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Everybody’s Business

Integrated mental health services for older adults

A service development guide

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Everybody’s Business: Guidance and Key Messages

Lesley Carter and Claire Goodchild

London

Care Services Improvement Partnership

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The sections:

• Introduction

• Foundations

• Primary and community care

• Intermediate care 

• Care for people in the general hospital

• Other specialist mental health services

• Special groups

• Annexes: Service assessment, policy drivers

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Everybody’s Business

Integrated mental health services for older adults

Key messages for Commissioners

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1) Older people’s mental health is everyone’s business

• Mental health problems are widespread: 40% of people visiting their GP 50% of general hospital inpatients 60% of people who live in care homes

• Depression is more common and worsens outcome in people with long term conditions

• Population increase in the next 10 years:15% increase in the over 65s27% increase in the over 85s

• Caring for people with Alzheimer’s disease costs more than the combined cost of stroke, cancer and heart disease

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2) Improving services for older people with mental health problems will help meet national targets and standards

• Commissioners can: Improve outcomes for service users and carers

Generate savings by improved efficiency

• Improving mental wellbeing in older people will support the delivery of a number of national targets and core standards:

Reducing emergency inpatient bed days Enabling people to live independently at home Reducing death from suicide

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3) Access to mental health services should be based on need not age

• DH is committed to age equality in mental health services

• Services need to be user led rather than service led

• The specialist service requirements of older people with mental health problems still need to be recognised and addressed

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4) Older people need holistic care in mainstream services

• DH is committed to developing health and care services that address mental and physical health needs

• Services should start with the needs of the individual, offer choice and support wellbeing and independence

• Whatever the setting, older people with mental health problems should not be discriminated against and should have their mental health needs met.

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5) Workforce development is central to driving service improvement

• Older people with mental health problems and their carers often have complex needs. There are few areas where the quality of the workforce matters more• A properly skilled workforce throughout health and social care is fundamental to delivering better mental health for older people

• It is vital to include mainstream staff in workforce development, education and training as well as staff specialising in mental health care

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6) Whole system commissioning and leadership are vital to deliver a comprehensive service

• A co-ordinated approach is needed across all health and social care – with links to housing, the voluntary sector etc

• Strong leadership across health, social services, local authorities and the voluntary sector is essential to:

Communicate the vision of age inclusive and holistic servicesEnsure the delivery of lasting results

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So what is going to make it happen?

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Supports:

• DH OPMH Programme Board

• Care Services Improvement Partnership: website: www.everybodysbusiness.org.uk

• Service and financial mapping

• The Commission for Social Care Inspection and the Healthcare Commission

• Our health, our care, our say: a new direction for community services: “Commissioners and providers of services will need to become familiar with this guide”

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Quality and Outcomes Framework(Changes from April 2006)

• Making working age adult mental health indicators age-inclusive

• Screening for depression in people with diabetes and heart disease

• New indicators involving a dementia register in primary care

• Extending the palliative care disease register to people with frailty and dementia

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What happens next?

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Other key events to watch out for: -

• ‘Next Steps’ – NSF update

• SCIE/NICE Dementia Guideline

• Mental Capacity Act implementation

• Mental Health Bill

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London CSIP implementation programmeOPMH programme• OPMH network

―Frontline providers ―Commissioners/strategic planning

• Service improvement directly with mental health trusts

• Influencing wider CSIP mental health programmes• Working alongside King’s Fund OPMH

Development Programme• Working with the whole system• Supporting OPMH needs across health and social

care

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Supporting Implementation

Web based resources • OPMH websitewww.olderpeoplesmentalhealth.csip.org.uk• Change Agent Team websitewww.changeagentteam.org.uk

Lesley.carter@londondevelopmentcentre.org.ukClaire.goodchild@dh.gsi.gov.uk