National Trends and Local Delivery in Old Age Mental Health Services: Towards an evidence-base

As our population ages, the demands on health and social care services will be amplified by a disporportionate increase in the number of older people with mental health problems. Nearly half of older adults visiting a GP or in hospital, and almost two-thirds of care home residents have a mental health problem, and older people with mental health problems are significant consumers of community-based social care services. In recent years, the National Service Framework for Older People and a number of related initiatives have given priority to the development of mental health services for older people, and specialist mental health services are now widespread. To date, however, the evidence-base available to inform the planning and organisation of services for this client group is limited.The proposed programme aims to identify more cost-effective ways of structuring and delivering services for older people with mental health problems. It focuses upon three areas of importance at different levels: the balance and mix of care and services; the effective working of community mental health teams for older people; and the effectiveness of services for older people with depression in care homes. Each area of work will involve detailed evaluations alongside the collection of national data to benchmark services.First, at the macro level, the programme examines the mix of in-patient, residential and community services needed in localities and the balance of provision between primary and secondary care. Strategically, the balance of provision and investment in localities between hospital wards, care homes and community services varies and is subject to debate. However, there is relatively little evidence or tools with which to consider the range of options for service developments or investment. This work will provide a framework of evidence by which reprovision of services may be considered and amongst its outputs will be a manual which can be used for local evaluation and service review by health and social care organisations.Second, at the mid level, it examines the factors which make for effective working of a key element of services, namely community mental health teams for older people. A systematic evaluation of the costs and outcomes of different models of these will be undertaken which is designed to identify the relative benefits of these different approaches.Third, at the micro level the programme examines ways to improve services for older people with depression living in care homes. Two different approaches to the detection, care and management of older people with depression will be evaluated in a trial that will seek to take forward the existing evidence-base.These will be complemented by four national surveys: two of NHS Trusts providing Old Age Mental Health Services at the beginning and end of the programme (to benchmark the detailed evaluations and indicate progress), and two of care home managers and consultant psychiatrists (to benchmark the care home work). The research team brings together significant research experience in mental health care of older people, health and social policy, health economics and statistical analysis allied to experience in service commissioning, management and clinical work (medical, nursing and social work). There are important links between the members of the team due to their respective locations in the University, PSSRU, the Manchester Mental Health and Social Care Trust and Commissioning that will facilitate the working of the programme. The team are based within a research environment with a long history of high quality research activity and have access to excellent computing and library facilities.There will be a variety of outputs from the programme throughout its lifetime. Information will be made available to a range of stakeholders in summary form on a specially designed website; workbooks will facilitate knowledge transfer from the research; learning opportunities