Mental Health and Older Age in Slovenia: Connecting Long-Term Care with Wider Support

An older person receiving help to wash, dress, prepare meals and move safely around the home may also be grieving a partner, becoming socially isolated or experiencing persistent anxiety. Another may have lived with severe mental illness for decades and now be developing frailty. Someone else may withdraw from everyday life after repeated falls, while a family interprets the change as an inevitable consequence of ageing rather than possible depression.

These situations expose an important boundary in Slovenia’s developing care system. Long-term care can respond to sustained dependency, but it is not a substitute for mental healthcare. Mental health services can assess and treat mental disorders, but they do not replace the practical assistance that enables somebody with declining function to remain at home. Social welfare, primary healthcare, families, municipalities and community organisations may all contribute to the wider conditions affecting wellbeing.

This article forms part of the Slovenia Ageing, Long-Term Care & Community Support Knowledge Hub and examines how these different parts of the system can connect around older people.

The issue is increasingly significant as Slovenia combines population ageing with major reform of long-term care and continued implementation of its National Mental Health Programme. The strategic opportunity is not to create a separate mental health system for older age. It is to make mental wellbeing visible wherever older people already encounter healthcare, long-term care and community support, while ensuring that specialist expertise remains accessible when needs become more complex.

Mental health in later life sits across several systems

Slovenia’s mental health architecture and long-term care architecture have different legal, professional and financing foundations.

Mental healthcare sits primarily within the health system. The Ministry of Health has responsibility for mental health policy, while the National Institute of Public Health, NIJZ, has an important public-health, monitoring and programme role. Slovenia’s Resolution on the National Mental Health Programme 2018–2028 provides the strategic framework for improving mental health across the life course, strengthening community-based services, reducing inequalities and stigma, and moving support closer to where people live.

An important implementation mechanism has been the development of mental health centres within Slovenia’s network of health centres. By 2026, 19 adult mental health centres were established nationally. These multidisciplinary services include community psychiatric treatment and form part of the broader attempt to improve access outside hospital settings.

Long-term care has a different purpose. It provides rights for people who, because of illness, age-related frailty, injury, disability or loss of intellectual capacity, require sustained assistance with basic or supporting activities of daily living. Its national entitlement structure now includes long-term care at home, institutional long-term care, day care, family caregiver arrangements and cash benefits, with e-care and services for strengthening and maintaining independence complementing relevant rights.

Older people may simultaneously need both systems. The distinction is essential because mental distress should not be reduced to dependency, while dependency should not be interpreted automatically as a psychiatric problem.

Operationally, this creates a coordination requirement. Primary care, adult mental health centres, hospitals, long-term care providers, Centres for Social Work and community services need routes through which concerns can move without making the older person responsible for navigating every institutional boundary.

Older age changes the context in which mental distress appears

Mental health difficulties in later life are rarely separable from the circumstances in which somebody is ageing.

Bereavement can remove both emotional companionship and practical support. Retirement may change identity and social contact. Reduced mobility can narrow somebody’s world. Hearing or sight loss can make social participation harder. Chronic pain, neurological disease, cancer or cardiovascular conditions can affect mood and confidence. A move from home into institutional care may bring safety and support while also involving loss, unfamiliarity and disruption.

Financial worries, caring responsibilities and loneliness can add further pressure. Rural geography may make access to both informal networks and professional support more difficult.

None of these experiences means that poor mental health is inevitable in older age. That distinction is important. Treating persistent distress as a normal feature of ageing can delay recognition and support.

At the same time, not every period of sadness or anxiety requires specialist psychiatric intervention. Community connection, practical assistance, physical rehabilitation, pain management, better housing, family support or restored access to meaningful activity may sometimes address important contributors to distress.

This is why a broader prevention and health inequalities perspective matters. Mental health is shaped not only by treatment availability but by whether older people retain relationships, security, mobility, purpose and access to community life.

The operational task is therefore one of differentiation: recognising when distress reflects a temporary response to life events, when wider social or physical factors require attention, and when assessment or treatment by mental health professionals is needed.

