This graph makes it clear that adults are subjected more to mental health disorders when compared to the aging population. Still, the impacts are huge when it comes to older aged people. Females above 60 years of age suffer from mental health problems when compared to male. 

Teesson et al (2000) found that the substance use disorders are prevalent among homeless people located in the inner regions of Sydney. Nearly half of the homeless men that were chosen for the research were exposed to alcohol use disorder but less number of women was exposed to sedative or drug related disorders. Unfortunately, such homeless people inform that they are unaware of the mental health services available to them by the government. With no access to the delivery of mental health treatment, the vulnerability is only on rise. 

Marel (2018) has highlighted the comorbidity that is prevalent among older population in Sydney as they are subjected to different forms of abuse and are forced to make use of alcohol and related products that can stimulate sleep and comfort and reduce the intensity of pain. This requires multidisciplinary care to control comorbidity. In fact, Australia’s health department cites that 1 in 5 suffer from one of the two prominent disorders of the country – substance use and mental disorders. Similarly, 1 in 3 people suffer from a comorbid anxiety disorder. The end result is a permanent disorder that needs long term medical intervention and treatment to control the prevalence as well as the impacts. 

This is another graph that indicates that access to pain killers is high and this needs to be controlled on priority. With the consumption of alcohol, the probability for addiction is high such that it becomes a life time disorder. At this stage, people only receive fragmented care to their mental health disorders in Sydney. Further, the access to care is less than ever. As majority of the people are homeless and require immediate attention, it is essential for the government to take immediate steps to reduce the waiting time. 

Let us also take a look at the mental health requirements by the year 2035 so the government can plan efficiently. 

The graph makes it clear that by 2035, people above 60 years would be high but lesser than that of adults. Hence, if we address the mental health disorders today, we can save the future. Here are the 3 major things to be carried out today so the normative trend has a lesser impact caused by people suffering from substance use disorders. 

- Exercise community level actions and encourage formation of new support groups that can teach older people to recognize mental health problems and substance use issues and let them build social connections. This needs to eliminate the existence of discrimination as the target audience largely includes homeless people who have faced some form of abuse. 

- Age appropriate treatments are required so it is possible to work on the cases for longer time and convert alcohol dependent people to normal ones without disorders. 

- Coordinated service responses that will address accommodation needs and other healthcare requirements needed for this population to survive in Sydney

All these suggestions can improve the quality of life and reduce the number of population vulnerable to mental disorders. Perhaps, evidence-based strategies can help the best. As we eliminate social isolation first, there is a high chance for aged population to experience psychological problems as they get settled and understand ways to fulfil their needs. This normative trend analysis is just an indicator of how the condition of this comorbid disorder in the year 2035 can easily be rectified with simple steps that we take today. Here are 3 potential consequences upon taking these actions – 

- Low number of homeless people

- Lower healthcare costs 

- Fulfilled inmates that will improve their efficiencies on social and financial aspects

The need of the hour is a holistic care plan that will improve the quality of service delivery and have positive impacts on the healthcare system. McCauley (2019) indicates thatAustralians spend about 30 billion dollars a year out of the pocket towards health treatment. 

This graph shows that the government of Australia is spending above the tax revenue to manage the health expenses of the country and control the exposure of inmates to various disorders. McCauley (2019) also states that the increase in insurance premium has affected the insurers and more people prefer to opt out from such plans to save money. On an average, 9.4 billion dollars are spent towards medicines and pharmacy associated products and 4 billion dollars are spent towards allied health professionals including psychiatrist, optometrists and physicians. There is only an increase in the total amount spent towards healthcare each year and this is alarming and calls for immediate action. 

Obtaining Medicare is just sufficient for people to access healthcare in Sydney at reduced prices. Further, the government of New South Wales has also maintained a 24/7 crisis lines for people to reach out if there is a mental illness reported. The Older People Mental Health (OPMH) service assesses diagnoses and develops a care plan for the older patients that are exposed to substance use or other mental disorders. There is also residential care facility available to elderly population above 65 years of age and this covers mental illness, dementia and related challenging behaviors. 

As already mentioned homeless population of Sydney will have to approach Housing and Accommodation Support (HASI) in Sydney and also reach out to Community Living Supports (CLS) program to receive psychosocial assistance. All of these include self-help plans and also promote management of mental health in easier ways. To improve the service design, organizations will have to be categorized as general medical care and specialty mental health organizations. 

The general medical care would typically cater to residential care requirements for people who have mental health and substance use disorders. On the other hand, the specialty organization will serve older population with disorders in particular. This needs to be run by the state. For instance, the presence of State Mental Health Agency (SMHA) can increase the number of service providers and community mental health centers. As a result, older population does not have to report on lack of access to specialty care. It is reported that 5% of 6.3 million people received services of SMHA in the year 2008 (Eden et al, 2012). 

The state has defined the criteria of eligibility for people to receive services and support from SMHAs. More rural SMHAs are needed when compared to the urban areas as the former has a higher proportion of vulnerable groups in older population. They are exposed to comorbid conditions. The existing infrastructure does not educate older population on importance of mental health and the presence of schemes like Medicare that can reimburse their expenditures. Though a part of the urban older population is aware of the scheme, they report that it is difficult to afford as it is expensive. This needs to be addressed too. 

While SMHAs operate on one side, there is also a need for social organizations that eliminate the stigma perceived by the older population. In a study by Eden et al (2012), it is identified that about 90% of the adults in the sample population experience emotional problem but do not seek professional help. They feel that they do not know where to seek treatment while a few others say they could not afford. It is astonishing to note that a group of the respondents said that people around them would find out if they take professional help for their disorders. Such stigmas will have to be handled as the primary step. 

When people feel embarrassed to take the help of a medical expert, it is hard to make the fullest use of the mental health programs arranged by the Sydney government. Some also assume that aging is the cause for mental problem. Here are a few things to carry out to improve the service design – 

- Create more support groups that will inform older population on available services and provide linguistically appropriate services to cater to their needs 

- Awareness programs that will eliminate the stigma surrounding them

- Infrastructure to improve transport facilities and insurance options so that they can pay for the services utilized

We also need more resources that can work with the aged population on case by case basis so the long term medical intervention can have significant positive impacts on their health conditions. The community living condition of older adults will have to be improved so they don’t suffer from disorders that exist for a long run. In the normative trend, we have not analyzed the condition of suicide in particular. With the increase in aging population, the drug related conditions are only getting complex day by day. 

There is a high number of suicides committed by the chosen target audience because of homelessness, social insecurity and financial insecurity. With mental health services that can cater to the growing population, it is feasible to see more number of positive consequences (NSW Government, 2018). In this section, we shall analyse the consequences of the normative trend. 

In a region like Sydney where there is constant development in standards of living, the substance use and mental health disorders faced by aged population have placed the state government at stake. Upon researching the condition further, it is identified that comorbid rates of disorders have affected the access to healthcare facilities as people experience such disorders for a longer period. The normative trend is an indicator of what the future would look like. With aging population on rise, the service design has to be improved in terms of costs, access and quality. This paper has identified the positive and negative consequences of the normative trend. It is identified that more SMHAs can improve the quality of life and also lead to the creation of new mental healthcare centers that have the essential infrastructure to assess and diagnose the needs of the older population. However, the government has to focus on removal of stigma and expansion of existing infrastructure with housing options and assisted living that can result in satisfactory living standards. It can also reduce the vulnerability to these mental health and substance use disorders by the year 2035.