Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-17T04:20:18.518Z Has data issue: false hasContentIssue false
  • English
  • Français

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].
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Banerjee, S. et al. (2007). Improving the quality of care for mild to moderate dementia: an evaluation of the Croydon Memory Service Model. International Journal of Geriatric Psychiatry, 22, 782–788.CrossRefGoogle ScholarPubMed
Burnes, B. (2005). Complexity theories and organizational change. International Journal of Management Reviews, 7, 73–90.CrossRefGoogle Scholar
Burns, T. (2004). Community Mental Health Teams: A Guide to Current Practices. Oxford: Oxford University Press.CrossRefGoogle Scholar
Campbell, M. et al. (2000). Framework for design and evaluation of complex interventions to improve health. BMJ, 321, 694–696.Google Scholar
Collins, D. (1998). Organizational Change: Sociological Perspectives. London: Routledge.Google Scholar
Comas-Herrera, A. et al. (2007). Cognitive impairment in older people: future demand for long-term care services and the associated costs. International Journal of Geriatric Psychiatry, 22, 1037–1045.CrossRefGoogle ScholarPubMed
Department of Health (2001). National Service Framework for Older People. London: Department of Health.Google Scholar
Donabedian, A. (1988). The quality of care: how can it be assessed? JAMA, 260, 1743–1748.Google Scholar
Drucker, P. F. (1995). Managing in a Time of Great Change. London: BCA.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). ‘Mini-mental state’: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle Scholar
Gournay, K. (2005). The changing face of psychiatric nursing. Advances in Psychiatric Treatment, 11, 6–11.CrossRefGoogle Scholar
Harrison, J. and Traill, B. (2004). What do consultants think about the development of specialist mental health teams? Psychiatric Bulletin, 28, 83–86.CrossRefGoogle Scholar
Hull, S. A. et al. (2002). Relationship style between GPs and community mental health teams affects referral rates. British Journal of General Practice, 52, 101–107.Google ScholarPubMed
Huxley, P. et al. (2009). The principles and provisions of relationships: findings from an evaluation of support, time and recovery workers in mental health services in England. Journal of Social Work, 9, 99–117.CrossRefGoogle Scholar
Iles, V. and Sutherland, K. (2001). Organisational Change: A Review for Health Care Managers, Professionals and Researchers. London: National Co-ordinating Centre for NHS Service Delivery and Organisation R & D.Google Scholar
Iliffe, S. and Manthorpe, J. (2004). The debate on ethnicity and dementia: from category fallacy to person-centred care? Aging and Mental Health, 8, 283–292.CrossRefGoogle ScholarPubMed
Judge, K. and Bauld, L. (2001). Strong theory, flexible methods: evaluating complex community-based initiatives. Critical Public Health, 11, 19–38.CrossRefGoogle Scholar
Killaspy, H. et al. (2006). The REACT study: randomised evaluation of assertive community treatment in north London. BMJ, 332, 815–818.CrossRefGoogle ScholarPubMed
Kimberly, J. and Cook, J. M. (2008). Organizational measurement and the implementation of innovations in mental health services. Administration and Policy in Mental Health, 35, 11–20.CrossRefGoogle ScholarPubMed
Kushner, S. (2000). Personalizing Evaluation. London: Sage.CrossRefGoogle ScholarPubMed
Lewin, K. (1952). Field Theory in Social Science: Selected Theoretical Papers. London: Tavistock.Google Scholar
McCrae, N. et al. (2008). An extra pair of hands? A case study of the introduction of support workers in community mental health teams for older adults. Journal of Nursing Management, 16, 734–743.CrossRefGoogle Scholar
Menzies, I. E. P. (1960). A case study in the functioning of social systems as a defence against anxiety: a report on a study of the nursing service of a general hospital. Human Relations, 13, 95–121.CrossRefGoogle Scholar
Meyer, J. (2001). Action research. In Fulop, N., Allen, P., Clarke, A. and Black, N. (eds.), Studying the Organisation and Delivery of Health Services: Research Methods (pp. 172–187). London: Routledge.Google Scholar
Miles, M. B. and Huberman, A. M. (1994). Qualitative Data Analysis (2nd edn). Thousand Oaks, CA: Sage.Google Scholar
Mintzberg, H. (1979). The Structure of Organizations. New Jersey: Prentice Hall.Google Scholar
Moore, K. et al. (1998). Caring and Coping with Loss in Dementia; Evaluating a Psychosocial Intervention. Sheffield: Community Health Sheffield NHS Trust.Google Scholar
Moos, R. H. (1994). Work Environment Scale Manual (3rd edn). Palo Alto, CA: Consulting Psychologists Press.Google Scholar
Morse, J. M. (1994). Qualitative research: fact or fantasy? In Morse, J. M. (ed.), Critical Issues in Qualitative Research Methods (pp. 1–7). Thousand Oaks, CA: Sage.Google Scholar
National Institute for Mental Health in England (2003). Inside Outside: Improving Mental Health Services for Black and Minority Ethnic Communities in England. London: Department of Health.Google Scholar
Norušis, M. J. (2001). SPSS 8.0: Guide to Data Analysis. Chicago: SPSS Inc.Google Scholar
Pawson, R. and Tilley, N. (1997). Realistic Evaluation. London: Sage.Google Scholar
Peters, T. J. (1987). Thriving on Chaos. London: Heinemann.Google Scholar
Plant, R. (1987). Managing Change and Making it Stick. London: Harper Collins.Google Scholar
QSR International (2002). N6. Doncaster, Australia: QSR International.Google Scholar
Roethlisberger, F. J. and Dickson, W. J. (1939). Management and the Worker: An Account of a Research Program Conducted by the Western Electric Company, Hawthorne Works, Chicago. Cambridge, MA: Harvard University Press.Google Scholar
Scriven, M. (1967). The methodology of evaluation. In Tyler, R.W., Gagne, R. M., and Scriven, M. (eds.), Perspectives of Curriculum Evaluation (pp. 39–83). Chicago: Rand McNally.Google Scholar
Seddon, J. (2008). Systems Thinking in the Public Sector: The Failure of the Reform Regime. . .and a Manifesto for a Better Way. Axminster: Triarchy Press.Google Scholar
Senge, P. N. (1992). The Fifth Discipline: The Art and Practice of the Learning Organization. New York: Century Business.Google Scholar
Tucker, S. et al. (2007). Old age mental health services in England: implementing the National Service Framework for Older People. International Journal of Geriatric Psychiatry, 22, 211–217.Google Scholar
Warne, T. (2004). The mental health practitioner: an oxymoron? Journal of Psychiatric and Mental Health Nursing, 11, 179–184.Google Scholar
Warnes, A. M., Warren, L. and Nolan, M. (2000). Health, welfare and old age: transformations and critiques. In Warnes, A. M., Warren, L. and Nolan, M. (eds.), Care Services for Later Life: Transformations and Critiques (pp. 15–38). London: Jessica Kingsley.Google Scholar
Weiss, C. H. (1990). Evaluation for decisions. Is anybody there? Does anybody care? In Alkin, M. C. (ed.), Debates on Evaluation (pp. 171–184). Newbury Parte: Sage.Google Scholar
West, M. A. et al. (2001). Team effectiveness in organisations. In Cooper, C. L. and Robertson, I. T. (eds.), Organizational Psychology and Development (pp. 150–196). Chichester: John Wiley.Google Scholar
Wheeler, N. and Grice, D. (2000). Management in Health Care. Cheltenham: Stanley Thornes.Google ScholarPubMed