Assessing the mental health needs of older people

Assessments of need

Introduction

Assessments of need for welfare services have been enshrined in 'good practice' for many years and identified as an expectation in law by:

the NHS and Community Care Act, which introduced the process of Care Management, incorporating assessments of need for community care services
the NHS Plan 2000 and the National Service Framework for Older People 2001, Standard 2 of which defines the role of the Single Assessment Process in delivering person-centred care.

Summary: Assessments of need

The NHS Plan 2000 and the National Service Framework for Older People introduced the Single Assessment Process (SAP), which aims to ensure that older people receive appropriate, effective and timely responses to their health and social care needs, and that professional resources are used effectively, minimising duplication.
There are four types of SAP depending on level and type of need: contact assessment, overview assessment, specialist assessment and comprehensive assessment.
The SAP is viewed as part of the wider process of Care Management, which also includes the stages of: deciding what help should be offered and what services a person is eligible for; care planning; and reviewing the care package.
People with severe and enduring mental health problems are subject to the Care Programme Approach (CPA), which aims to provide a framework for the delivery of effective care.
It is expected that the SAP plus critical aspects of CPA will be applied to older people with severe functional or organic mental health problems.
Carers who provide 'intensive and substantial' levels of care have a right to an assessment of their needs by their local authority under the Carers (Recognition and Services) Act 1995 and the Carers and Disabled Children Act 2000.

The Single Assessment Process (SAP)

The Single Assessment Process (SAP) aims to ensure that older people receive appropriate, effective and timely responses to their health and social care needs, and that professional resources are used effectively, minimising duplication. It is a pivotal mechanism:

for health and social services staff to use to identify individuals' needs for treatment, care and support
as the basis for the development of a 'personal care plan' (statements of service delivery and intent) agreed with the older person and held by them.

There are four types of SAP depending on the nature, severity and complexity of need:

contact assessment, including the collection of basic personal information
overview assessment
specialist assessment
comprehensive assessment.

SAP is viewed as part of the wider process of Care Management, which also includes the stages of:

evaluating the assessment information
deciding what help should be offered, including eligibility decisions
care planning and a statement of service delivery
monitoring
reviewing.

It is also regarded as a mechanism which all statutory agencies and professionals in a single area 'sign up to', so that local care and assessment systems align with the SAP.

The Care Programme Approach (CPA)

People with severe and enduring mental health problems are subject to the Care Programme Approach (CPA). CPA was implemented at the same time as Care Management with the specific aim of providing a framework for the delivery of effective care of adults with mental health care problems. Its role has been reinforced by the National Service Framework for Mental Health. (50);

Although not primarily associated with older people, the CPA is relevant because one of the criteria for inclusion is a history of self-neglect, which is often a feature of older people with severe mental health problems. It is expected that the SAP will work in an integrated way with the requirements of the CPA and that the SAP plus critical aspects of CPA will be applied to older people with severe functional or organic mental health problems (see Further information for more on integrating the CPA and the SAP).

Carers' assessments

Carers who provide 'intensive and substantial' levels of care have a right to an assessment of their needs under the Carers (Recognition and Services) Act 1995 and the Carers and Disabled Children Act 2000. The former gave a carer the right to have their needs assessed at the same time as the person they care for. The latter Act gives carers a further right to an assessment even if the cared-for person refuses to be assessed. This Act also extended local authorities' powers to provide or arrange services that support carers in their caring role.