The birth of a specialty: the first ten thousand patients of an old age psychiatry service

MacDonald, A J; Ball, Chris; Burton, Stephen W.; Herzberg, Joe; Murphy, Erin; Philpot, Michael; Rao, Rahul

doi:10.1017/s1041610206003759

Cited by 10 publications

(5 citation statements)

References 9 publications

(14 reference statements)

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“…Although geriatric psychiatry has been a growing field since the 1970s (MacDonald et al, 2007), to our knowledge, there have been few quantitative accounts of inpatient geriatric referral patterns for psychiatric consultation. While few studies have been done in the United States in over twenty years, previous research focused on three aspects of hospitalized inpatient psychiatric consultation in the geriatric population (defined in these studies as age 60): diagnosis, referral source, and rates of consultation in comparison to younger patients (Folks and Ford, 1975;Bustamente and Ford, 1981;Rabins et al, 1983;Popkin and Mackenzie, 1984;Rosse et al, 1986).…”

Section: Introductionmentioning

confidence: 99%

A comparison of psychiatric consultation between geriatric and non‐geriatric medical inpatients

Schellhorn

Barnhill

Raiteri

et al. 2009

Int J Geriat Psychiatry

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Section: Introductionmentioning

confidence: 99%

A comparison of psychiatric consultation between geriatric and non‐geriatric medical inpatients

Schellhorn

Barnhill

Raiteri

et al. 2009

Int J Geriat Psychiatry

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“…In keeping with past studies of CMHTs for older and working‐age adults (Brown et al ., ; Macdonald et al ., ; Hunter et al ., ), this analysis found that the duration of CMHT support varied considerably according to the types of people concerned. Thus, individuals with functional mental health problems or more complex needs tended to have longer care episodes than people with organic diagnoses or less complex needs.…”

Section: Discussionmentioning

confidence: 99%

“…In light of increasing numbers of CMHT referrals (Banerjee and Chan, 2008), this may be a necessity. Nevertheless, it cannot be desirable, as not only do older people and their carers value continuity of care, rereferrals also often present in a less well-managed state (Macdonald et al, 2007). The finding that people with dementia also had less regular contact with CMHT staff (particularly consultants) is also potentially concerning, and more research is needed to ascertain the reasons for this.…”

Section: Variations In Service Receipt Between Patientsmentioning

confidence: 99%

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

Wilberforce

Tucker

Brand

et al. 2014

Int J Geriat Psychiatry

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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.

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“…In only one was there potential selection bias which the authors had not considered. 193 Integration was one of the driving forces behind the development of CMHTsOP 217 and was integral to this review, relating to many specific issues. There is broad agreement across the policy and professional literature on those key attributes which an integrated CMHTOP should possess -highlighted in Table 40.…”

Section: Discussionmentioning

confidence: 99%

“…Over 75% of studies had a local focus, covering 57 teams. Ten publications 25,[188][189][190][191][192][193][194][195][196] related to just three of these teams which can be regarded as 'exemplars': early well-resourced teams, established by research active consultants, wanting to test new service delivery approaches. Local studies offered a level of detail not available in the broader national/ regional literature.…”

Section: Community Mental Health Teams For Older People: a Systematicmentioning

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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The birth of a specialty: the first ten thousand patients of an old age psychiatry service

Abstract: Descriptive data on referrals and workload of the first open-access multidisciplinary old age psychiatry service have generated cause for both celebration and concern.

Cited by 10 publications

References 9 publications

A comparison of psychiatric consultation between geriatric and non‐geriatric medical inpatients

A comparison of psychiatric consultation between geriatric and non‐geriatric medical inpatients

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

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

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