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Provision of specialist continuing care services for older adults across the UK. Int Psychogeriatr 2016; 28:959-66. [PMID: 26796492 DOI: 10.1017/s1041610215002367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Older people with mental health problems who meet needs based criteria for National Health Service (NHS) continuing care funding may be cared for in a variety of settings. These services have evolved due to socio-economic and political pressure, with the extent of movement of care from traditional NHS run long stay units into the private sector being unclear. Little attention has been paid to the best model of service provision for this group in terms of quality of care, patient outcomes, and cost effectiveness. METHODS A literature review was conducted in order to explore what is known about service models for long-term psychiatric care for older people and their cost effectiveness. Following this review, an online survey was conducted in order to establish current specialist continuing care service provision by provider organizations, as well as any planned developments in services. RESULTS The way specialist mental health continuing care services are provided in the United Kingdom (UK) varies, with just 45% (33) of NHS providers still operating their own services. Specialist mental health continuing care is an area of current service review for a number of organizations. CONCLUSIONS Specialist care services for older adults with mental health problems in the UK are changing, but there is a lack of research on models of service delivery for this group of vulnerable individuals with complex needs. In the context of financial pressures within the NHS, and an increasing awareness of the need to develop and improve quality of services both for those with dementia and other mental illnesses, an urgent need for further research in this area is identified.
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Galletly C, Castle D, Dark F, Humberstone V, Jablensky A, Killackey E, Kulkarni J, McGorry P, Nielssen O, Tran N. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust N Z J Psychiatry 2016; 50:410-72. [PMID: 27106681 DOI: 10.1177/0004867416641195] [Citation(s) in RCA: 502] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This guideline provides recommendations for the clinical management of schizophrenia and related disorders for health professionals working in Australia and New Zealand. It aims to encourage all clinicians to adopt best practice principles. The recommendations represent the consensus of a group of Australian and New Zealand experts in the management of schizophrenia and related disorders. This guideline includes the management of ultra-high risk syndromes, first-episode psychoses and prolonged psychoses, including psychoses associated with substance use. It takes a holistic approach, addressing all aspects of the care of people with schizophrenia and related disorders, not only correct diagnosis and symptom relief but also optimal recovery of social function. METHODS The writing group planned the scope and individual members drafted sections according to their area of interest and expertise, with reference to existing systematic reviews and informal literature reviews undertaken for this guideline. In addition, experts in specific areas contributed to the relevant sections. All members of the writing group reviewed the entire document. The writing group also considered relevant international clinical practice guidelines. Evidence-based recommendations were formulated when the writing group judged that there was sufficient evidence on a topic. Where evidence was weak or lacking, consensus-based recommendations were formulated. Consensus-based recommendations are based on the consensus of a group of experts in the field and are informed by their agreement as a group, according to their collective clinical and research knowledge and experience. Key considerations were selected and reviewed by the writing group. To encourage wide community participation, the Royal Australian and New Zealand College of Psychiatrists invited review by its committees and members, an expert advisory committee and key stakeholders including professional bodies and special interest groups. RESULTS The clinical practice guideline for the management of schizophrenia and related disorders reflects an increasing emphasis on early intervention, physical health, psychosocial treatments, cultural considerations and improving vocational outcomes. The guideline uses a clinical staging model as a framework for recommendations regarding assessment, treatment and ongoing care. This guideline also refers its readers to selected published guidelines or statements directly relevant to Australian and New Zealand practice. CONCLUSIONS This clinical practice guideline for the management of schizophrenia and related disorders aims to improve care for people with these disorders living in Australia and New Zealand. It advocates a respectful, collaborative approach; optimal evidence-based treatment; and consideration of the specific needs of those in adverse circumstances or facing additional challenges.
