Community mental health teams for older people: variations in case mix and service receipt (II)

Abstract

Objectives: To determine the extent to which services provided to older people via community mental health teams (CMHTs) vary in duration, composition and intensity. In particular, to identify the degree to which differences between teams are due to casemix. Methods: Data were collected about the services provided to a random sample of patients from 15 CMHT caseloads, including contact with CMHT staff, other specialist mental health and social care services. The relationship between patients' needs and service receipt was explored. Results: Information was obtained for 1396 patients. Average time on CMHT caseloads was 11.6 months, but there were marked between-team differences. The proportion of re-referrals also varied from under a tenth to over half. People with functional mental health problems and complex needs were most likely to be long-term CMHT clients. The proportion of patients seen by a consultant in the previous 6 months ranged from approximately a fifth to almost all. Differences with respect to contact with other qualified practitioners were less marked. Older people with functional disorders, challenging behaviour and at least one medium risk had the most regular contact with CMHT staff. Risk of self-harm, delusions and paranoia increased the likelihood of consultant involvement. Support workers were more likely to see people at risk of self-neglect. The receipt of other services, including day hospitals and inpatient care varied greatly. Conclusions: Considerable diversity was found in the length, nature and frequency of services provided to patients with different needs. Differences between teams were not wholly explained by case mix.

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

“…The authors, like us, note a weighting within CMHTsOP towards cases where the individual has a functional mental health problem, rather than dementia conditions. 284 Wilberforce et al 284 also note a huge variation of practices in CMHTsOP in England, similar to the findings of their literature review of 2008, which concluded that there was patchy evidence for CMHTsOP practices, compared with policy and practice guidance. 285 Our examination of every new case referred to 33 CMHTsOP suggests that only a very small part of work accepted by CMHTsOP focuses on supporting new cases of people with dementia and family carers at home.…”

The patient experience in community mental health services for older people: a concept mapping approach to support the development of a new quality measure

“…Importantly, CMHTs are able to directly access a range of personal and social care services, including specialist community care services for older people with dementia and other support needs. These are commonly delivered by separate organisations under contract to local commissioners, but CMHT practitioners may remain responsible for their coordination and reviewing successful delivery [ 5 ].…”

Support workers in community mental health teams for older people: roles, boundaries, supervision and training

“…Support workers commonly work with clients with complex needs, requiring understanding and judgement relating to psychiatric risk and vulnerability (Warne & McAndrew , Wilberforce et al . ) and the locus of CMHT work in people's homes raises particular concerns about autonomous working and supervision (McCrae et al . ).…”