The Work of a Community Mental Health Team for the Elderly: Referrals, Caseloads, Contact History and Outcomes

Brown, Pamela; Challis, David; Abendorff, Richard von

doi:10.1002/(sici)1099-1166(199601)11:1<29::aid-gps265>3.0.co;2-k

Cited by 23 publications

(20 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

“…Other aspects of assessment were its setting, with general agreement that domiciliary assessments were vital to gathering accurate information on people's needs; 19,46,47,179,189,190,199,217 and the extent of multidisciplinary involvement. 19,46,47,179,208,218 National reports suggested that such practice occurred in only a minority of teams, varied greatly, and most frequently involved doctors and nurses only.…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

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

confidence: 99%

mentioning

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

Self Cite

View full text Add to dashboard Cite

show abstract

“…Brown et al, 1996;Wattis, 1980) have assessed the conditions most frequently considered for domiciliary assessment and analysed outcomes. Dementia and depression are the most common reasons for requesting domiciliary visits.…”

Section: General Practitioners and Domiciliary Visitsmentioning

confidence: 99%

Home assessments in old age psychiatry

Richardson¹,

Orrell²

2002

Adv. psychiatr. treat

View full text Add to dashboard Cite

“For people to be successfully supported at home, a comprehensive assessment is an essential first step.” (Audit Commission, 2000: p. 43.)Home visits by old age psychiatrists remain popular with elderly patients, their carers and general practitioners (GPs). Home assessments by various disciplines working with older people have been endorsed as a sign of good practice by the Audit Commission (2000) in their recent national report on mental health services for older people: “Assessment at home is often better as people are most likely to behave and communicate in their normal way in familiar surroundings. Staff can also build a more accurate picture of people's needs and learn the views of their carers. Professionals can observe whether there is adequate food in the house, whether people can make themselves a hot drink, and whether there are any likely risks from poor hygiene or fire hazards.” (Audit Commission, 2000: p. 43.)

show abstract

“…T he working m ethods of this team are described in m ore detail elsewhere (Brow n et al, 1996;C oles et al, 1991). Patients requiring day-care for social reasons alone received this in social service day centres in both cases.…”

Section: Ethodmentioning

confidence: 99%

The prognosis of late-life depression in two contiguous old age psychiatry services: An exploratory study

Philpot¹,

Drahman²,

Ball³

et al. 2000

Aging & Mental Health

View full text Add to dashboard Cite

A retrospective case-note study of 131 patients with depressive disorder over the age of 65 years discharged over a 3-year period from acute in-patient care in two neighbouring but organizationally distinct old age psychiatry services was made to determine the factors affecting subsequent readmission to hospital and mortality. Dem ographic data, clinical aspects and initial management of patients were similar at discharge with the exception of fam ily history of depression and a measure of social deprivation. Patients from the traditionally organized service (A) had greater lengths of stay in hospital, were m ore likely to be discharged to institutional care and died earlier than patients from the comm unity-focussed service (B). There was a trend for patients from service A to be readmitted sooner than those from service B. Differences in follow-up arrangements re¯ected the differen t models of service organisation employed. Despite the limitations of a retrospective study it is suggested that the results provide the grounds for further prospective examination of the effects of service organization on outcome in depression.

show abstract

The Work of a Community Mental Health Team for the Elderly: Referrals, Caseloads, Contact History and Outcomes

Cited by 23 publications

References 16 publications

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

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

Home assessments in old age psychiatry

The prognosis of late-life depression in two contiguous old age psychiatry services: An exploratory study

Contact Info

Product

Resources

About