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Affiliation(s)
- Cherrie Galletly
- Discipline of Psychiatry, School of Medicine, The University of Adelaide, SA, Australia Ramsay Health Care (SA) Mental Health, Adelaide, SA, Australia Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - David Castle
- Department of Psychiatry, St Vincent's Health and The University of Melbourne, Melbourne, VIC, Australia
| | - Frances Dark
- Rehabilitation Services, Metro South Mental Health Service, Brisbane, QLD, Australia
| | - Verity Humberstone
- Mental Health and Addiction Services, Northland District Health Board, Whangarei, New Zealand
| | - Assen Jablensky
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia (UWA), Crawley, WA, Australia
| | - Eóin Killackey
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia The University of Melbourne, Melbourne, VIC, Australia
| | - Jayashri Kulkarni
- The Alfred Hospital and Monash University, Clayton, VIC, Australia Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
| | - Patrick McGorry
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia The University of Melbourne, Melbourne, VIC, Australia Board of the National Youth Mental Health Foundation (headspace), Parkville, VIC, Australia
| | - Olav Nielssen
- Psychiatry, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Nga Tran
- St Vincent's Mental Health, Melbourne, VIC, Australia Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
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Abdul-Hamid WK, Lewis-Cole K, Holloway F, Silverman AM. Comparision of how old age psychiatry and general adult psychiatry services meet the needs of elderly people with functional mental illness: cross-sectional survey. Br J Psychiatry 2015; 207:440-3. [PMID: 26450580 DOI: 10.1192/bjp.bp.114.145706] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 01/30/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is little research evidence as to whether general adult psychiatry or old age psychiatry should look after old people with enduring mental illness. AIMS To compare the extent to which general adult and old age psychiatric services meet the needs of older people with enduring mental illness. METHOD A total of 74 elderly patients with functional psychiatric disorders were identified by reviewing the notes of patients over the age of 60 living in a defined inner urban catchment area. Data were collected on the morbidity and needs of the sample. Needs were assessed using the Elderly Psychiatric Needs Schedule (EPNS). RESULTS The participants in contact with old age psychiatry had significantly fewer unmet needs compared with those in contact with general adult psychiatry (2.8 v. 5.6, t = 2.2, P<0.03). Total needs were not significantly different between those managed by old age and general adult services (8.0 v. 6.5 respectively, t = 1.2, P = 0.2). CONCLUSIONS This study found that old age psychiatry services were better placed to meet the needs of elderly people with mental illness. This finding supports the need for a separate old age psychiatry service.
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Affiliation(s)
- Walid Khalid Abdul-Hamid
- Walid Khalid Abdul-Hamid, MRCPsych, PhD, Centre for Psychiatry, Barts and the London, Queen Mary's School of Medicine and Dentistry and The Linden Centre, Broomfield, Chelmsford, UK; Kelly Lewis-Cole, PhD, clinical psychologist (independent), Andalusia, Spain; Frank Holloway, FRCPsych, Emeritus consultant psychiatrist, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK; Ann Marisa Silverman (retired), South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Kelly Lewis-Cole
- Walid Khalid Abdul-Hamid, MRCPsych, PhD, Centre for Psychiatry, Barts and the London, Queen Mary's School of Medicine and Dentistry and The Linden Centre, Broomfield, Chelmsford, UK; Kelly Lewis-Cole, PhD, clinical psychologist (independent), Andalusia, Spain; Frank Holloway, FRCPsych, Emeritus consultant psychiatrist, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK; Ann Marisa Silverman (retired), South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Frank Holloway
- Walid Khalid Abdul-Hamid, MRCPsych, PhD, Centre for Psychiatry, Barts and the London, Queen Mary's School of Medicine and Dentistry and The Linden Centre, Broomfield, Chelmsford, UK; Kelly Lewis-Cole, PhD, clinical psychologist (independent), Andalusia, Spain; Frank Holloway, FRCPsych, Emeritus consultant psychiatrist, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK; Ann Marisa Silverman (retired), South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Ann Marisa Silverman
- Walid Khalid Abdul-Hamid, MRCPsych, PhD, Centre for Psychiatry, Barts and the London, Queen Mary's School of Medicine and Dentistry and The Linden Centre, Broomfield, Chelmsford, UK; Kelly Lewis-Cole, PhD, clinical psychologist (independent), Andalusia, Spain; Frank Holloway, FRCPsych, Emeritus consultant psychiatrist, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK; Ann Marisa Silverman (retired), South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
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