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Articles: Robert Colgate and Selina Jones Controlling the confusion: management of referrals into mental health services for older adults Adv Psychiatr Treat 2007; 13: 317-324 [Abstract] [Full text] [PDF]

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Integrated community mental health teams for older adults: twenty years’ experience

Tarun Kuruvilla, Delyth Alldrick   (5 October 2007)

Integrated community mental health teams for older adults: twenty years’ experience 5 October 2007
Tarun Kuruvilla, Locum Consultant in Old Age Psychiatry Gloucestershire Partnership NHS Foundation Trust, Delyth Alldrick Send letter to journal: Re: Integrated community mental health teams for older adults: twenty years’ experience tarun2k{at}yahoo.com Tarun Kuruvilla, et al.	Colgate & Jones (2007) describe innovative service organisation with a referrals coordinator to manage referrals into a mental health service for older adults at Bridgend. This model could be generalised to old age and general adult services across the UK. We would like to describe another innovation in the neighbouring county of Cardiff and Eastern Vale of Glamorgan, namely the establishment of community mental health teams for older adults fully integrated with Social Services at operational, strategic and funding levels. These teams have existed since 1989 being lead by Social Services, unlike the more recent Partnership Trusts in other regions where social workers are ‘seconded’ into Health Trusts. With an endorsement from the Department of Health’s recently outlined National Dementia Strategy (Department of Health, 2007), joint health and social care CMHTs for older adults could become the norm. There are likely to be initial teething problems in establishing these teams with a perceived ‘clash of cultures’. In Cardiff, examples of reconciliation on the part of the Health Service were adopting the open referral system of Social Services, where patients can be referred from any source thereby making the service more inclusive; operating a duty worker system for dealing with emergencies during working hours and for maintaining a single point of access to the service; training of nurses and therapists in social needs assessments and in procurement of social care packages. Examples of the challenges faced by social workers were training in cognitive screening assessments, mental state monitoring and effects of medication; establishing close links with in-patient and day hospital units; adopting the Care Programme Approach and dove-tailing it with the Single Assessment Process. With time and familiarity; clear operational policies underpinned by clinical governance; adequate training; and supervision of both clinical and professional needs, the integrated teams in Cardiff have matured into providing a truly patient-centred, needs based service, avoiding duplication of assessments and with effective sharing of information. Members of one discipline have been able to absorb some of the skills of other disciplines, furthered by joint working, without having to abandon their professional roles. This has enabled effective utilisation of resources for assessments and care-planning, essential for the larger number of referrals to these integrated teams. Managing the larger number of referrals will be challenging. The traditional consultant-led system is likely to be over-whelmed, while an administrative referral management centre lacks clinical input into prioritisation and allocation according to patient needs. These can be met by the referral coordinator model, described by Colgate & Jones, with added advantages of information gathering prior to triaging, feedback to referrers and data gathering. However it relies heavily on the co-ordinator and lacks multi-disciplinary input into the triaging and allocation process. The Cardiff teams have a weekly allocation meeting with a parallel duty worker system for emergencies Robust studies are needed to compare integrated community mental health teams for older adults with the standard health-based teams in the domains of patient outcomes; patient and carer satisfaction; professional satisfaction; and cost-effectiveness. References: Colgate, C. & Jones, S. (2007) Controlling the confusion: management of referrals into mental health services for older adults. Advances in Psychiatric Treatment, 13, 317-324. Department of Health (2007). Government project to produce the first ever national dementia strategy: work programme. http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Olderpeoplesservices/DH_077211 Authors: Tarun Kuruvilla, Locum Consultant in Old Age Psychiatry, Gloucestershire Partnership NHS Foundation Trust, Charlton Lane Centre, Charlton Lane, Cheltenham GL53 9DZ, UK. Tel:01242272018 Fax:01242272163 Email: tarun2k@yahoo.com Delyth Alldrick, Consultant in Old Age Psychiatry, Cardiff and Vale NHS Trust, Whitchurch Hospital, Park Road, Cardiff CF14 7XB, UK. Declaration of interest: None