Community mental health creates an important bridge

Slovenia’s development of adult mental health centres is particularly relevant to older people because it strengthens a community-facing layer between general healthcare and hospital psychiatry.

The centres operate through multidisciplinary teams and are intended to improve accessible, comprehensive mental healthcare closer to people’s homes. Community psychiatric treatment allows professionals to work with people whose circumstances may make conventional outpatient attendance difficult or insufficient.

For an older person with frailty, this matters practically. Travelling repeatedly to distant specialist appointments can become a barrier in itself. Mental health difficulties may also be more understandable when professionals see the person’s home environment, relationships and everyday functioning rather than assessing symptoms in isolation.

The model creates potential connections with long-term care at home, primary healthcare and social services. A long-term care worker may notice a sustained change in mood or behaviour. A community mental health professional may identify that deteriorating living conditions or unmet personal-care needs are worsening somebody’s mental health. A family doctor may recognise that repeated consultations are connected with bereavement, anxiety or isolation as well as physical symptoms.

The value lies in creating pathways between these observations.

That does not mean every long-term care worker should become a mental health practitioner. It means workers need sufficient competence to recognise significant change, respond respectfully and know where concerns should go. Mental health teams, in turn, need to understand how functional dependency and the organisation of daily support affect recovery and stability.

The wider principle reflects community mental health and integrated support: specialist expertise becomes more effective when it can connect with the ordinary environments in which people live.

A change in mood may first appear as a change in care

Consider an 82-year-old widower living alone outside Maribor. He receives long-term care at home following declining mobility and several falls. For the first few months the arrangement works well. He engages with workers, prepares part of his breakfast himself and walks short distances with support.

Over several weeks, workers notice a change. He stays in bed later, eats less, stops telephoning a friend and repeatedly says that there is little point in going outside. His physical condition has not obviously deteriorated enough to explain the change.

The issue should not be resolved by simply increasing assistance with tasks he has stopped doing. That could unintentionally conceal a mental health problem by converting lost motivation into greater dependency.

The worker needs a clear route for recording and escalating the change. Depending on the circumstances and the person’s agreement, this may lead to contact with primary healthcare and potentially the relevant adult mental health service. Immediate risk would require a different and more urgent response.

At the same time, the review should examine his everyday environment. Bereavement, loneliness, fear of falling and reduced community contact may all be contributing. Mental healthcare may therefore sit alongside rehabilitation, social connection and adjustment of his long-term care plan rather than replacing them.

If his functioning improves after appropriate support, the care package should also be reviewed rather than allowing temporary additional assistance to become permanent automatically.

The scenario illustrates why care planning and review need to respond to changes in emotional wellbeing as well as physical dependency.

Long-term care workers are important observers, but their role needs boundaries

Home-based and institutional long-term care workers may spend considerably more time with an older person than many healthcare professionals. This gives them an important observational role.

They may notice withdrawal, disrupted sleep, reduced appetite, unusual fearfulness, changes in self-care, increasing alcohol use, expressions of hopelessness or changes in interaction with relatives. They may also observe confusion that could reflect cognitive impairment, medication effects, infection, delirium or another physical health problem rather than a primary mental disorder.

The strength of this position is continuity. The risk is over-interpretation.

Workers need to recognise change without diagnosing conditions beyond their competence. Training should therefore combine mental health awareness with clear escalation pathways. Records should describe what was observed, what the person said, what changed from their usual presentation and what action followed.

This is particularly important where suicide risk may be present. Slovenia continues to treat suicide prevention as a national mental health priority. Expressions suggesting that somebody no longer wishes to live should not be dismissed because the person is old, physically unwell or recently bereaved.

Workforce development should consequently connect older-person care competence with mental health literacy. The objective is not to turn the long-term care workforce into a parallel psychiatric service. It is to ensure that people closest to changes in everyday life can recognise when additional expertise is required.

Organisations examining comparable workforce interfaces can use the Governance Maturity Assessment to test whether responsibilities, escalation routes and organisational oversight remain clear where several services contribute to one person’s support.

Physical health, frailty and mental health need to be understood together

Older-age mental healthcare cannot operate effectively if physical health is treated as background information.

