers with expertise in psychology, gerontology, and public health. The questionnaire was informed by qualitative interviews conducted with older adults in WA as part of another study by the authors.

The consumer reference group had input into each item in the questionnaire. Specific questions were driven by the reference group, including options for getting out of the house and preparedness for lockdowns. Upon advice from the reference group, when asking about the utilisation of mental health and social care services, terms such as anxiety and depression were phrased in general to aid in participants interpretation of the questions. The phrasing “did you discuss or try to discuss feeling down, worried or alone with any of the following?” was agreed upon by the reference group. Based on feedback from the reference group, all COVID-19 restrictions were referred to as ‘lockdowns’ to aid with recall and comprehension.

The questionnaire was piloted with 14 older adults in WA, who were recruited using Qualtrics research services. Minor amendments were made before the questionnaire was implemented in the present research. A copy of the questionnaire is provided in Appendix A.

Demographic Information

Participants provided demographic information and were asked to indicate their options for getting out of the house through one multiple choice question. Participants were asked to rate the extent to which they had been personally affected by COVID-19 on a 5-point Likert-type scale from not at all to extremely.

Social Networks

Participants were asked to respond to two items measuring the strength of their pre-existing social networks. Each item was rated on a 6-point Likert-type scale, higher scores indicate wider social networks.

Utilisation of Mental Health and Social Care Services

Mental health and social care services were defined as any service or organisation that provides formal or informal mental and psychosocial support to older adults. Support may be provided by government funded specialist and non-specialist services, not for profit organisations, and/or community groups (Australian Institute of Health and Welfare, 2021). A list of services is provided in Table 1.

Participants reported whether they accessed mental health and social care services during the 2020 COVID-19 lockdown (mid-March 2020 to early June 2020). Participants who reported accessing services during this time were asked to indicate which one service provided them the greatest support.

[Insert Table 1 here]

Experiences with Services

Participants who accessed services during the 2020 COVID-19 lockdown were asked to rate their overall experience with the service(s) in meeting their needs. This was assessed using 11 self-report items, rated on 4-point Likert-type scales from strongly disagree to strongly agree. Needs rated included time frame, communication, cultural and language needs, affordability, safety, ease of access, and comfort with technology/remote delivery.

Barriers to Accessing Services

All participants were asked to indicate whether there were any services they would like to have accessed to support their mental health during the 2020 COVID-19 lockdown but chose not to access. Participants who chose not to access services were asked to indicate what prevented them from accessing services from a list of 17 possible reasons. The possible reasons listed were based upon barriers identified in previous qualitative research by the authors. Participants were also asked to describe any difficulties or barriers to accessing services during lockdown with one open-ended question.

Facilitators to Accessing Services

All participants were asked whether there was anything that made it easier to obtain the support they needed during lockdown with one open-ended question.

Attitudes towards Service Use Post-Lockdown

Attitudes towards accessing services since the 2020 COVID-19 lockdown were assessed using four items, designed to measure knowledge and comfort in accessing help, and perceived changes in access to support since COVID-19. Each item was rated on a 4-point Likert-type scale from strongly disagree to strongly agree. Participants could also indicate if there were no perceived differences.

Preparedness for Lockdowns

In February 2021, the Perth, Peel and Southwest regions of WA entered a five-day lockdown. People were required to stay at home unless they needed essential services or supplies. Participants’ preparedness for the February 2021 lockdown was measured using one item, rated on a 3-point scale from more prepared, the same, to less prepared for the February 2021 lockdown than the 2020 COVID-19 lockdown. Participants were asked to provide a reason for their response.

Data Analysis

Frequency analyses were used to report on demographic information, social networks, utilisation of services, experiences with services, barriers, attitudes, and preparedness for lockdowns. Continuous data were reported as means (M) and standard deviations (SD). Categorical data were reported as counts and percentages. Missing data were not replaced as less than 5% were missing (Jakobsen et al., 2017). Qualitative data obtained from open-ended questions were assessed using thematic analyses. SPSS version 27 was used to analyse quantitative data. Qualitative data were analysed using Microsoft Excel.

Community Participation

The consumer reference group provided input into all stages of the research process, from study design to translation of findings. The study documents (e.g., information letter, questionnaire) were co-developed by the researchers and reference group, and the research findings were presented to the reference group, supporting the interpretation and dissemination of results. Reference group members discussed whether they considered the findings to be representative of the community and made recommendations for future research and changes to service delivery. Including a consumer reference group helped ensure the research was relevant to and informed by the target population.

