Assessing the mental health needs of older people
This guide assumes that you are a practitioner without psychiatric training who has responsibility for assessing the needs of older people, some of whom may have mental health needs. While it is likely that the majority of older people with mild to moderate mental health needs will have their care, treatment and services provided by non-specialists such as yourself, it is important to recognise when specialist services and professionals should be called in.
Department of Health guidance states:
The majority of older people with mental illness do not come into contact with specialist mental health services. To maximise care therefore requires effective management by others in contact with older people. There should be a protocol for the detection, initial assessment (incorporating contact and overview assessment within the Single Assessment Process), initial management and specialist referral of older people with mental illness, including depression and dementia. This should be adapted for use in primary care, the general hospital, care homes, and social services. The protocol should indicate when and how people with mental illness should be referred between different services across different agencies, with mechanisms to optimise appropriate information sharing.' (30)
To some extent how this happens will depend on the specialist services in your locality, such as the Memory Clinic, Acute Psychiatry Team and Community Mental Health Team for Older People, and the criteria by which they operate. You will need to find out what specialist services there are in your area for older people with mental health needs, what they do, and their criteria for referral. This information should be available in the form of protocols or care pathways (see quotation above), but are likely to include referral to specialist services in the following circumstances:
- if you suspect someone may have mental health needs but no diagnosis has been made
- if diagnosis remains uncertain or symptoms are particularly complex
- if the person's behaviour or emotional state is creating a risk to themselves or others
- if the person's behaviour or emotional state is such that their care arrangements are likely to break down
- if problems are particularly complex or legal issues are involved.
Finally, you need to consider your own entitlement to help or advice on behalf of the older people you work with. Many specialist services now provide advice and support to workers in other settings. If you need more specialist advice or support than your own team can provide, ask for advice from your mental health colleagues.
- In Warwickshire, Community Psychiatric Nurses were appointed to work directly with care home staff in the support and management of residents with mental health needs.
- In Coventry, there is a Hospital Liaison Team linking mental health specialists to general hospital staff, and a Practice Educator running workshops and training for ward staff.
Next: Meeting needs