Assessing the mental health needs of older people
The single assessment process
Standard 2 of the National Service Framework for Older People is concerned with 'Person-Centred Care'. It aims to 'Ensure that older people are treated as individuals and they receive appropriate and timely packages of care which meets their needs as individuals, regardless of health and social services boundaries.' (Department of Health 2001)( 21)
The Single Assessment Process is the means by which health and social care organisations work together to ensure that assessment and subsequent care planning for older people are person-centred, effective and coordinated. Since April 2004, all older people with health and social care needs should have those needs assessed using the locally agreed framework for the Single Assessment Process. This entails health and social care professionals working together, sharing information, trusting one another's judgement, reducing duplication, and together ensuring that the range and complexity of an older person's needs are properly identified and addressed in accordance with their wishes and preferences.
The following extract from Birmingham 's multi-agency guidelines for staff is an example of what person-centred care through the Single Assessment Process should mean in practice':
'Person-centred care and approaches put the needs and views of the individual at the centre of any professional involvement or intervention.
'Practitioners working in a person-centred way would be expected to:
- involve the person in all decisions about their care
- see the person as the expert in their own care and take account of strengths the person can bring to bear on their needs
- provide information and carry out assessments and other processes in the person's preferred language, making necessary arrangements for interpreters/translations/communication aids
- ensure each person is informed of, and consents to, information about their needs and circumstances being collected and shared
- ensure the person's contribution is not underestimated however disabled they are or whatever their level of difficulties
- work together across agencies in the best interests of the older person
- acknowledge and take account of the impact of a person's age, gender, living arrangements, personal relationships, lifestyle and culture - as well as their illness or disability - on their choices and needs
- require information about needs to be given once only in building a rounded picture of the person's needs and circumstances and be of a depth and detail "proportionate to the person's needs"
- have key decisions and issues copied in writing, or other appropriate formats, and given to the older person
- safeguard the person's interests when they lack capacity
- empower the person to decide about the level of risk they are prepared to take.'
© North Birmingham PCT ( SAP Birmingham Multi-Agency Steering Group) April 2003
The Care Programme Approach was introduced in 1991 to ensure that people with severe mental health problems discharged into the community received appropriate support and treatment through proper care planning and review. With the introduction of the Single Assessment Process for older people, some practitioners have been confused about whether older people with mental health needs should come under the Care Programme Approach or the Single Assessment Process. The Department of Health issued guidance in 2004 (22), which can be summarised as follows:
- Older people with severe mental illness due to schizophrenia or other psychoses should have their needs assessed using the Single Assessment Process, but should be care managed under the Care Programme Approach.
- For other older people with mental health problems, both the assessment and care management aspects of the Single Assessment Process should be applied.
- Adults currently under the Care Programme Approach when they enter old age do not have to switch to the Single Assessment Process.
For more on the Care Programme Approach, see Section 8.
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