Intermediate Care
Written by Tresa Andrews, Julia Little and Mandy Bingham
The Development of Mental Health Intermediate Care
The Department of Health (DoH) in 2000 proposed a new layer of care called Intermediate
Care (IC) as a means of building a bridge between hospital and home and to help
people recover and resume independent living more quickly (DoH, 2000). The DoH
then outlined the aims of these services in the National Service Framework for
Older People (NSF-OP) as providing “integrated services to promote faster
recovery from illness, prevent unnecessary acute hospital admissions, support
timely discharge and maximise independent living” (DoH, 2001, p.41). However,
it was quickly recognised by the DoH that out of this proposal and outline there
had developed a diversity of service implementations based on local need and
circumstances and as such “a thousand flowers” of IC had bloomed
(DoH, 2002, p.5). It was also quickly recognised by the DoH, older people with
mental health problems were potentially being excluded from IC services (DoH,
2002; Nuffield Institute for Health, 2002). Therefore, subsequent DoH guidance
to support the implementation of IC services emphasised “the importance
of ensuring that people with mental health problems, including cognitive impairment,
have access to IC services” (DoH, 2002, p.3). Additional DoH guidance
has further supported the development of IC for older people with mental health
needs by suggesting the strengthening of mainstream and specialist health and
social care provision for older people with mental health needs (CSIP/DoH, 2005,
DoH, 2005). A whole systems response across health and social care, physical
and mental health, mainstream and specialist services was emphasised in order
to “develop coordinated services that focus on people’s mental health
and physical needs – not their age – and promote respect and dignity”
(CSIP/DoH, 2005).
Forms of Mental Health Intermediate Care
Since 2002, mental health IC services have grown with two main blooms showing
themselves:
1. Providing a mental health resource to IC services (to help prevent people
with mental health issues being excluded from accessing IC services) - For example
services in Southwark (Andrews, 2004) and Salford (Watts and Read, 2007).
2. Providing an enhanced IC/rehabilitation resource to secondary mental health
for older adults services - For example services in North Kensington and North
East Westminster (McNab, Smith and Minardi, 2006) and Portsmouth City and East
Hampshire (Sullivan and Trinder, 2004).
Role of Psychology in Mental Health Intermediate Care
In their vision for securing better mental health for older adults, the DoH
highlighted key mental health priorities for all mainstream services (including
IC services) (DoH, 2005). These included improving mainstream staffs’
skills in detection and assessment of mental health problems in older adults
and providing guidance to mainstream staff on initial management of mental health
issues and referral pathways to appropriate mental health services. PSIGE outlined
how psychologists offer specialist psychological input through direct clinical
work and offer mainstream staff consultation, training, service development
and research and evaluation (PSIGE, 2006).
As previously mentioned since 2002 we have seen new blooms of mental health
IC services, their characteristics (e.g. size, position, structure, professional
membership, process) closely related to their local circumstances. Similarly,
we have seen the characteristics of psychology provision within these mental
health IC services being closely related to the local circumstances. Hence,
where mental health for older adults services are attempting to further embrace
IC objectives, there has been a number of ways of configuring psychology services.
For instance, in North Kensington and North East Westminster (McNab, Smith and
Minardi, 2006) and in East Kent (Culverwell, 2004). Where IC services have invited
and welcomed mental health resources, there has also been a number of ways of
configuring psychology services within the mental health resource. For instance,
psychology has found itself at times alone as the mental health resource in
IC services (Watts and Read, 2007). However, psychology has also found itself
at times in IC services within a larger multi-disciplinary mental health resource.
For instance, in Southwark there are several psychologists within their multi-disciplinary
mental health intermediate care team (Keane, Andrews, Akritas and Boddington,
2007, Bingham, Andrews, Little, Davies, Akritas, and Keane 2007).
Why This Site Would be Useful for Psychologists
Despite the increasing numbers of services offering mental health IC, the area
remains in a budding state with many services still being developed and many
being small and/or with few or no psychologists. The benefits of this website
will be the development of a network of psychologists working in mental health
IC and therefore the provision of resources (practice examples, associated literature
and research findings) and the opportunity for sharing ideas and experiences.
It is hoped this site will be a useful resource for all psychologists in the
process of negotiating, navigating and charting this new territory. It is anticipated
that pre and post qualified psychologists and those clinically active, applying
for funding, setting up, developing and evaluating services will find this resource
to be of use.
References
Andrews, T.K. (2004). A Model for Partnership Working with Mental Health. Improving Intermediate Care for Older People with Mental Health Needs – Good Practice & Key Issues. Retrieved February 5th, 2008 from website:
http://www.changeagentteam.org.uk/_library/OPMHICREPORT%20v8%20141105%20(FINAL).doc
Bingham, A., Andrews, T., Little, J., Davies, D., Akritas, S., & Keane, C. (2007). Southwark Mental Health Intermediate Care Team: Examples of Partnership Working. Proceedings of the Psychologists’ Special Interest Group, Working with Older People (PSIGE) 27th Conference.
Care Services Improvement Partnership / Department of Health (2005). Everybody’s Business. Integrated Mental Health Services for Older Adults: A Service Development Guide. London: Department of Health.
Culverwell, A. (2004). Developing an Intermediate Care Service for People with Dementia. Improving Intermediate Care for Older People with Mental Health Needs – Good Practice & Key Issues. Retrieved February 5th, 2008 from website:
http://www.changeagentteam.org.uk/_library/OPMHICREPORT%20v8%20141105%20(FINAL).doc
Department of Health (2000). NHS Plan: A Plan for Investment, A Plan for Reform. London: Department of Health.
Department of Health (2001). National Service Framework for Older People. London: Department of Health.
Department of Health (2002). National Service Framework for Older People. Supporting Implementation Intermediate Care: Moving Forward. London: Department of Health.
Department of Health (2005). Securing Better Mental Health for Older Adults. London: Department of Health.
Keane, C., Andrews, T., Akritas, S., & Boddington, S. (2007). Two Years On: Clinical Psychology’s Increasing Presence within the Southwark Mental Health Intermediate Care Team. Proceedings of the Psychologists’ Special Interest Group, Working with Older People (PSIGE) 27th Conference.
McNab, L., Smith, B., & Minardi, H.A. (2006). A New Service in the Intermediate Care of Older Adults with Mental Health Problems. Nursing Older People, 18, 3, 22-26.
Nuffield Institute for Health (2002). Exclusivity or Exclusion? Meeting Mental Health Needs in Intermediate Care. Leeds: Nuffield Institute for Health.
Psychology Specialists Working with Older People (2006). Commissioning Clinical Psychology Services for Older People, their Families and other Carers. The British Psychological Society, Division of Clinical Psychology, Briefing Paper 5. Leicester: British Psychological Society.
Sullivan, J., & Trinder, S. (2004). Intermediate Care and Mental Health. Working with Older People, 8,1, 21-24.
Watts, S., & Read, J. (2007). Improving Access to Psychological Therapies in Physical Health Intermediate Care. In British Psychological Society, Good Practice Guide on the Contribution of Applied Psychologists to Improving Access for Psychological Therapies (p.52). Leicester: British Psychological Society.
Downloads
The above text can be downloaded as a word document using the link below
PSIGE website Intermediate Care introductory article (38KB)
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