Pain can affect sleep and mood. Breathlessness can increase anxiety. Parkinson’s disease, stroke and other neurological conditions can influence both functioning and emotional wellbeing. Medication effects can alter cognition or behaviour. Frailty may increase fear of falling and lead somebody to restrict activity, which can in turn increase isolation and physical deconditioning.

The relationship also works in the other direction. Depression may reduce appetite, activity and adherence to treatment. Severe anxiety may make somebody reluctant to leave home. Long-standing mental illness can make management of physical conditions more difficult where services are poorly coordinated.

For an older person receiving long-term care, separating these issues too rigidly can create fragmented responses. A worker sees declining daily function. A family doctor sees physical symptoms. A mental health professional sees anxiety. A relative sees somebody who is “giving up”. Each observation may be valid while remaining incomplete.

The stronger approach is not to make one professional responsible for everything. It is to ensure that the relevant information can be brought together and that somebody recognises when the overall pattern has changed.

Long-term care assessments and personal plans provide useful information about functioning, while healthcare records contain clinical information that care providers should not simply duplicate. The challenge is appropriate communication across organisational boundaries, respecting confidentiality while avoiding situations in which important risk information remains trapped inside one service.

For people with both frailty and mental health difficulties, connecting physical and mental healthcare is therefore an operational requirement rather than an abstract integration objective.

Long-standing mental illness creates a different ageing pathway

Not every older person enters later life with newly emerging mental distress. Some have lived with schizophrenia, bipolar disorder, recurrent severe depression or other enduring conditions for many years.

Ageing can change the support these people require.

A person who previously managed in the community with psychiatric treatment and social support may develop arthritis, mobility limitations, continence needs or frailty. Another may have lived for years in a special social welfare institution and now require increasing long-term assistance. Medication regimes established earlier in adulthood may need closer review as physical health and vulnerability change.

Slovenia’s social welfare system has historically included special social welfare institutions providing accommodation, care, healthcare, assistance and professional treatment for adults with long-term mental health problems. The Mental Health Act also establishes specific protections and procedures relating to psychiatric treatment, supervised treatment and secure wards within social welfare institutions.

Long-term care reform does not erase this existing architecture.

The central question becomes which needs arise from sustained functional dependency, which require specialist mental health treatment and which relate to housing, social inclusion or other social support. An older person should not remain in a more restrictive setting merely because physical care needs have increased, but neither should transfer into a general long-term care environment remove access to necessary psychiatric expertise.

This creates a particular challenge for deinstitutionalisation. Community living needs sufficient mental health, housing and long-term support to be sustainable. Moving somebody physically into the community without the required relationships and professional infrastructure changes location without necessarily changing institutional dependence.

A familiar psychiatric condition can hide a new long-term care need

Consider a 71-year-old woman who has lived with schizophrenia for much of her adult life. Her mental health has been stable for several years with treatment and community support. She lives in supported accommodation and manages many daily activities with prompts.

Over time she becomes physically slower, experiences repeated falls and starts requiring help with bathing, dressing and preparing meals. Staff initially interpret the deterioration through the lens of her established mental health condition.

A more complete review shows that her psychiatric presentation is largely unchanged. The emerging issue is physical dependency associated with ageing and frailty.

This changes the planning question. Increasing psychiatric intervention alone will not address the assistance she now needs. Long-term care assessment may become relevant, alongside review of her physical health, medication and living environment.

Any transition must nevertheless protect the mental health relationships that have contributed to years of stability. If she receives long-term care at home or moves to another setting, continuity with relevant mental health professionals should be planned rather than assumed.

Her own preferences also remain central. A history of severe mental illness does not remove the right to participate in decisions about where and how she lives.

This scenario shows why person-centred planning in older age requires professionals to distinguish the person from diagnostic labels accumulated over a lifetime.

Dementia and mental health require connected but distinct responses

Cognitive decline adds another layer of complexity.

Dementia may involve anxiety, depression, changes in behaviour, sleep disturbance or psychological distress, but it should not be collapsed into a generic category of mental illness. Equally, an older person with dementia can develop a separate mental health condition requiring recognition and treatment.