Ethics Approval

Ethics approval was granted by the Edith Cowan University Human Research Ethics Committee, approval number 2020-01693-STROBEL.

There were 194 older adults included: 109 (56.2%) females and 85 (43.8%) males. The mean age of participants was 71.41 years (SD = 6.93). Most participants resided in the Perth metropolitan area (n = 154, 79.4%). Most participants were born in Australia (n = 111, 57.2%), followed by the United Kingdom (n = 52, 26.8%), and New Zealand (n = 5, 2.6%); 191 (98.5%) spoke English as their main language at home. There were 75 participants (38.7%) who reported living with a chronic health condition. Participant characteristics are presented in Table 2.

[Insert Table 2 here]

Regarding options for getting out of the house, most participants 186 (95.8%) were able to get out of the house by driving, public transport and/or walking, 4 (2.1%) could only leave the house with aid, and 4 (2.1%) were housebound. When asked to rate the extent to which they had been personally affected by COVID-19, 60 (31.1%) reported not at all affected, 61 (31.6%) slightly, 55 (28.5%) moderately, 15 (7.8%) very, and 2 (1.0%) extremely affected.

To assess participants’ social networks, an indication of social isolation, frequency analyses were conducted (Table 3). Participants commonly reported having three or four people they could call on for help (n = 86, 44.3%), and three or four people they were able to have a chat with if they were feeling down, worried or wanted to be less alone (n = 79, 40.7%). Concerningly, 8 (4.1%) participants had no one they could call on for help, and 13 (6.7%) participants had no one they felt able to have a chat with.

[Insert Table 3 here]

Older Adults Experiences with Mental Health and Social Care Services

Most participants (n = 148, 76.3%) did not access mental health or social care services during the 2020 COVID-19 lockdown, 23.7% (n = 46) did access services. Of the participants who did access services, 54.4% (n = 25) accessed mental health-related services only, 17.4% (n = 8) accessed social care services only, 21.7% (n = 10) accessed both mental health and social care services, and 6.5% (n = 3) accessed other services. Most participants reported that mental health-related services provided them with the greatest support, with GPs the most common source of support (n = 24, 58.5%).

Experiences with services during the 2020 COVID-19 lockdown were generally positive. Of those who accessed services, most agreed the services met their needs (n = 33, 76.7%), felt their needs were met within a reasonable timeframe (n = 31, 72.1%), and were able to discuss their needs (n = 33, 76.7%). However, 65.1% (n = 28) would have preferred getting information or support face-to-face. A summary of participants’ experiences with services is provided in Table 4.

[Insert Table 4 here]

Barriers and Facilitators to Accessing Services during the 2020 COVID-19 Lockdown

Of the overall sample of 148, 35 participants (18.0%) reported they would have liked to access a mental health or social care service during the 2020 COVID-19 lockdown but chose not to. Among this group, 42.8% did access a service but wanted to access other services. Barriers to accessing services are presented in Table 5.

[Insert Table 5 here]

The two most endorsed barriers to accessing services were the belief that I ‘should be able to cope on my own’ (n = 15, 42.8%) and I ‘prefer face-to-face care’ (n = 11, 31.4%). Interestingly, no participant endorsed the belief that services cannot help them.

Qualitative feedback regarding barriers and facilitators to accessing services are presented in Figure 1. Eight participants provided qualitative feedback regarding barriers to service access and 18 participants reported on facilitators.

[Insert Figure 1 here]

Current and Future Implications of COVID-19 on Mental Health and Social Care Services

Participants’ attitudes towards accessing services since the 2020 COVID-19 lockdown were assessed in 2021. Attitudes were generally positive. Most participants reported knowing where to get information to help them (n = 122, 64.9%), most felt comfortable getting care that will help them (n = 108, 57.8%), and most thought support is easier to get now than before COVID-19 (n = 97, 51.9%). Changes made to service delivery appeared to have minimal impact on participants’ perceived access to services; 88 (47.8%) felt the changes made no difference, 57 (31.0%) reported the changes benefitted them, and 39 (21.2%) reported the changes did not benefit them.

Regarding preparedness for lockdowns, participants either felt more prepared (n = 91, 48.9%) or the same (n = 85, 45.7%) for the February 2021 lockdown than the 2020 COVID-19 lockdown. Participants reported they “knew what to expect” and it is “becoming a way of life”. Ten participants (5.4%) reported feeling less prepared, indicating it was “too much to take in”.

