Mental health service discrimination against older people

Anderson, D. N.; Connelly, Peter; Meier, Richard; McCracken, Cherie

doi:10.1192/pb.bp.112.040097

Cited by 14 publications

(10 citation statements)

References 14 publications

(13 reference statements)

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“…Older adults have historically had reduced access to psychological services; for example, Anderson et al (2012), in a survey of health commissioners in England, Scotland and Wales, found that psychotherapy was available to older adults in only 68% of services that they commissioned, compared with inpatient or community mental health care in 99% of services. In the first wave of the Improving Access to Psychological Therapy (IAPT) evaluation in England, older adults were under represented at 4% of those accessing therapy rather than at the expected rate of 12.5% allowing for the age profile of the population and the morbidity rate of this group (Department of Health, 2011).…”

Section: Introductionmentioning

confidence: 99%

Comparison of access, outcomes and experiences of older adults and working age adults in psychological therapy

Chaplin

Farquharson

Clapp

et al. 2014

Int J Geriatr Psychiatry

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Section: Introductionmentioning

confidence: 99%

Comparison of access, outcomes and experiences of older adults and working age adults in psychological therapy

Chaplin

Farquharson

Clapp

et al. 2014

Int J Geriatr Psychiatry

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“…A better understanding of views about equity of specialist mental health support for older people without dementia 297 may explain our observations of the flow of new referrals to CMHTsOP, in which 1385 of these were not accepted for any assessment by the teams. Of these, we would argue that 61.5% were probably referred for dementia symptoms, as they were signposted on, prior to any evaluation, to memory clinics (see Appendix 3).…”

Section: Implications For Servicesmentioning

confidence: 88%

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

Moniz–Cook

Hart

Woods

et al. 2017

Programme Grants Appl Res

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BackgroundDementia with challenging behaviour (CB) causes significant distress for caregivers and the person with dementia. It is associated with breakdown of care at home and disruption in care homes. Challenge Demcare aimed to assist care home staff and mental health practitioners who support families at home to respond effectively to CB.ObjectivesTo study the management of CB in care homes (ResCare) and in family care (FamCare). Following a conceptual overview, two systematic reviews and scrutiny of clinical guidelines, we (1) developed and tested a computerised intervention; (2) conducted a cluster randomised trial (CRT) of the intervention for dementia with CB in care homes; (3) conducted a process evaluation of implementation of the intervention; and (4) conducted a longitudinal observational cohort study of the management of people with dementia with CB living at home, and their carers.Review methodsCochrane review of randomised controlled trials; systematic meta-ethnographic review of quantitative and qualitative studies.DesignResCare – survey, CRT, process evaluation and stakeholder consultations. FamCare – survey, longitudinal cohort study, participatory development design process and stakeholder consultations. Comparative examination of baseline levels of CB in the ResCare trial and the FamCare study participants.SettingsResCare – 63 care homes in Yorkshire. FamCare – 33 community mental health teams for older people (CMHTsOP) in seven NHS organisations across England.ParticipantsResCare – 2386 residents and 861 staff screened for eligibility; 555 residents with dementia and CB; 277 ‘other’ residents; 632 care staff; and 92 staff champions. FamCare – every new referral (n = 5360) reviewed for eligibility; 157 patients with dementia and CB, with their carer; and 26 mental health practitioners. Stakeholder consultations – initial workshops with 83 practitioners and managers from participating organisations; and 70 additional stakeholders using eight group discussions and nine individual interviews.InterventionAn online application for case-specific action plans to reduce CB in dementia, consisting of e-learning and bespoke decision support care home and family care e-tools.Main outcome measuresResCare – survey with the Challenging Behaviour Scale; measurement of CB with the Neuropsychiatric Inventory (NPI) and medications taken from prescriptions; implementation with thematic views from participants and stakeholders. FamCare – case identification from all referrals to CMHTsOP; measurement of CB with the Revised Memory and Behaviour Problems Checklist and NPI; medications taken from prescriptions; and thematic views from stakeholders. Costs of care calculated for both settings. Comparison of the ResCare trial and FamCare study participants used the NPI, Clinical Dementia Rating and prescribed medications.ResultsResCare – training with group discussion and decision support for individualised interventions did not change practice enough to have an impact on CB in dementia. Worksite e-learning opportunities were not readily taken up by care home staff. Smaller homes with a less hierarchical management appear more ready than others to engage in innovation. FamCare – home-dwelling people with dementia and CB are referred to specialist NHS services, but treatment over 6 months, averaging nine contacts per family, had no overall impact on CB. Over 60% of people with CB had mild dementia. Families bear the majority of the care costs of dementia with CB. A care gap in the delivery of post-diagnostic help for families supporting relatives with dementia and significant CB at home has emerged. Higher levels of CB were recorded in family settings; and prescribing practices were suboptimal in both care home and family settings.LimitationsFunctionality of the software was unreliable, resulting in delays. This compromised the feasibility studies and undermined delivery of the intervention in care homes. A planned FamCare CRT could not proceed because of insufficient referrals.ConclusionsA Cochrane review of individualised functional analysis-based interventions suggests that these show promise, although delivery requires a trained dementia care workforce. Like many staff training interventions, our interactive e-learning course was well received by staff when delivered in groups with facilitated discussion. Our e-learning and decision support e-tool intervention in care homes, in its current form, without ongoing review of implementation of recommended action plans, is not effective at reducing CB when compared with usual care. This may also be true for staff training in general. A shift in priorities from early diagnosis to early recognition of dementia with clinically significant CB could bridge the emerging gap and inequities of care to families. Formalised service improvements in the NHS, to co-ordinate such interventions, may stimulate better opportunities for practice models and pathways. Separate services for care homes and family care may enhance the efficiency of delivery and the quality of research on implementation into routine care.Future workThere is scope for extending functional analysis-based interventions with communication and interaction training for carers. Our clinical workbooks, video material of real-life episodes of CB and process evaluation tool resources require further testing. There is an urgent need for evaluation of interventions for home-dwelling people with dementia with clinically significant CB, delivered by trained dementia practitioners. Realist evaluation designs may illuminate how the intervention might work, and for whom, within varying service contexts.Trial registrationCurrent Controlled Trials ISRCTN02553381 (the ResCare trial) and ISRCTN58876649 (the FamCare study).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. 15. See the NIHR Journals Library website for further project information.