Slovenia has increasingly brought mental health and dementia into connected national policy structures. Within the Ministry of Health, the Mental Health and Dementia Division addresses mental health promotion, mental illness, dementia and associated human-rights issues. Community developments are also extending beyond clinical treatment.

In 2026, three municipalities in eastern Slovenia — Ormož, Maribor and Novo mesto — were selected for co-financing to establish community centres for people with dementia and other forms of cognitive decline. These centres are intended to provide support programmes for people affected by dementia and their relatives or caregivers.

The development is important, but it should be understood accurately. Three new centres do not constitute a universal national dementia network. They represent an emerging community model within a broader landscape of health, social and long-term care provision.

For long-term care, the practical challenge is recognising whether changes in behaviour arise from cognitive deterioration, unmet physical need, environmental stress, mental distress or some combination. Poorly differentiated responses can lead to unnecessary medication, avoidable hospital attendance or increased restriction.

That is why dementia assessment and changing needs should remain connected with, but not subsumed by, older-age mental health practice.

Families can provide insight without becoming the default care system

Family members often recognise changes before formal services do. They know somebody’s usual routines, personality and history. A daughter may notice that her father no longer answers messages. A spouse may identify sleep disturbance long before it appears during a clinical appointment.

That knowledge can be invaluable, particularly where cognitive impairment or communication difficulty makes assessment more complex.

But family involvement has limits.

An older person retains rights to privacy, autonomy and participation. Professionals should not automatically direct conversations to relatives because somebody is frail, uses long-term care or has a psychiatric diagnosis. Where the person can participate, their own account remains fundamental.

Nor should coordination failures be solved by turning relatives into unpaid case managers. Families frequently become responsible for carrying information between healthcare, social services and care providers precisely because formal interfaces are weak.

The pressure can be substantial when a relative is already providing practical or emotional care.

Slovenia’s formal recognition of family caregivers within long-term care can strengthen support for some households, but formal status does not remove the emotional impact of caring for somebody experiencing depression, severe anxiety, dementia or enduring mental illness.

The wider family partnership and carer-support principle therefore needs two dimensions: listening to families as important partners while also recognising their own support needs and boundaries.

Institutional long-term care needs mental health capability without becoming psychiatric care

Residential long-term care settings encounter mental health every day.

Residents may arrive after bereavement, hospitalisation or loss of the home in which they lived for decades. Some will have dementia. Others will have depression, anxiety or established psychiatric conditions. Loneliness can persist inside a communal building if relationships and meaningful activity are weak.

Institutional care therefore needs sufficient mental health awareness to recognise deterioration and create psychologically supportive environments. Staff should understand how routines, privacy, relationships, noise, activity and communication affect wellbeing.

At the same time, a care home should not be expected to reproduce specialist psychiatric services internally.

The operational requirement is access: routes to primary healthcare, specialist mental health assessment and urgent support where necessary. Mental health professionals also need to understand the institutional context in which treatment recommendations will be implemented.

Consider an 87-year-old resident who begins refusing meals and remaining in her room after moving into institutional long-term care following a hip fracture. Staff could interpret the behaviour as non-compliance, cognitive decline or an inevitable adjustment to admission.

A stronger response explores what has changed. She describes missing her home, feeling that she has lost control over her day and believing that her family would be better off without her. These statements require more than encouragement to join activities.

Her immediate safety and mental health need assessment, while the care team also examines whether everyday routines can restore meaningful control. Can she choose when to get up? Can familiar activities continue? Is rehabilitation helping her regain capability? Can family contact be organised around her preferences?

Specialist intervention and good long-term care are complementary here. One cannot substitute for the other.

Autonomy remains important when mental health risk increases

Mental health risk can create pressure towards overly protective responses, particularly where the person is also frail.

An older adult experiencing anxiety may want to continue walking independently despite a previous fall. Someone with recurrent depression may value living alone even though relatives would feel reassured by residential care. A person with an enduring psychiatric condition may make choices professionals consider unwise without those choices automatically becoming evidence that the person cannot participate in decisions.