The present study aimed to shed light on the impact of the COVID-19 pandemic on access to mental health and social care services among older adults in WA. In our sample, 76.3% of participants did not access mental health or social care services during the 2020 COVID-19 lockdown. It is possible that many older adults did not require mental health or social support services during this time, as 62.7% of participants reported being ‘not at all’ or ‘slightly’ affected by COVID-19, and 40.7% reported having three or four people to chat with if feeling distressed or alone. This supports earlier work indicating older adults are able to adapt well to challenges (Neubauer et al., 2019), and suggests older adults in the present sample may have relied on their existing social networks for psychosocial support during COVID-19 restrictions if needed, rather than formal services.

Nevertheless, 18.0% reported choosing not to access services during lockdown, even though they would have liked to. This is greater than in the general population, where 6% of Australians reported needing to use a mental health or social support service since March 2020 but chose not to (Australian Bureau of Statistics, 2020). Older adults often have low rates of mental health service engagement and low perceived need for help (Byers et al., 2012; Wuthrich & Frei, 2015) and thus are more likely to be self-reliant than seek support. Furthermore, concerningly, 6.7% of participants had no one they felt able to chat with. It is therefore important that attention is paid to older adults in times of crisis, particularly now that border restrictions have eased in WA, as they may be likely to abstain from help-seeking.

Of the 23.7% of participants who did access services during the 2020 COVID-19 lockdown, mental health-related services were more commonly accessed than social care services. Most participants who accessed services had positive experiences; they felt their needs were met, and they felt able to discuss their needs, within a reasonable time frame. This is encouraging, as it suggests despite the challenges of delivering services during COVID-19, mental health and social care services were able to provide the care and support older adults needed.

The main reasons for not accessing care reported by the 18.0% who chose not to access services include I ‘should be able to cope on my own’ (42.8%) and I ‘prefer face-to-face care’ (31.4%). The belief that I should be able to cope on my own may indicate a low perceived need for help. A recent systematic review of 32 articles on barriers to mental health services among older adults found a lack of perceived need for professional help was a common barrier to accessing mental health care (Lavingia et al., 2020). Choi et al. (2014) found adults aged 65 years and older were less likely to perceive a need for treatment than younger age groups. Endorsement of this barrier may also be reflective of mental health stigma, which has been shown to reduce help-seeking and lead to self-reliance (Clement et al., 2015).

Preferring face-to-face care was the second most common reason for not accessing services in the present study. Older adults may not be comfortable using remote means (e.g., telephone, online) to discuss their mental health and prefer traditional forms of communication. However, it is important to note that this finding is not unique to older adults. March et al. (2018) conducted a community survey in Australia on attitudes towards online mental health services and found most adults in their sample (85.7%, n = 264) preferred traditional, face-to-face mental health support rather than internet-based support.

Being able to access mental health support remotely was also reported as a facilitator to accessing care by some participants. This highlights that there is not a 'one-size-fits-all' approach to service delivery. Older adults are diverse and have individual preferences and needs (Fulmer et al., 2021). Services that are adaptable and use multiple methods to provide care may increase the likelihood of older adults engaging with services to discuss their mental health.

Few older adults (8.6%) reported cost as a barrier to care, likely due to the availability of Government funded services. It is also interesting that no participant believed services could not help them. This indicates that all older adults in our sample felt mental health and social care services can provide them with the support they need, if/when required. Knowledge of available treatments, including beliefs that services are likely to be helpful, is a key component of mental health literacy (Jorm, 2012). Studies have demonstrated increases in mental health literacy in Australia over the past three decades; improvements in the perceived helpfulness of GPs, mental health professionals, and telephone support in providing mental health care have been observed (Jorm et al., 2006; Reavley & Jorm, 2011, 2012). Indeed, GP’s provided older adults with the greatest support during lockdown, accessed by 58.5% of service users. Thus, to encourage timely access to services, efforts should be focused on increasing knowledge of when to seek help, and reducing stigma, to alleviate barriers to care.

We reported our findings back to the consumer reference group who highlighted important areas for consideration. The reference group was concerned that 4.1% of participants had no one they could call on for help, and 38.7% had two or less people they can chat with. Whilst our sample may not be representative of the WA population, if it were, this represents 14,193 and 133,973 older adults respectively, who have no one they can call on for help or chat with, based on the latest 2016 census (Australian Bureau of Statistics, 2017). Improving relationships within older adults’ local communities may be important to fostering mental health and social wellbeing. The consumer reference group was also interested in participants’ options for getting out of the house, as this may be an indicator of their ability to access services. In our sample, 95.8% of older adults were able to get out of the house by driving, public transport and/or walking, which is comparable to the wider population of older adults in WA (Department of Communities, 2016). Including a more heterogenous sample of older adults, particularly those with English as a second language, was deemed important by the reference group to understand the needs of older adults who may have additional barriers to care. We were not able to detect whether services met older adults’ cultural needs and language needs in this study, as 98.5% of the sample spoke English as their main language at home.

