Support in the community for people with dementia and their carers: a comparative outcome study of specialist mental health service interventions

Woods, Bob; Wills, Walter; Higginson, Irene J; Hobbins, Joanne; Whitby, Matthew C.

doi:10.1002/gps.822

Cited by 54 publications

(64 citation statements)

References 21 publications

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“…Specialised dementia-care trained nurses compared with conventional community mental health nursing (CMHN) support also demonstrates better outcomes for carer well-being (Woods et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

Can training community mental health nurses to support family carers reduce behavioural problems in dementia? An exploratory pragmatic randomised controlled trial

Moniz-Cook

Elston

Gardiner

et al. 2007

Int J Geriat Psychiatry

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Section: Introductionmentioning

confidence: 99%

Can training community mental health nurses to support family carers reduce behavioural problems in dementia? An exploratory pragmatic randomised controlled trial

Moniz-Cook

Elston

Gardiner

et al. 2007

Int J Geriat Psychiatry

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“…Thus, although the policy of governments in many countries is predicated on the belief that most older people can, and would, prefer to live in their own homes, care home admission per se is not always an undesirable event. 216,277 Inappropriate admissions are a more sensitive target, albeit more complex to adjudge.…”

Section: Broader Implicationsmentioning

confidence: 99%

National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

Challis

Tucker

Wilberforce

et al. 2014

Programme Grants for Applied Research

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BackgroundThe rising number of older people with mental health problems makes the effective use of mental health resources imperative. Little is known about the clinical effectiveness and/or cost-effectiveness of different service models.AimsThe programme aimed to (1) refine and apply an existing planning tool [‘balance of care’ (BoC)] to this client group; (2) identify whether, how and at what cost the mix of institutional and community services could be improved; (3) enable decision-makers to apply the BoC framework independently; (4) identify variation in the structure, organisation and processes of community mental health teams for older people (CMHTsOP); (5) examine whether or not different community mental health teams (CMHTs) models are associated with different costs/outcomes; (6) identify variation in mental health outreach services for older care home residents; (7) scope the evidence on the association between different outreach models and resident outcomes; and (8) disseminate the research findings to multiple stakeholder groups.MethodsThe programme employed a mixed-methods approach including three systematic literature reviews; a BoC study, which used a systematic framework for choosing between alternative patterns of support by identifying people whose needs could be met in more than one setting and comparing their costs/outcomes; a national survey of CMHTs’ organisation, structure and processes; a multiple case study of CMHTs exhibiting different levels of integration encompassing staff interviews, an observational study of user outcomes and a staff survey; national surveys of CMHTs’ outreach activities and care homes. A planned randomised trial of depression management in care homes was removed at the review stage by the National Institute for Health Research (NIHR) prior to funding award.ResultsBoC: Past studies exhibited several methodological limitations, and just two related to older people with mental health problems. The current study suggested that if enhanced community services were available, a substantial proportion of care home and inpatient admissions could be diverted, although only the latter would release significant monies. CMHTsOP: 60% of teams were considered multidisciplinary. Most were colocated, had a single point of access (SPA) and standardised assessment documentation. Evidence of the impact of particular CMHT features was limited. Although staff spoke positively about integration, no evidence was found that more integrated teams produced better user outcomes. Working in high-integration teams was associated with poor job outcomes, but other factors negated the statistical significance of this. Care home outreach: Typical services in the literature undertook some combination of screening (less common), assessment, medication review, behaviour management and training, and evidence suggested intervention can benefit depressed residents. Care home staff were perceived to lack necessary skills, but relatively few CMHTs provided formal training.LimitationsLimitations include a necessary reliance on observational rather than experimental methods, which were not feasible given the nature of the services explored.ConclusionsBoC: Shifting care towards the community would require the growth of support services; clarification of extra care housing’s (ECH) role; timely responses to people at risk of psychiatric admission; and improved hospital discharge planning. However, the promotion of care at home will not necessarily reduce public expenditure. CMHTsOP: Although practitioners favoured integration, its goals need clarification. Occupational therapists (OTs) and social workers faced difficulties identifying optimal roles, and support workers’ career structures needed delineating. Care home outreach: Further CMHT input to build care home staff skills and screen for depression may be beneficial. Priority areas for further study include the costs and benefits for older people of age inclusive mental health services and the relative cost-effectiveness of different models of mental health outreach for older care home residents.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…Indeed, it is likely that a substantial amount of effort will be required to put the necessary structures and working practices in place. 51 While there have been few appraisals of the organisation or processes of CMHTs for older people, 52,53 studies of the principles of good teamworking in CMHTs for working age adults suggest such teams need: ■ adequate resources (staff, money and accommodation); ■ clear, realistic aims/objectives; ■ a single team leader with sufficient authority to ensure that all disciplines work to an agreed operational policy; ■ clarity about the role of each team member, their tasks and place within the team; ■ an appropriate breadth of skills and knowledge to meet clients' needs; and ■ explicit models of care supported by joint training and ongoing team development. 50,[54][55][56][57][58][59] Although the social work staff who participated in this study held generic rather than specialist mental health caseloads, the high level of psychiatric comorbidity seen in their clients would suggest that this is a group with whom they are very familiar 35 and over 40% of their working week was spent in core care management tasks.…”

Section: Care Management Should Be Provided By Members Of a Multidiscmentioning

confidence: 99%

Care management for older people with mental health problems: from evidence to practice

Tucker¹,

Hughes²,

Sutcliffe³

et al. 2008

Aust. Health Review

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Aim: To explore the implications of providing intensive care management in a typical old age mental health service in North West England. Methods:The time spent by core groups of specialist mental health and social services staff on a range of activities deemed central to the provision of intensive care management was explored by means of a diary exercise. The difference between what is actually being done and what evidence suggests is needed was examined.Results: More than 1500 hours of activity were appraised. Assessment and care managementrelated tasks accounted for more than 40% and 30% of social work and nursing staff's time, respectively. However, several fundamental features of intensive care management were lacking, including health staff's adoption of the care manager role, arrangements to facilitate appropriate information sharing and sufficient time for practitioners to provide the necessary careful assessment of needs, liaison with other agencies, and close and regular contact with the elderly person and their care network.

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Support in the community for people with dementia and their carers: a comparative outcome study of specialist mental health service interventions

Cited by 54 publications

References 21 publications

Can training community mental health nurses to support family carers reduce behavioural problems in dementia? An exploratory pragmatic randomised controlled trial

Can training community mental health nurses to support family carers reduce behavioural problems in dementia? An exploratory pragmatic randomised controlled trial

National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

Care management for older people with mental health problems: from evidence to practice

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