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ADULTS’ SERVICES: SCIE GUIDE 03 Assessing the mental health needs of older peop

ADULTS’ SERVICES: SCIE GUIDE 03 Assessing the mental health needs of older people ii The Social Care Institute for Excellence (SCIE) was established by Government in 2001 to improve social care services for adults and children in the United Kingdom. We achieve this by identifying good practice and helping to embed it in everyday social care provision. SCIE works to disseminate knowledge-based good practice guidance; involve service users, carers, practitioners, providers and policy makers in advancing and promoting good practice in social care; enhance the skills and professionalism of social care workers through our tailored, targeted and user- friendly resources. ADULTS’ SERVICES Assessing the mental health needs of older people iii Assessing the mental health needs of older people Angela Nicholls iv First published in Great Britain in April 2006 by the Social Care Institute for Excellence © SCIE 2006 All rights reserved Written by Angela Nicholls This PDF document was created in April 2006, and will not reflect any changes made since that date. Please visit our website for the latest version: www.scie.org.uk Social Care Institute for Excellence Goldings House 2 Hay’s Lane London SE1 2HB tel 020 7089 6840 fax 020 7089 6841 textphone 020 7089 6893 www.scie.org.uk ADULTS’ SERVICES Assessing the mental health needs of older people v Contents Introduction 1 Author and acknowledgements 2 About this guide 3 Who the guide is for Aims of the guide Section 1: A framework for wellbeing 8 The National Service Framework Mental health and wellbeing Section 2: The main problems 12 Depression Dementia Other psychiatric illnesses Drug and alcohol problems Treatment and recovery What you can do Section 3: The assessment process 21 Key research findings The Single Assessment Process Hospital discharge Communication skills Understanding dementia Mental capacity Assessing risk Gathering information Assessment tools Specialist assessment What you can do: top tips Section 4: Meeting needs 39 What you can do: top tips Key research findings Information, advice and planning Specialist or mainstream Widening choice and access Assistive technology Financial entitlements vi Risk taking Continued contact Case study 1 Case study 2 Section 5: Carers 57 Key research findings Special problems What you can do Section 6: Black and minority ethnic communities 61 Key research findings Needs and barriers What you can do Section 7: Abuse 65 Key research findings What you can do Institutional abuse Section 8: Law and policy 70 The broader context Assessment of need Mental health legislation Mental capacity Protecting vulnerable adults Advocacy Care standards Policy on carers Equal opportunities Further information References 108 Introduction The Social Care Institute for Excellence (SCIE) aims to improve the experience of people who use social care by developing and promoting knowledge about good practice. Using knowledge gathered from diverse sources and a broad range of people and organisations, SCIE develops resources that it shares freely, supporting those working in social care and empowering service users. This is an updated edition of SCIE’s online practice guide to assessing older people with mental health needs. It has been revised for first-line assessors, who require accessible and accurate information and knowledge about mental illness in older people, to ensure that they, and their carers, get the right help and support. The guide is equally accessible to older people themselves; to their carers, supporters, and families; and to all those who plan, deliver and use services for older people. Working with you SCIE welcomes email or written comments on any aspect of this guide. The feedback will inform future practice guide updates. We are also keen to collect examples that translate key research findings and practice points into practice. You can contact SCIE at www.scie.org.uk 2 Author and acknowledgements The author of the main guide is Angela Nicholls, independent consultant and researcher The ‘Law and policy section’ was written by Alisoun Milne, University of Kent and the ‘Messages for research’ section was written by Jo Moriarty, King’s College London. The revision of the guide was commissioned by Mary Sainsbury, Practice Development Manager at SCIE. SCIE would like to also like to thank all members of the SCIE reference group for their input and insight. ADULTS’ SERVICES Assessing the mental health needs of older people 3 About this guide Who the guide is for This guide is designed for practitioners in England who are assessing the social care needs of older people with mental health problems. It is particularly aimed at those working with older people in non-specialist settings, who are often the first professional in contact with an older person and their family and friends, and who may have limited knowledge and experience of mental health issues. The guide will also be valuable and interesting for everyone concerned with good practice in older people’s services, including older people themselves, and their families and friends. If you are an older person If you are an older person reading this guide, you may be worried about your own health or that of a family member or friend. We hope you will find the guide helpful and informative. Mental health and emotional wellbeing are of course as important in older age as at any other time of life. Everyone has mental health needs, although only some people are diagnosed as having a mental illness. The majority of older people have good mental health, but they are more likely to experience events that affect emotional wellbeing, such as bereavement or disability. This guide sets out to describe some of the specific mental health problems that you may experience, and gives advice to practitioners such as social workers and nurses who may need to take these problems into account when working with you. Health and social care professionals should carry out an assessment of the needs of older people they are working with, which means talking to you about your health and any illnesses or disabilities you might have, finding out how you are managing at home and about any problems you are experiencing, and discussing with you and your family what help you may need. Your mental health needs may be assessed as part of a general assessment. This does not mean that anyone thinks you are ‘going mad’ or ‘senile’. But what happens to you, and illnesses you experience, affect the way you feel and your ability to cope, so they are important. If there is a problem, it is important for you and your doctors to understand what that problem is and how it might be tackled. Many things can be done to help you with mental health needs, and your families, improve your quality of life. This guide aims to help professionals working with older people to maintain a positive outlook and gives practical suggestions for things they can do to help. 4 Further information Throughout the guide you will find references to helpful organisations, websites and literature for further reading. Organisations that produce helpful advice leaflets and factsheets especially for older people include: Alzheimer’s Society (covering all forms of dementia) Help the Aged Age Concern If you look after an older person If you look after someone else, whether or not you live with them, you may be referred to as that person’s ‘carer’. Some people dislike the word ‘carer’, believing it diminishes the relationship they have with the cared-for person as husband, wife, daughter, son or friend. Health and social care professionals use the word ‘carer’ as a shorthand to represent a whole range of people who look after others. This is not intended to devalue the uniqueness of your relationship with the person, but to recognise that looking after someone else brings with it particular features that professionals should take into account. Looking after an older person with mental health needs may bring particular problems, and Section 5 discusses these. As a carer you are entitled to a separate assessment of your own needs, so, if the person you care for is having their needs assessed, make sure that you are also offered your own assessment. Further information The following organisations provide information on caring and services available: • Carers UK • The Princess Royal Trust for Carers • Alzheimer’s Society ADULTS’ SERVICES Assessing the mental health needs of older people 5 Aims of the guide The purpose of this guide is to offer quick and easy access to knowledge about working with older people with mental health needs, and to suggest practical things that can be done. Older people’s mental health is a vast field, and this guide does not attempt to cover it all. For example, the needs of older people with learning disabilities and the needs of service providers are not included1. The guide does provide: • Basic knowledge of older people’s mental health needs, including the legal context in England and key messages from research • Good practice principles and practical suggestions for assessing and arranging services, including practice and service examples. • Detailed information, references and resources for those who wish for further information, including useful web links and extracts from official uploads/s1/ guide-03.pdf