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“…Services for older people have continued to lag behind those for younger people (Anderson 2013; Hilton 2015). Since the 1970s, policies for older people have appeared after those for younger people, reinforcing the idea that the needs of older people are less pressing.…”

Section: History Of Old Age Psychiatrymentioning

confidence: 99%

“…In the UK, a number of factors appear to have contributed to a move to integrate old age services with those of working-age adults, including changes in healthcare commissioning, the economic downturn since 2008, the cost pressures faced by the National Health Service (NHS), the austerity drive aiming for greater efficiency, and innovative use of available resources to meet the complex physical, psychological and social needs of the mentally ill (Anderson 2013; Warner 2014, 2015). With a growing older population there has also been an associated increase in the incidence of dementia.…”

mentioning

confidence: 99%

Interface between general adult and old age psychiatry

Khrypunov¹,

Aziz²,

Al-Kaissy³

et al. 2018

BJPsych advances

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SUMMARYOlder people with mental health problems are entitled to the same level and quality of care as younger people. Several factors continue to influence policy and delivery of older adults' mental health services in the UK. Following the introduction of the Equality Act 2010, there has been a drive to create an ‘ageless’ National Health Service. This has opened up the debate about whether such a service is best equipped to meet the specific needs of older adults. In this contribution we consider the concepts of ‘old age’ and ‘frailty’ and their clinical and service provision implications in psychiatry. The management of late-life depression and early-onset dementia, advance care planning and palliation in dementia are also considered.LEARNING OBJECTIVES•Appreciate how old age psychiatric services and the concept of ‘old age’ have evolved over time•Gain an understanding of issues at the interface between old age and general adult psychiatry and those specific to old age psychiatry•Gain an overview of procedures involved in transferring care between general adult and old age psychiatric services and the need for a separate old age psychiatry subspecialtyDECLARATION OF INTERESTNone.

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Mental health service discrimination against older people

Cited by 14 publications

References 14 publications

Comparison of access, outcomes and experiences of older adults and working age adults in psychological therapy

Comparison of access, outcomes and experiences of older adults and working age adults in psychological therapy

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

Interface between general adult and old age psychiatry

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