Talking Mental Health in home care services for older people: implementation and process evaluation

Background There is evidence that early intervention addressing older adults’ mental health needs can improve health outcomes and reduce the risk of critical events. However, these needs are not adequately addressed across the aged care system due to factors such as stigma, capacity, and access barriers. This study co-designed, implemented, and evaluated a pilot program, ‘Talking Mental Health’, to promote the uptake of mental health evidence into routine community aged care services in Australia. Methods We co-designed the Talking Mental Health program’s formal organisational protocols as a key implementation strategy and used a rapid-cycle implementation, assessment, and adaptation methodology based on the RE-AIM framework. A mixed methods process evaluation used the Consolidated Framework for Implementation Research (CFIR) to identify facilitators and barriers to the implementation process. Data were collected from organisational systems on the use of the protocols, and from surveys and focus groups with staff, people with lived experience, and experts. Descriptive statistics assessed the degree of adoption and effectiveness of the protocols, and qualitative methods identified characteristics influencing the uptake of the program. Results The analysis and evaluation identified that the implementation of Talking Mental Health was effective, with modified protocols adopted well by staff to identify older people with mental health needs and improve care and access to support. The evaluation identified key contextual and implementation factors that affect the successful adoption of strategies to enhance the uptake of evidence in community aged care. Conclusions The findings indicate that successful uptake of the Talking Mental Health program in community aged care requires 1) the alignment of external and organisational strategies with staff concerns for clients, 2) leaders to demonstrate commitment to addressing client and staff needs and 3) the process to involve stakeholders, with clear communication and easy-to-use strategies for implementation. Future research should examine how to scale this approach to other aged care settings and sustain the use of the Talking Mental Health and other mental health protocols to improve access to mental health interventions for older people.