Slovenia has its own legal frameworks governing mental healthcare, consent, representation and situations in which treatment or placement may occur without ordinary voluntary agreement. These should not be replaced conceptually with terminology imported from another jurisdiction.

For everyday long-term care, however, the broader principle remains important: protection should be proportionate to the actual risk and should preserve autonomy wherever possible.

The Positive Risk-Taking Planner offers organisations considering similar questions a structured way to examine desired outcomes, foreseeable risks, protective factors and proportionate safeguards. It does not determine Slovenian legal decisions, but it can help prevent risk management from becoming synonymous with removing choice.

This aligns with wider positive risk-taking in older-age support: safety is strongest when it enables life rather than simply restricting exposure to uncertainty.

Information needs to cross boundaries without dissolving confidentiality

Connecting mental health and long-term care inevitably raises questions about information.

A long-term care provider may need to know that somebody has a condition affecting support, medication or risk. A mental health professional may need information about changes in daily functioning. Primary healthcare may hold clinical information relevant to both. Family members may possess important contextual knowledge.

Yet integration does not justify unrestricted information sharing.

The practical objective is purposeful exchange: the right information reaching the right people for a legitimate care purpose, with appropriate attention to consent, confidentiality and data protection.

This becomes particularly important as services digitalise. Shared or interoperable systems can reduce repeated assessments and fragmented records, but they can also make excessive access easier if governance is weak.

For older people, digital exclusion adds another consideration. Increasingly digital processes should not make it harder for somebody to understand what information is held, correct inaccuracies or participate in decisions because they do not use digital technology confidently.

Organisations examining this interface can use the Digital Transformation Readiness Assessment to explore governance, workforce capability, information architecture and digital risk. The framework is not a Slovenian regulatory instrument; its relevance lies in testing whether technology strengthens coordination without weakening accountability.

Good interoperability is ultimately behavioural as well as technical. A perfectly connected record achieves little if professionals do not know what information matters, who is responsible for acting on it or how an older person’s own account should shape interpretation.

Prevention should begin before somebody reaches specialist services

Slovenia’s National Mental Health Programme places substantial emphasis on promotion, prevention, early recognition, community support and reducing stigma. This matters particularly in older age because opportunities for prevention exist well beyond mental health services.

A municipality supporting age-friendly community activity may reduce isolation. Accessible transport can preserve relationships. Rehabilitation after a fall can rebuild confidence. Support for a bereaved caregiver may prevent prolonged deterioration. Primary healthcare can identify emerging distress. Long-term care workers can notice changes in daily behaviour.

None of these interventions guarantees good mental health, but together they create conditions in which difficulties may be recognised earlier.

Recent national development also shows continued investment in community mental health. Slovenia is supporting new forms of mental health provision through programmes running into 2029, including peer support for adults, early identification, mental health literacy and new approaches to accessible community support. Digital mental health tools are also being piloted rather than treated as established substitutes for face-to-face provision.

The distinction between pilot and established service is important. Innovation can extend access, but older people vary considerably in digital confidence, sensory ability, cognition and preference. New channels should broaden routes into support rather than quietly making digital participation a condition of receiving it.

The wider prevention and early-intervention principle is therefore strongest when mental health is considered within everyday ageing policy rather than activated only after somebody meets the threshold for specialist treatment.

Governance should reveal where people repeatedly fall between services

The most important evidence about integration is often found at the boundaries.

If long-term care providers repeatedly struggle to obtain mental health input for residents, that pattern matters. If adult mental health teams frequently encounter older people whose principal difficulty is unmet practical support, that matters too. Repeated hospital presentations, interrupted discharges, avoidable institutional admissions and escalating family strain can all indicate that individual services are functioning while the pathway between them is not.

Governance therefore needs information beyond simple service volumes.

A useful system view would connect measures such as:

• access to community mental health support for older people with complex care needs;
• changes in functioning and wellbeing following intervention;
• unplanned transfers between home, hospital and institutional settings;
• recurring delays where mental health and long-term care responsibilities intersect;
• feedback from older people and families about continuity and involvement;
• workforce concerns showing where staff lack confidence or specialist support.