The reference group felt that having health appointments via remote means during lockdown could be a barrier to care, but also enabled access to care, reduced physical barriers such as travel time and finding parking, and thus could be helpful particularly for routine appointments. Fear of catching COVID-19 was another barrier to care considered relevant by the reference group, which may have led to reduced service utilisation. Furthermore, additional data comparing the use of primary health and mental health services may have provided important information as to the type of mental health treatment received, however, we were unable to draw these comparisons in the present study due to limited sample size.

There are a few limitations to this study. WA has been relatively unaffected by COVID-19 compared with other states in Australia and overseas, with duration of lockdown being short compared with other jurisdictions, which may account for the low rates of service use in our study. Therefore, the results may not be generalisable to older adults living in other regions. Nevertheless, service delivery was still disrupted by COVID-19 and changes to service provision were widespread (Callis et al., 2020). Participants reported preferring face-to-face care, however, we did not collect data on which services did not deliver face-to-face care during the 2020 COVID-19 lockdown. Therefore, the actual availability of face-to-face care during this time is unclear. Further information on the availability of face-to-face care during lockdown would help to clarify this barrier. Additionally, nearly all data were collected via an online survey. This may have resulted in a sample with greater digital literacy than the general population. Although we offered face-to-face and telephone data collection to ensure participants with low digital literacy were not excluded, we were unable to recruit as many participants as we expected via these methods. Hence, it is likely that those hardest to reach were not represented in our study, biasing our sample.

A key strength of the present study is the inclusion of a consumer reference group who provided input into all stages of the research process. This aided in the interpretation of results and helped to ensure the research is relevant to older people in our community. Including consumers in research is significant to responsible health research and is in accord with recommended best practice (National Health and Medical Research Council, 2016).

Since the global spread of COVID-19, there has been an increased demand on mental health and social care services to meet the needs of their communities. WA has experienced increased community transmission of COVID-19 with the easing of interstate and international borders in March 2022. Thus, it is pertinent and timely to investigate older adults’ access to mental health and social care during COVID-19 restrictions, which may help inform the delivery of services. In the present study, older adults who did access services reported having their needs meet, indicating services have been resilient to coping with the increased demands and changes in service provision. However, some older adults (18.0%) reported choosing not to access services during the 2020 COVID-19 lockdown, and 38.7% had two or less people they felt able to chat with, which is concerning, and suggests more needs to be done to foster relationships within older adults’ local communities. Doing so may help to improve older adults’ psychosocial wellbeing during COVID-19 and in future times of crises, and potentially alleviate the pressure on formal services.

The present findings have important practice and policy implications. Given the belief that ‘I should be able to cope on my own’ was the main barrier to care, mental health and social care services may wish to focus their efforts on helping older adults to recognise when their mental health is declining, and when to seek help. Promoting timely access to support systems may help to facilitate early intervention and prevent health declines. Access to telephone and online consultations can act as both a barrier and facilitator to service utilisation among older adults, therefore, marketing the benefits of telehealth and working with service providers to make online consultations more comfortable and user-friendly for older adults may increase the likelihood of older adults accessing services when needed. Communicating the infection prevention and control measures that are being followed by each service may also help to alleviate older adults’ fears of catching COVID-19 and increase their willingness to engage services, particularly during times of increased risk of infection.

Finally, opportunities exist to enhance older adults’ mental health and wellbeing through interventions that increase community engagement and connectedness. Local governments and community organisations can play an important role in maintaining and building community relations during and post-COVID-19. Strengthening social networks may help to improve older adults’ psychosocial health, prevent health declines, and ease pressure on the healthcare system during the pandemic.

Acknowledgements

We would like to acknowledge our reference group members Paul Albert, Tim Benson, Anne Cordingley, Barbara Daniels, Noreen Fynn, Mary Gurgone, Chris Jeffery, and Ann White. The reference group members provided input into all stages of the research process, from study design to the translation of findings. Their contributions have been highly valued.

