National Survey of Older People’s Community Mental Health Teams in England

Background The mental health care workforce supporting people with dementia and comorbid mental disorders requires specific skills and knowledge. Aims We co-designed and conducted a survey aimed to understand key current issues facing community mental health care services accessed by older adults. Method We invited all English National Health Service (NHS) Older People’s Community Mental Health Teams (OPCMHTs) providing care for people with dementia in England to complete the survey. We compared service structures, resourcing, and waiting times between regions, and asked service leads about changes in the past five years that made them feel proud, caused them concern, and changes they anticipated over the next five years. We considered how responses might inform current policy priorities. Results Staff representing 182/242(75.2%) English NHS OPCMHTs participated. We estimated there were 120,233 referrals to English OPCMHT services per year. In 141 of 182 (77.5%) services, referral rates were increasing. In a quarter of services (46/182, 25.3%), clients waited over a month from referral to initial assessment; and most services (107/181, 59.1%) experienced difficulties accessing in-patient beds for people with dementia. The extent of these challenges varied considerably across regions, with rural regions more likely to report difficulties accessing inpatient beds. Half of respondents (100/182, 55.2%) felt their service provided higher quality care for people with dementia than five years ago, despite increasing caseload complexity related to fewer inpatient beds and increasing client needs. Many respondents highlighted resource limitations that limited opportunities for prevention and challenged care quality and collaborative working and rated team relationships with: social services (86, 47.8%), general hospital inpatient (74, 41.4%) and outpatient (54, 30.2%) services, and primary care (54, 30.2%) as poor or requiring improvement. Conclusion OPCMHT service leads are committed to the integrated working planned within neighbourhood health services, but believe they are insufficiently resourced to realise their potential to deliver treatments that could prevent dementia among people with severe mental illness and improve life quality of those living with dementia and co-morbid mental disorders. Addressing challenges related to workforce retention, training, and ways of working could optimise OPCMHT contributions to integrated care for people with dementia.