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Community mental health teams for older people: variations in case mix and service receipt (I)
- Authors:
- TUCKER Sue, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 30(6), 2015, pp.595-604.
- Publisher:
- Wiley
Objectives: The study sought to identify the characteristics of community-dwelling older people supported by community mental health teams (CMHTs) in England and, in particular, to determine whether there is a common threshold for CMHT entry and/or a core client group. Methods: Data were collected about a random sample of 15 CMHTs' caseloads, including information about their sociodemographic characteristics, physical health, dependence, mental health, risks and service receipt. The sample was divided into 16 subgroups of people with similar needs for care (case types), and differences between teams were explored. Results: Information was obtained for 1396 patients. Just under half had a functional mental health problem, slightly over a third an organic disorder, seven per cent both, and nine per cent no diagnosis. Considerable variation was found in teams' caseloads, and there was no evidence of a common caseload threshold. Two of the commonest case types represented people with functional diagnoses who were independent in activities of daily living (ADL) and had no/low levels of challenging behaviour. Another representing people with organic/mixed diagnoses, ADL dependence, challenging behaviour and at least one medium risk was also fairly common. The two case types that represented patients with the most complex needs accounted for more than a quarter of some teams' caseloads but less than a tenth of others. Conclusions: It is wrong to assume that CMHTs all have similar caseloads. Commissioners must ensure that the network of services provided can meet the needs of all eligible patients, whilst more research is required on who such teams should target. (Publisher abstract)
Community mental health teams for older people: variations in case mix and service receipt (II)
- Authors:
- WILBERFORCE Mark, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 30(6), 2015, pp.605-613.
- Publisher:
- Wiley
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. (Publisher abstract)
All things to all people? The provision of outreach by community mental health teams for older people in England: findings from a national survey
- Authors:
- TUCKER Sue, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 29(5), 2014, pp.489-496.
- Publisher:
- Wiley
Objective: The objective of this study is to identify the extent of outreach activity community mental health teams (CMHTs) for older people provide to mainstream services in light of the recommendations of the National Dementia Strategy. In particular, to determine the range of settings in receipt of support; to specify the form of this activity; to identify the professionals involved; and to explore the factors associated with the provision of such support. Methods: A self-administered postal questionnaire was sent to all CMHTs in England. The reported arrangements were categorised and reviewed according to a taxonomy of outreach developed from the literature. Results: Three hundred and seventy six (88%) of the CMHTs responded. Although nearly all teams undertook some outreach work, much of this was informal in nature. Nevertheless, the vast majority of teams had some formal outreach arrangements in at least one mainstream setting. Just less than three-quarters provided support (most typically education) to care homes, approaching half centres to day centres, and over a third to primary care practices, social services teams, home care providers and general hospitals, respectively. Link workers were the favoured means of supporting general hospital staff. Community mental health nurses were most commonly involved in providing outreach, and larger teams were more likely than smaller teams to have formalised arrangements. A significant minority of teams expressed concerns about their capacity to provide effective services. Conclusions: The findings suggest that both more resources and more evidence will be needed to meet the National Dementia Strategy's aim of improving care for older people with mental health problems in mainstream settings. (Publisher abstract)
On the way to work: a vocational training project for people with mental health problems
- Authors:
- McGILLOWAY Sinead, DONNELLY Michael
- Journal article citation:
- A Life in the Day, 6(4), November 2002, pp.13-19.
- Publisher:
- Emerald
Describes a study undertaken to assess the extent to which a vocational training service, ACCEPT (NI), providing a service for people with mental health problems. The service aims to provide assessment, counselling and coaching in employment, placement and training. The article looks at the effectiveness of the service as perceived by clients and social care professionals. Quantitative and qualitative methods were used.
