Integrated community mental health teams for older adults: 20 years' experience

An innovation in the Welsh county of Cardiff and Eastern Vale of Glamorgan is the establishment of community mental health teams (CMHTs) for older adults which are fully integrated with social services. The teams (which have existed since 1989) are led by social services, unlike the more recent partnership trusts in other regions where social workers are ‘seconded’ into health trusts.

With an endorsement from the Department of Health's recently outlined National Dementia Strategy (Department of Health, 2007), joint health and social care CMHTs for older adults could become the norm.

There are likely to be initial teething problems in establishing these teams, with a perceived clash of cultures. In Cardiff, examples of reconciliation on the part of the health service included the adoption of the open referral system of social services, whereby patients can be referred from any source; the operation of a duty worker system for dealing with emergencies during working hours and maintaining a single point of access; and the training of nurses and therapists in social needs assessments and in procurement of social care packages. Among the challenges faced by social workers were training in cognitive screening assessments, mental state monitoring and effects of medication; establishing close links with in-patient and day hospital units; and adopting the care programme approach and dovetailing it with the single assessment process.

With time and familiarity, clear operational policies underpinned by clinical governance, adequate training, and both clinical and professional supervision, the integrated teams in Cardiff have matured to provide a truly patient-centred, needs-based service, avoiding duplication of assessments and with effective sharing of information. Members of one discipline have been able to absorb some of the skills of other disciplines, furthered by joint working, without having to abandon their professional roles. This has enabled effective utilisation of resources.