Assessing the mental health needs of older people
Research into which models of care management work best for older people with mental health needs emphasises the importance of continued contact.
Review and monitoring of the effectiveness of services provided is an essential aspect of working with older people. Situations can change dramatically in a short time, or slowly over time. In addition, older people with mental health needs are likely to have long-term or degenerative conditions, for which the normal service model of assessment, provision of service and withdrawal until review is not appropriate.
Practitioners working in systems which do not allow them to remain involved with people they have assessed (for instance intake and assessment units or hospital discharge teams) should ensure that a care coordinator is nominated as part of the person's care plan, with responsibility for ongoing support and monitoring rather than just periodic reviews.
Continuity of care arrangements and personnel is essential for older people with mental health needs, and particularly for those with memory loss or dementia. The importance of taking time to build up trust has already been emphasised in the section on assessing needs. This applies to service providers too. Care agencies need to ensure that staff are given time to build up a relationship with the older person and that staff changes are kept to a minimum. This is one requirement with which specialist services with a limited scale and focus can more easily comply, but, if general services are being used, assessors can ensure that such conditions are specified in the contract and/or care plan. For people with dementia, it is essential that care plans include the co-ordinated support of both health and social services, and take account of the changing needs of the older person and their carers.
Finally, it may be uncomfortable to acknowledge that plans go wrong, but it is important for all those involved in an assessment to know what is happening and have an agreed plan of action for changes in circumstances. Evaluation of the arrangements made, contingency plans for possible eventualities, and plans for unforeseen circumstances all need to be agreed and recorded. Professional opinions and decisions and the reasons for them need to be open and understandable.
Next: Case example 1