Crisis resolution and home treatment teams for older people with mental illness

Dibben, Claire; Saeed, Humera; Stagias, Konstantinos; Khandaker, Golam M.; Rubinsztein, Judy S.

doi:10.1192/pb.bp.107.018218

Cited by 28 publications

(29 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Crisis resolution home treatment provided by older people's mental health services now show reductions in unplanned admissions, discharge to care homes, length of stay and high user satisfaction. 1,24,25 General hospital liaison is a rare example of service development for older people, with services increasing from 27% of providers in 2003 26 to 84% of commissioning areas now, with 91% considered to provide equality of access and 82% of the 91% provided by older people's mental health services. Validity of this increase can be found in the National Audit of Dementia when 88% of general hospitals in England reported access to a liaison psychiatry service that can assess older people and 81% of those provided by a dedicated team.…”

Section: Discussionmentioning

confidence: 99%

Mental health service discrimination against older people

et al. 2013

View full text Add to dashboard Cite

Aims and methodTo provide a picture of availability and equality of access to mental health services for older people prior to the Equality Act. In 2010, a questionnaire was sent to health commissioners in England, Scotland and Wales under a Freedom of Information request.ResultsOverall, 132 (76%) replied. Of 11 services, 7 were either unavailable or did not provide equality of access to older people in more than a third of commissioning areas. When provided by specialist older people's mental health, services were more often considered to ensure equality.Clinical implicationsIncreasing need resulting from an ageing population is unlikely to be met in the face of current inequality. Inequality on the basis of age is the result of government policy and not the existence of specialist services for older people. Single age-inclusive services may create indirect age discrimination. Availability alone is insufficient to demonstrate equality of access. Monitoring the effects of legislation must take this into account.

show abstract

Section: Discussionmentioning

confidence: 99%

Mental health service discrimination against older people

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Ten references were included: three cohort studies, 170,189,190 one descriptive study, 27 one survey-related research study, 191 two theoretical papers 192,193 and three government policy documents. 23,194,195 Cohort studies and descriptive study…”

Section: Results: Literature Reviewmentioning

confidence: 99%

“…Dibben et al 190 found a statistically significant reduction in admissions 6 months after the introduction of the CRHTT. Sixty-nine per cent of referrals (n = 70) were admitted in the intervention group, compared with 100% (n = 65) in the comparison group (see Table 45).…”

Section: Number Of Admissionsmentioning

confidence: 99%

Support at Home: Interventions to Enhance Life in Dementia (SHIELD) – evidence, development and evaluation of complex interventions