Funding Details

This work was supported by the Department of Jobs, Tourism, Science and Innovation (DJTSI) under Edith Cowan University Covid-19 Research Projects Grant [there is no grant number affiliated with this scheme].

Disclosure Statement

The authors report there are no competing interests to declare.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, CA, upon reasonable request.

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Table 1

Mental Health and Social Care Services

Mental Health-Related Services

General Practitioner (GP)

Nurse

Hospital emergency department

Aboriginal health worker

Psychologist, counsellor, or therapist

Psychiatrist

Mental health facility

Online chat service, e.g., Beyond Blue

Telephone support, e.g., Lifeline, The Samaritans

Social Care Services

Recreational group or support group, e.g., men's shed, art class, bowling club, knitting club, book club, RSL, cultural group

Religious or spiritual support

Community support services, e.g., in-home aged care support, family, and carer support services

Table 2

Characteristics of Participants

Characteristics	Total (N =194)
Age M(SD)	71.41 (6.93)
Sex n(%)
Female	109 (56.2%)
Male	85 (43.8%)
Relationship Status n(%)
In a current relationship	106 (54.6%)
Not in a current relationship	87 (44.8%)
Other	1 (0.5%)
Level of Education n(%)
Up to Year 10	52 (26.8%)
Year 11 or above	142 (73.2%)
Employment Status n(%)
Employed	22 (11.3%)
Unemployed	13 (6.7%)
Retired	156 (80.4%)
Volunteer work only	3 (1.5%)
Financial Situation n(%)
Always/Mostly able to make ends meet	165 (85.0%)
Sometimes able to make ends meet	24 (12.4%)
Never able to make ends meet	5 (2.6%)
Government healthcare card or pension card n(%)	156 (80.4%)
Private Health Insurance n(%)	112 (57.7%)

Table 3

Participants’ Social Networks

Social network	n (%)
How many people do you feel close to that you could call on for help?
None	8 (4.1%)
One or two	47 (24.2%)
Three or four	86 (44.4%)
Five or more	53 (27.3%)

How many people would you feel able to have a chat with?
None	13 (6.7%)
One or two	62 (32.0%)
Three or four	79 (40.7%)
Five or more	40 (20.6%)

Table 4
Experiences with Mental Health and Social Care Services during the 2020 COVID-19 Lockdown
Statement	Disagree	Agree	N/A
These services met my needs	7 (16.3%)	33 (76.7%)	3 (7.0%)
I felt like my needs were met within a reasonable timeframe	8 (18.6%)	31 (72.1%)	4 (9.3%)
I was able to discuss my needs	8 (18.6%)	33 (76.7%)	2 (4.7%)
I felt these services met my cultural needs	2 (4.7%)	17 (39.5%)	24 (55.8%)
I felt these services met my language needs	2 (4.8%)	20 (47.6%)	20 (47.6%)
I could afford these services	5 (11.4%)	31 (70.4%)	8 (18.2%)
I felt safe from COVID-19 in my dealings with these services	3 (7.0%)	35 (81.4%)	5 (11.6%)
I could easily find information about these services	4 (9.3%)	30 (69.8%)	9 (20.9%)
I felt comfortable using online technologies to get information	7 (16.7%)	21 (50.0%)	14 (33.3%)
I felt comfortable using the telephone to get information	4 (9.8%)	23 (56.1%)	14 (34.1%)
I would have preferred getting information or support face-to-face	3 (7.0%)	28 (65.1%)	12 (27.9%)
Notes. Participants with missing data were excluded from the analyses.

Table 5

Barriers to Accessing Services during the 2020 COVID-19 Lockdown

Barrier	n (%)
Should be able to cope on my own	15 (42.8%)
Prefer face-to-face care	11 (31.4%)
Afraid of being exposed to COVID-19	6 (17.1%)
Had more important responsibilities	6 (17.1%)
Limited/no access to digital technologies	4 (11.4%)
Difficulties communicating online	4 (11.4%)
Worried that staff would not take my concerns seriously	4 (11.4%)
Believed services were too overwhelmed, my concerns were not severe enough	4 (11.4%)
Could not afford it	3 (8.6%)
Did not know what services were available	3 (8.6%)
Did not know how to use digital technologies	3 (8.6%)
Difficulties communicating through face masks	2 (5.7%)
Difficulties accessing transport	2 (5.7%)
Did not feel I could trust service providers	1 (2.9%)
Do not believe services can help me	0 (0.0%)

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Older adults access to mental health and social care services during COVID-19 restrictions in Western Australia

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