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This commentary considers the demographic ‘bulge’ of the so‐called ‘baby boomer’ generation and the public mental health challenge that this group will represent as they move into old age. Toby Williamson argues that now is the time to start a debate with the aim of identifying long‐term solutions to these new challenges.

The purpose of this paper is to systematically appraise the effect of use of interpreters for mental health problems in old age. The primary objective of the review is to assess the impact of a language barrier for assessment and management in relation to mental health problems in the old age. The secondary objectives are to assess the effect of the use of interpreters on patient satisfaction and quality of care, identify good practice and make recommendations for research and practice in the old age mental health.

The following data sources were searched for publications between 1966 and 2011: PubMed, PsycINFO, CINAHL and Cochrane Library. The authors found in previous reviews that a substantial number of papers from developing and non-English speaking countries are published in journals not indexed in mainstream databases, and devised a search strategy using Google which identified a number of papers, which could not be found when the search was limited to scientific data bases only (Farooq et al., 2009). The strategy was considered especially important for this review which focuses on communication across many different languages. Thus, the authors conducted a search of the World Wide Web using Google Scholar, employing the search term Medical Interpreters and Mental Health. The search included literature in all languages. The authors also searched the reference lists of included and excluded studies for additional relevant papers. Bibliographies of systematic review articles published in the last five years were also examined to identify pertinent studies.

Only four publications related specifically to “old age” and 33 addressed “interpreting” and “psychiatry” generally. Four articles presented original research (Parnes and Westfall, 2003; Hasset and George, 2002; Sadavoy et al., 2004; Van de Mieroop et al., 2012). One article (Shah, 1997) reports an “anecdotal descriptive account” of interviewing elderly people from ethnic backgrounds in a psychogeriatric service in Melbourne and does not report any data. Therefore, only four papers met the inclusion and exclusion criteria and present original research in the field of “old age”, “psychiatry” and “interpreting”. None of these papers present UK-based research. One is a quantitative study from Australia (Hasset and George, 2002), the second is a qualitative study from Canada (Sadavoy et al., 2004), in the third paper Van de Mieroop et al. (2012) describe community interpreting in a Belgian old home and the final paper is an American case study (Parnes and Westfall, 2003).

Interviewing older patients for constructs like cognitive function and decision-making capacity through interpreters can pose significant clinical and legal problems. There is urgent need for training mental health professionals for developing skills to overcome the language barrier and for interpreters to be trained for work in psychogeriatrics.

The literature on working through interpreters is limited to a few empirical studies. This has serious consequences for service users such as lack of trust in services, clinical errors and neglect of human rights. Further studies are needed to understand the extent of problem and how effective interpreting and translating services can be provided in the routine clinical practice. It is also essential to develop a standard of translation services in mental health that can be measured for their quality and also efficiency. At present such a quality standard is not available in the UK, unlike Sweden (see www.regeringen.se/sb/d/3288/a/19564). This omission is disturbing – especially when decisions on human rights are being considered as part of the Mental Health Act. Such a standard can best be achieved by collaboration between medical profession and linguists’ professional associations (Cambridge et al., 2012).

Whilst translation/interpretation has been addressed more generally in mental health: specific considerations related to old age psychiatry are almost absent. This needs urgent rectification given that a large proportion of older people from BME communities will require translation and interpretation services.

It was hypothesised that there were variations in health and social care services available for older people with dementia and their carers, and that measurement of this between localities was possible. The purpose of this paper is to present a framework for examining this.

Using a case study approach, data from national surveys of local authorities providing social care and National Health Services Trusts providing old age mental health services conducted in 2014/2015 in England were used. From these, indicators of variation in services for people with dementia and their carers in different geographical areas were created. Measurement of the presence/absence of each service permitted the creation of a service mix score for each area.

The framework comprised 16 attributes each with indicators describing the characteristics of the organisations providing the services; the skill mix of community mental health teams for older people; and the health care and social care services available in localities. Variation was evident, confirmed by quartile analysis and exemplars, suggesting that older people with dementia and their carers in different localities are likely to experience differences in the range of provision available, particularly social care services.

The case study approach used achieved its objectives, and the resultant framework has potential for generalisability and utility, given acceptable ecological validity and discriminant validity in identifying variations in service mix. It could be used in both research and practice.

This case study is of a man with learning disabilities and significant general medical and mental health problems. It illustrates some of the difficulties in assessment, diagnosis, management and service provision with such cases. It is described how an extended admission to a specialist in‐patient unit was necessary in which the Care Programme Approach (CPA) was used to organise multidisciplinary care.

The purpose of this paper is to present a framework for examining variation in care coordination arrangements for older people.

