‘We are doing the best we can’ realities and challenges of staff working with in-home aged care clients living with complex mental health issues

OBJECTIVES: This qualitative study explored the experiences and perspectives of in-home aged care staff supporting clients living with Complex Mental Health Issues (CMHI), including how these experiences shape care provision and staff wellbeing. METHODS: Aged care staff from a single in-home aged care provider attended seven focus groups. Data were analyzed using thematic analysis. RESULTS: Thirty-one staff representing direct care, nursing, care coordination/team leadership, and management roles participated. Six themes were identified: (1) understanding and responding to CMHI presentations, (2) challenges in delivering in-home care, (3) emotional, professional and safety experiences of staff, (4) organizational and system barriers, (5) challenges accessing and coordinating mental health support, and (6) strategies used to support clients safely and effectively. Complex cases were exacerbated by multimorbidity and family conflict. Challenges included care refusal, aggression, limited support, funding constraints and insufficient staff training. Staff reported exhaustion and safety concerns, while highlighting flexible care approaches, continuity of care and team debriefing as important supports. CONCLUSION: Our study highlights that many in-home aged care staff feel ill-equipped to support older Australians with CMHI in their day-to-day roles. Mental health training is recommended, as well as identification of opportunities for referrals to increase access to mental health services.