Treatment decisions following assessment by multidisciplinary psychogeriatric teams

Lindesay, James; Herzberg, Joe; Collighan, Gill; Macdonald, Alastair; Philpot, Michael

doi:10.1192/pb.20.2.78

Cited by 8 publications

(9 citation statements)

References 4 publications

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“…The second considered post-assessment decision-making and reported a high degree of agreement in relation to antidepressant use; satisfactory agreement regarding the use of neuroleptic drugs; but less agreement with regard to psychological interventions. 188 The authors concluded that this did not suggest that assessments by non-doctors resulted in either 'substantial under-use or DOI: 10.3310/pgfar02040 PROGRAMME GRANTS FOR APPLIED RESEARCH 2014 VOL. 2 NO.…”

Section: Evidence Of Effectivenessmentioning

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%

“…All were local studies, four 188,[190][191][192] referring to exemplar teams. Three examined referral/access arrangements, three others considered assessment or immediate post-assessment issues, and one focused on longer term support.…”

Section: Evidence Of Effectivenessmentioning

confidence: 99%

“…Use of research psychiatrists as proxies for real decision makers, also potentially limited generalisability. 188,190 One paper evaluated the impact of intensive care management (involving a designated case manager with a flexible budget) for older people with dementia and their carers in comparison with those provided with 'usual' support from the CMHT. 192 Findings after 2 years revealed that, at an increased cost to social care budgets, just over half of those receiving the intensive service remained at home compared with 35% of the control group.…”

Section: Evidence Of Effectivenessmentioning

confidence: 99%

“…Finally, the question of whether some of the work traditionally undertaken by consultants could be competently done by others was considered by a number of articles, particularly those reporting on teams in Lewisham and Cambridge. 48,188,203,204,209 This related particularly to initial assessments, one of the few aspects to have been evaluated, and, as such, is considered further in the next section.…”

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confidence: 99%

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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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Section: Evidence Of Effectivenessmentioning

confidence: 99%

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

confidence: 99%

Section: Evidence Of Effectivenessmentioning

confidence: 99%

Section: Evidence Of Effectivenessmentioning

confidence: 99%

mentioning

confidence: 99%

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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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What Becomes of People With Dementia Referred to Community Psychogeriatric Teams?

Bedford¹,

Melzer²,

Dening³

et al. 1996

Int. J. Geriat. Psychiatry

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Objective: To monitor key processes and outcomes in joint health and social services community psychogeriatric teams. Design: Six month follow‐up of new referrals to 4 teams in Cambridge. Data collected from structured clinical assessment forms at baseline and interviews with keyworkers at follow‐up. Data for groups with and without dementia were compared. Setting: Two rural and two urban teams in area with relatively large long stay inpatient facility but low independent sector provision. All were routine service teams, rather than run for research purposes. Main outcome measures: The main outcome measures were survival, institutionalisation, key worker assessments of avoidable admissions, appropriateness of placement, unmet needs, carer stress and global outcome for patient and carers. Results: Rates of referral to urban teams were double rural rates. Around forty percent of the dementia group had a social worker as assessor and keyworker. The dementia group was significantly more dependent and received more informal and formal care. After six months, only 54% of the dementia group were alive and living outside institutional care, compared to 79% in the functionally ill group. Unplanned admissions to hospitals or homes were rarely judged avoidable by keyworkers. Outcomes for carers were judged poor in 15% of both groups, and 13% and 11% of carers respectively were judged to be under severe stress. Unmet needs were more common in the dementia group, and related principally to residential care and carer respite. A number of measures, including evidence of geographical inequity and identification of unmet needs, provided an important contribution to local policy development. Further work is needed on the validity of keyworker assessments of carer stress, given the findings of the carer interview sub‐study.

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Care management, dementia care and specialist mental health services: an evaluation

Challis

Abendorff

Brown

et al. 2002

Int J Geriat Psychiatry

100

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The benefits to older people and their carers confirms previous findings that the most effective case management interventions are those targeted on a highly specific client group. Issues which influence the cost-effectiveness of intensive case management are discussed. The benefits of locating this service within a specialist mental health team are explored in the context of current initiatives to promote greater service integration between health and social services.

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Treatment decisions following assessment by multidisciplinary psychogeriatric teams

Cited by 8 publications

References 4 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

What Becomes of People With Dementia Referred to Community Psychogeriatric Teams?

Care management, dementia care and specialist mental health services: an evaluation

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