A multi-method approach was adopted combining analysis of secondary data and primary data. There were two stages: the development of the framework and its constituent attributes and indicators; and its validation from two perspectives: a meeting with managers and focus groups with practitioners. It was informed by an existing generic framework; subsequent policy guidance; data from an English national survey; previous research; and international literature.

The framework comprises 19 attributes each with indicators measuring performance relating to: organisational arrangements influencing service delivery; the performance of core tasks of care coordination; and differentiation within the process to distinguish between responses to different levels of need.

Care coordination arrangements in England are characterised by diversity. This paper provides a framework for evaluating local arrangements thereby highlighting strengths and where improvements are needed. It offers a means to promote programme fidelity. As such it has utility for both service commissioners and providers.

The purpose of this paper is to explore the experience of older people and their sense of developing wellbeing, including consideration of the strategies they employ to respond to perceived risk.

An Appreciative Inquiry study was used, which collected data with 58 participants in focus group and individual interviews. Interviews focussed on ways in which older people in South Africa, Australia, Germany and the UK understand and seek to maintain wellbeing.

The changing time horizons of older people lead to perceptions of risk and concerns that embrace societal as well as individual concerns. Often, this leads to a sense of societal responsibility and desire for social change, which is frustrated by a perceived exclusion from participation in society.

In mental health practice and education, it is imperative to embrace the shift from ageist concerns (with later life viewed as risky and tragic in itself) towards a greater sensitivity for older people’s resilience, the strategies they deploy to maintain this, and their desire for more control and respect for their potential to contribute to society.

Variation in time horizons leads to changes in temporal accounting, which may be under-utilised by society. Consequently, societies may not recognise and support the resilience of older people to the detriment of older people as individuals and to the wider society.

The purpose of this paper is to identify features of community mental health teams (CMHTs) for older people valued by their managers, and those they would most like to change.

Content analysis was used to analyse “free text” responses to open questions from a national survey about CMHTs’ organisational structures and processes. Responses were sorted into statements which were categorised into content areas and higher level dimensions.

Free text information was provided by 376 teams (an 88 per cent response rate). Eight higher level dimensions were identified. One related specifically to integration with social care services, whilst several more included material about other aspects of intra-team integration (e.g. documentation and location). The largest proportion of statements related to staffing and teamwork. Statements about inter-personal and inter-professional issues were largely positive, whilst statements about resources, bureaucracy and integration with social care services typically detailed desired changes.

Four key issues emerged comprising a high level of support from managers to develop integrated practices; a need to define the focus of CMHTs for older people and to be fully resourced; and the importance of a nurturing and supportive team environment.

The methodology provides a bridge between qualitative and quantitative research, exploring the volume of statements on particular topics and their meaning.

The purpose of this paper is to raise issues around the involvement of clinicians relevant to current policies for integrated care by reviewing a previous policy to integrate assessments.

This paper is a review of data from a survey of specialist clinicians' involvement in the single assessment process for older people.

The paper finds that clinician involvement was limited, with assessments not changing to a discernable degree and little involvement of older people. Changes to assessment were predominantly related to paperwork. However, the use of standardised tools by clinicians did increase. The use of shared record systems with social services was significantly associated with involvement.

Clinicians have previously not been engaged in policies around integrated assessments. Factors that can help engagement include development of a shared vision, drawing on the traditions of particular groups of clinicians in informing integrated assessment policies, and appropriate IT systems to promote information sharing. Factors hindering engagement include national policy implementation, viewed as inimical to clinical practice and low involvement by service users/patients.

Reviewing such previously implemented polices around integration, particularly at the assessment stage, offers lessons to learn in terms of the factors that may help or hinder the achievement of integrated practice, particularly regarding current policies around clinical leadership.

While personalisation and service choice remains a central plank of the Labour Government's policies in health and social care, there is a growing evidence base confirming that ethnic minority groups, are disadvantaged as service users in the UK. Building on some baseline data collected in 2000 and 2003/04, our recent research (Jutlla & Moreland, 2007) has reaffirmed the difficulties that Asian carers have in accessing services when caring for a relative with dementia.While such access data is important, we wish to move beyond the demographic aspects to consider the existential realities (the ontology) of the lives and cultures of those in minority ethnic groups. This paper consequently discusses the diversity and complexity of migration patterns among the Sikh community living in Wolverhampton. The paper conceptualises some of the ways in which different migration experiences and the realities of daily life influence the perceptions, experiences and patterns of care among migrant Sikh carers in Wolverhampton caring for an older person with dementia. The paper thus explores the thesis that the Sikh community is not a homogeneous group; and that the diversity and differences within the Sikh community can have important implications for care. Taking a biographical narrative approach to fieldwork, the relevant factors to be considered include: the carer's country of origin; their migration route and reasons for migration; their age at migration and the cultural experiences of the carers and their communities both in the UK and India.