Not every indicator needs to become a national target. The purpose is to make recurring friction visible at the level capable of responding to it.

The Quality Dashboard Builder can help organisations exploring comparable governance questions combine operational, quality, workforce and outcome evidence rather than relying on isolated activity measures.

For Slovenia, the national picture also needs to recognise geography. Nineteen adult mental health centres represent substantial development, but practical access is still shaped by workforce, travel, local capacity and how effectively services connect with other parts of the care system. National availability and equivalent lived access are not automatically the same thing.

Future integration depends on relationships as much as structures

Slovenia enters the later stages of its 2018–2028 National Mental Health Programme while simultaneously embedding a fundamentally redesigned long-term care system. Its 2026–2036 national healthcare plan also places longer-term emphasis on accessible, sustainable healthcare and prevention across the life course.

This creates an opportunity to design the next phase around interfaces rather than programmes alone.

Older-age mental health is one such interface. Long-term care reform creates more systematic contact with people experiencing dependency. Community mental health expansion creates greater capacity to deliver support closer to home. Primary healthcare remains a crucial entry point. Municipal and community activity influences isolation and participation. Social welfare provides additional forms of support for people with enduring mental health needs.

The question is how those elements behave together.

Future development could strengthen common transition protocols, consultation between specialist and long-term care teams, mental health capability within the care workforce and shared outcome measurement. Digital infrastructure may support this, but it cannot replace professional relationships or clear accountability.

Workforce planning is particularly important. Integration that simply asks existing staff to coordinate more meetings, complete more documentation and absorb additional responsibilities will not necessarily produce better care. Roles need to be clear and coordination proportionate.

The strongest opportunity lies in making specialist expertise easier to reach while increasing the ability of ordinary services to recognise and respond appropriately to mental wellbeing.

The international lesson is to integrate around the older person, not around a diagnosis

Slovenia’s institutions, legislation and financing arrangements are specific to its social security and healthcare system. Other countries cannot reproduce its adult mental health centres or long-term care architecture simply by adopting the same organisational labels.

The underlying challenge, however, is widely shared.

Ageing exposes the limitations of systems designed around separate categories. An older person may simultaneously experience frailty, depression, chronic disease, bereavement, cognitive change, housing difficulty and family strain. Assigning each issue to a different service may be administratively logical while producing a fragmented life.

The transferable lesson lies less in merging organisations and more in designing reliable interfaces. Mental health professionals should be able to recognise practical care needs. Long-term care workers should recognise significant mental health change. Primary healthcare should connect physical and psychological health. Families should contribute without becoming the default coordination mechanism. Governance should identify repeated gaps rather than treating each as an isolated case.

Person-centred integration also means resisting two opposite mistakes: interpreting all distress as illness requiring specialist treatment, and dismissing serious mental health problems as normal consequences of ageing.

A mature system can hold both positions simultaneously. It can recognise the social and emotional realities of later life while ensuring that treatable mental health conditions receive timely professional attention.

Conclusion

Slovenia’s approach to mental health in older age is developing at the intersection of two major policy directions: the expansion of community-based mental healthcare and the implementation of a new national long-term care system. Neither can deliver the full response alone.

Long-term care creates sustained contact with people whose dependency may interact with bereavement, isolation, anxiety, depression, dementia or long-standing psychiatric illness. Community mental health services bring multidisciplinary expertise closer to where people live. Primary healthcare, social welfare, families, municipalities and community organisations contribute different parts of the wider support environment.

The central strategic challenge is therefore connection without confusion. Long-term care workers need mental health awareness without being expected to diagnose. Specialist services need to understand functional dependency without becoming responsible for ordinary daily care. Families should be heard without carrying the coordination burden. Information needs to travel appropriately while privacy and autonomy remain protected.

As Slovenia develops the next phase of mental health and long-term care policy, implementation will matter as much as formal structures. The strongest system will be one in which a change in an older person’s wellbeing is noticed early, understood in context and connected to the right response without requiring that person to navigate every institutional boundary themselves.

That is ultimately the connection between mental health and good long-term care: preserving not only safety and function, but identity, relationships, participation and the possibility of living later life with meaning and dignity.