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Modernizing mental health services for older people: a case study

Published online by Cambridge University Press:  21 July 2010

Niall McCrae  and
Sube Banerjee
Niall McCrae*
Affiliation:
King's College London, Section of Mental Health and Ageing, Institute of Psychiatry, London, U.K.
Sube Banerjee
Affiliation:
King's College London, Section of Mental Health and Ageing, Institute of Psychiatry, London, U.K.
*
Correspondence should be addressed to: Dr Niall McCrae, Box P026, Section of Mental Health and Ageing, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, U.K. Phone: +44 20 7848 5057; Fax: +44 20 7848 5056. Email: [email protected].
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Abstract

Background: This paper describes an evaluation of a redevelopment program in a mental health service for older people, stimulated by U.K. Department of Health policy. IQCOL (Improving Quality of Care for Older People in Lambeth) was a two-year program to modernize and expand an inner-city service, with objectives to improve access, embed new functions, and tune the service towards the needs of the local community. The program evaluation aimed to contribute to knowledge on service planning and methodology for evaluating complex interventions.

Methods: The study evaluated the progress and outcomes of this multifaceted program. The realist model of evaluation was followed, with a dual emphasis on utility and generalizability. With an iterative approach, the pragmatic, longitudinal design comprised a combination of qualitative and quantitative methods to explain the process of change and to measure achievement of objectives.

Results: A high level of participation in evaluation activities was achieved. The workforce generally responded well to the program. However, progress in one team was hindered by understaffing and resistance to change, emphasizing that while localized provision may be desirable, team viability requires adequate resources and professional support. Improved access was indicated by a 13% increase of referrals. Data suggested earlier referral of dementia cases. Carer support was implemented, but assertive outreach was impeded by professional boundary issues. Ethnicity data showed that the service was responding to demographic trends. Positive views towards the program were associated with team resources and recent professional training.

Conclusions: This case study demonstrates how whole system change can be achieved if sufficient attention is given to the needs of staff implementing the program. The evaluation emphasizes the importance of context in producing generalizable evidence on service development, and contributes useful methodological insights.

Keywords

community mental health servicesevaluationquality improvement
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 1 , February 2011 , pp. 10 - 19
Copyright
Copyright © International Psychogeriatric Association 2010

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