"We have a behaviour support plan, let's have a mental health support plan": Perspectives of staff, residents and family carers on understanding, responding to and promoting the mental health of residents within long-term care.

Up to two thirds of people living in long-term care homes experience mental health conditions such as anxiety and depression. In addition, over half of residents have cognitive impairment or dementia. However, the quality of mental health care provided in residential care homes is often poor, and the use of mental health quality indictors is lacking. As the first step in a larger project to develop mental health quality indicators for long-term care (MHICare project), this study aimed to explore factors considered important for understanding and responding to mental health conditions and promoting mental well-being of residents. Individual interviews and small group discussions were conducted with twelve residents (both with and without dementia), eight family carers of residents with dementia, and six care home staff members, from across Australia. Qualitative data were analysed using an inductive thematic analysis approach to generate themes and a deductive approach to generate factors and map these to a Balanced Score Card quality indicator framework. Four main factors with several inter-related themes were identified: (1) Resident-related (Transitional impacts, Social connections and active engagement, and Pre-existing and co-morbid conditions); (2) Care and Communication Practices (Assessment and care strategies, Person-centred mental health care, Cultural and generational communication differences, and Staff handover and knowledge sharing); (3) Staff-related (Staff mental health awareness, Staff knowledge, practical skills and training needs, and Staff values and attitudes); and (4) Organisational (Internal staffing levels, Access to external mental health professionals, and Provision of volunteer programs). Findings will inform the key areas and initial content for mental health indicators for use in residential care homes. Once developed, these have the potential to highlight both strengths and gaps in current mental health care practices, and drive quality improvement initiatives.