Everybody’s Business Integrated mental health services for older adults A service development guide

Everybody’s Business: Guidance and Key Messages Lesley Carter and Claire Goodchild London Care Services Improvement Partnership

The sections: Introduction Foundations Primary and community care Intermediate care  Care for people in the general hospital Other specialist mental health services Special groups Annexes: Service assessment, policy drivers

Everybody’s Business Integrated mental health services for older adults Key messages for Commissioners

Older people’s mental health is everyone’s business • Mental health problems are widespread: 40% of people visiting their GP 50% of general hospital inpatients 60% of people who live in care homes Depression is more common and worsens outcome in people with long term conditions • Population increase in the next 10 years: 15% increase in the over 65s 27% increase in the over 85s • Caring for people with Alzheimer’s disease costs more than the combined cost of stroke, cancer and heart disease

2) Improving services for older people with mental health problems will help meet national targets and standards • Commissioners can: Improve outcomes for service users and carers Generate savings by improved efficiency • Improving mental wellbeing in older people will support the delivery of a number of national targets and core standards: Reducing emergency inpatient bed days Enabling people to live independently at home Reducing death from suicide

3) Access to mental health services should be based on need not age • DH is committed to age equality in mental health services • Services need to be user led rather than service led • The specialist service requirements of older people with mental health problems still need to be recognised and addressed

4) Older people need holistic care in mainstream services • DH is committed to developing health and care services that address mental and physical health needs • Services should start with the needs of the individual, offer choice and support wellbeing and independence • Whatever the setting, older people with mental health problems should not be discriminated against and should have their mental health needs met.

5) Workforce development is central to driving service improvement • Older people with mental health problems and their carers often have complex needs. There are few areas where the quality of the workforce matters more A properly skilled workforce throughout health and social care is fundamental to delivering better mental health for older people • It is vital to include mainstream staff in workforce development, education and training as well as staff specialising in mental health care

6) Whole system commissioning and leadership are vital to deliver a comprehensive service • A co-ordinated approach is needed across all health and social care – with links to housing, the voluntary sector etc • Strong leadership across health, social services, local authorities and the voluntary sector is essential to: Communicate the vision of age inclusive and holistic services Ensure the delivery of lasting results

So what is going to make it happen?

Supports: DH OPMH Programme Board Care Services Improvement Partnership: website: www.everybodysbusiness.org.uk Service and financial mapping The Commission for Social Care Inspection and the Healthcare Commission Our health, our care, our say: a new direction for community services: “Commissioners and providers of services will need to become familiar with this guide”

Quality and Outcomes Framework (Changes from April 2006) • Making working age adult mental health indicators age-inclusive • Screening for depression in people with diabetes and heart disease • New indicators involving a dementia register in primary care • Extending the palliative care disease register to people with frailty and dementia

What happens next?

Other key events to watch out for: - ‘Next Steps’ – NSF update SCIE/NICE Dementia Guideline Mental Capacity Act implementation Mental Health Bill

London CSIP implementation programme OPMH programme OPMH network Frontline providers Commissioners/strategic planning Service improvement directly with mental health trusts Influencing wider CSIP mental health programmes Working alongside King’s Fund OPMH Development Programme Working with the whole system Supporting OPMH needs across health and social care

Supporting Implementation Web based resources OPMH website www.olderpeoplesmentalhealth.csip.org.uk Change Agent Team website www.changeagentteam.org.uk Lesley.carter@londondevelopmentcentre.org.uk Claire.goodchild@dh.gsi.gov.uk