Shit is good: mental health social work with squalor
- Author:
- SMITH Stephen
- Journal article citation:
- Journal of Social Work Practice, 15(1), May 2001, pp.37-56.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This paper investigates the phenomenon of three clients living in squalor, all of whom have severe and enduring mental health problems, and are on the caseload of a mental health social work team. By thinking about the clients both individually and as a group, within a psychoanalytic framework, it attempts to understand their squalor in a new way, with a particular regard to the transference and counter transference experienced by the practitioner. By making use of social work literature as well as that concerning organisations and community care, it also discusses the impact these clients make on the wider community around them, and examines some of the dilemmas faced by the practitioner. The implications for social work are serious and far-reaching, and these are discussed with regard to long-term intervention as well as professional and personal scrutiny.
Divided priorities: mental health referrals
- Authors:
- TREDGET John, BOWLER Nick
- Journal article citation:
- Nursing Times, 20.1.00, 2000, pp.47-48.
- Publisher:
- Nursing Times
This report presents the findings of an audit of primary care referrals to a community mental health team which revealed that most were non-serious problems.
Pause for thought
- Author:
- RUSHTON Brian
- Journal article citation:
- Mental Health Care, 2(8), April 1999, pp.277-279.
- Publisher:
- Pavilion
Reports on how reflective practice has transformed the work of the South West Wirral elderly mental health community team.
The impact of primary care counselling on psychiatric symptoms
- Authors:
- GORDON Kenneth, GRAHAM Carolyn
- Journal article citation:
- Journal of Mental Health, 5(5), December 1996, pp.515-523.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
The work of three primary care counsellors was assessed over a one year period, in which clients were offered a brief intervention, under supervision of a clinical psychologist. Results suggested that clients were referred with significant mental health problems, and that counselling was effective in reducing psychiatric symptomatology. However, some of the more severely disturbed clients needed to be referred on to specialist teams, and while it can produce cost savings in some areas, counselling may therefore also create new demands on secondary care. Concludes that general practice counselling is valuable, but should be seen as an expansion of the range of mental health care, rather than an alternative to existing specialist services.
Is integrated care associated with service costs and admission rates to institutional settings? An observational study of community mental health teams for older people in England
- Authors:
- WILBERFORCE Mark, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(11), 2016, pp.1208-1216.
- Publisher:
- Wiley
Objectives: To evaluate the association between the degree of integration in community mental health teams (CMHTs) and: (i) the service costs of community mental health and social care provision; (ii) rates of mental health inpatient and care home admission. Methods: An observational study of service use and admissions to institutional care was undertaken for a prospectively-sampled cohort of patients from eight CMHTs in England. Teams were chosen to represent ‘high’ or ‘low’ levels of integrated working practice and patients were followed-up for seven months. General linear models were used to estimate service costs and the likelihood of institutional admission. Results: Patients supported by high integration teams received services costing an estimated 44% more than comparable patients in low integration teams. However, after controlling for case mix, no significant differences were found in the likelihood of admission to mental health inpatient wards or care homes between team types. Conclusions: Integrated mental health and social care teams appeared to facilitate greater access to community care services, but no consequent association was found with community tenure. Further research is required to identify the necessary and sufficient components of integrated community mental health care, and its effect on a wider range of outcomes using patient-reported measures (Edited publisher abstract)
Mental health services for adults with learning disabilities
- Authors:
- BOURAS Nick, HOLT Geraldine
- Journal article citation:
- British Journal of Psychiatry, 184(4), April 2004, pp.291-292.
- Publisher:
- Cambridge University Press
The specialisation of mental health services for people with learning disabilities, provided by mainstream mental health services at a tertiary care level, offers a way forward. Such a solution should be instrumental in surmounting the bureaucratic barriers to care at all service levels. It would bridge the gulf between service systems and would endorse working within the National Framework for Mental Health as well as sharing resources and expertise. This service model would be compatible with other tertiary mental health services such as home treatment teams, assertive outreach services, eating disorders teams and early intervention teams for psychosis. The clinical interface between mental health and learning disability services should follow the pattern of that existing between child development teams and child and adolescent mental health teams, and old age mental health teams and geriatric services.