Orrell

Hoe

Charlesworth

et al. 2017

Programme Grants Appl Res

View full text Add to dashboard Cite

BackgroundDementia is a national priority and this research addresses the Prime Minister’s commitment to dementia research as demonstrated by his 2020 challenge and the new UK Dementia Research Institute. In the UK > 800,000 older people have dementia. It has a major impact on the lives of people with dementia themselves, on the lives of their family carers and on services, and costs the nation £26B per year. Pharmacological cures for dementias such as Alzheimer’s disease are not expected before 2025. If no cure can be found, the ageing demographic will result in 2 million people living with dementia by 2050. People with dementia lose much more than just their memory and their daily living skills; they can also lose their independence, their dignity and status, their confidence and morale, and their roles both within the family and beyond. They can be seen as a burden by society, by their families and even by themselves, and may feel unable to contribute to society. This programme of research aims to find useful interventions to improve the quality of life of people with dementia and their carers, and to better understand how people with dementia can be supported at home and avoid being admitted to hospital.Objectives(1) To develop and evaluate the maintenance cognitive stimulation therapy (MCST) for people with dementia; (2) to develop the Carer Supporter Programme (CSP), and to evaluate the CSP and Remembering Yesterday, Caring Today (RYCT) for people with dementia both separately and together in comparison with usual care; and (3) to develop a home treatment package (HTP) for dementia, to field test the HTP in practice and to conduct an exploratory trial.Methods(1) The MCST programme was developed for people with dementia based on evidence and qualitative work. A randomised controlled trial (RCT) [with a pilot study of MCST plus acetylcholinesterase inhibitors (AChEIs)] compared MCST with cognitive stimulation therapy (CST) only. The MCST implementation study conducted a trial of outreach compared with usual care, and assessed implementation in practice. (2) The CSP was developed based on existing evidence and the engagement of carers of people with dementia. The RCT (with internal pilot) compared the CSP and reminiscence (RYCT), both separately and in combination, with usual care. (3) A HTP for dementia, including the most promising interventions and components, was developed by systematically reviewing the literature and qualitative studies including consensus approaches. The HTP for dementia was evaluated in practice by conducting in-depth field testing.Results(1) Continuing MCST improved quality of life and improved cognition for those taking AChEIs. It was also cost-effective. The CST implementation studies indicated that many staff will run CST groups following a 1-day training course, but that outreach support helps staff go on to run maintenance groups and may also improve staff sense of competence in dementia care. The study of CST in practice found no change in cognition or quality of life at 8-month follow-up. (2) The CSP/RYCT study found no benefits for family carers but improved quality of life for people with dementia. RYCT appeared beneficial for the quality of life of people with dementia but at an excessively high cost. (3) Case management for people with dementia reduces admissions to long-term care and reduces behavioural problems. In terms of managing crises, staff suggested more costly interventions, carers liked education and support, and people with dementia wanted family support, home adaptations and technology. The easy-to-use home treatment manual was feasible in practice to help staff working in crisis teams to prevent hospital admissions for people with dementia.LimitationsGiven constraints on time and funding, we were unable to compete the exploratory trial of the HTP package or to conduct an economic evaluation.Future researchTo improve the care of people with dementia experiencing crises, a large-scale clinical trial of the home treatment manual is needed.ConclusionThere is an urgent need for effective psychosocial interventions for dementia. MCST improved quality of life and was cost-effective, with benefits to cognition for those on AChEIs. MCST was feasible in practice. Both CSP and RYCT improved the quality of life of people with dementia, but the overall costs may be too high. The HTP was useful in practice but requires evaluation in a full trial. Dementia care research may improve the lives of millions of people across the world.Trial registrationsCurrent Controlled Trials ISRCTN26286067 (MCST), ISRCTN28793457 (MCST implementation) and ISRCTN37956201 (CSP/RYCT).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 5. See the NIHR Journals Library website for further project information.

show abstract

“…However, this raises issues of equity as there is no evidence that these groups would not benefit. Some CRTs extend their client age range beyond 65, and specialist home treatment services for elderly people have begun to develop, with some evidence that they can prevent admissions (Dibben 2008). Preliminary evidence suggests that CRTs can also prevent admission among people with personality disorders, and many services do work with this group (Cotton 2007).…”

Section: The Remit Of Crtsmentioning

confidence: 99%

Crisis resolution and home treatment teams: an evolving model

Johnson

2013

Adv. psychiatr. treat

View full text Add to dashboard Cite

SummaryCrisis resolution and home treatment teams have been introduced throughout England as part of a transformation of the community mental healthcare system. They aim to assess all patients being considered for acute hospital admission, to offer intensive home treatment rather than hospital admission if feasible, and to facilitate early discharge from hospital. Key features include 24-hour availability and intensive contact in the community, with visits twice daily if needed. This article describes the main characteristics and core interventions of these teams, and reviews the impact of their nationwide introduction. The model has evolved as a pragmatic response to difficulties in the acute care system, and its adaptation continues. Key challenges include achieving close integration with the rest of the mental health system and delivering continuity of care and effective therapeutic relationships despite the involvement of multiple workers in each crisis.

show abstract

Crisis resolution and home treatment teams for older people with mental illness

Cited by 28 publications

References 7 publications

Mental health service discrimination against older people

Mental health service discrimination against older people

Support at Home: Interventions to Enhance Life in Dementia (SHIELD) – evidence, development and evaluation of complex interventions

Crisis resolution and home treatment teams: an evolving model

Contact Info

Product

Resources

About