The balance of care: Reconfiguring services for older people with mental health problems

Abstract

The belief that most older people, including those with complex needs, can, and would prefer to be, cared for in their own homes underpins community care policy in many developed nations. There is thus a common desire to avoid the unnecessary or inappropriate placement of older people in care homes or in hospital by shifting the balance of provision. This paper demonstrates the utility of a 'balance of care' approach to address these issues in the context of commissioners' intention to reconfigure services for older people with mental health problems in a defined geographical area of the North West of England. The findings suggest that, if enhanced community services were available, a number of people currently admitted to residential or hospital beds could be more appropriately supported in their own homes at a cost that is no greater than local agencies currently incur.

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

“…71,91,110 The remainder considered only public expenditure which, depending on their foci, covered the costs incurred by health and/or social services. 103,106,118,120,121 Interestingly, although many aspired to a comprehensive costing approach, there was little evidence that one framework had come to dominate the field. However, there appeared to be an order in which non-public costs were considered with more studies including housing than living expenses, and informal care costs least likely to be examined.…”

“…80,105 Subsequent BoC studies have, however, generally taken a simpler approach. Many asked practitioners (individuals, monodisciplinary or multidisciplinary groups) to identify the most appropriate form of care for particular case types/individuals (facilitating the incorporation of new services), 101,117,118,120,121 whereas others asked practitioners to identify those people in location A who could be cared for in location B. 71,91,113,114 An alternative was to draw on policy documents, 103 research recommendations 10,121,122 or comparative provision elsewhere.…”

“…the impact of their mental state/behaviour 108,117,118,124 commonly thought important. Those studies concerned with the location for a specific treatment (as opposed to where different groups of people might reside) also considered such factors as the distance a person would have to travel 97,111 and the severity of their illness.…”

“…One key feature of BoC studies is their depiction of the needs of people supported in different settings, and in the majority of studies (n = 20) this information was collected via some form of local survey, typically completed by practitioners 110,[115][116][117][118] and/or researchers. [119][120][121] Those studies that employed secondary data generally obtained this from national data sets or surveys in other areas.…”

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

“…35,36 While commissioners desired to reconfigure services, they lacked information on which to base decisions, and commissioned a multi-faceted study. This included the collection of data about local people' s mental health needs, an examination of the effects of changing the mix of institutional and community services 37,38 and, as the provision of intensive care management by members of a specialist CMHT was seen as a prerequisite for the delivery of the multi-faceted packages of care needed if older people were to be diverted from institutional care, a study of the key activities undertaken by staff caring for older people with mental health problems. This paper focuses on the latter work, and is particularly interested in: ■ the amount of time spent on care management; ■ the extent to which the roles of mental health nurses and social work staff overlapped; and ■ how patterns of working in a typical service for older people with mental health problems differed from what evidence suggests is needed.…”