Home visits for older people: a practical model outside Yorkshire

Professors Benbow & Jolley invite us to ‘set the record straight’ in agreeing with them that ‘in many good services for older people home visits are the reality’. ¹ We are pleased to concur with them and refer them to the title of our paper. ² However, they appear to be confusing ‘community clinics’ with community-oriented mental health services.

In her original paper, ³ Professor Benbow described replacing a psychiatric out-patient clinic with what she designated a ‘community clinic’, whereby the catchment area was divided into four geographical areas, each being visited by the psychiatrist once every 4 weeks. To our knowledge, this model has not been adopted elsewhere, or if it has, no one has written about it in peer-reviewed journals. Elderly mental health services in Sheffield are not resourced to provide such a service. If services were reconfigured in this way, psychiatrists’ time would be deflected from community mental health team (CMHT) work or other community-oriented work such as the dementia rapid response team and the (functional illness) discharge and rehabilitation team.

Our paper does not in any way suggest replacing community work with out-patients; what we are advocating is efficiently run out-patient clinics in the context of well-coordinated community-oriented services. Older patients who are independently mobile are capable of attending an out-patient department, as they do for appointments in general hospitals. For psychiatric patients who are immobile, house-bound, refusing to attend, or in residential/nursing homes, in Sheffield they are seen in their own home either by a psychiatrist or another CMHT member.

The purpose of our simple questionnaire study was to assess user and carer acceptability of attending psychiatric out-patients. The majority of older users and carers were highly satisfied with all aspects of their attendance, irrespective of the seniority of the psychiatrist seen, and we believe our findings are potentially transferable outside Sheffield.

Professors Benbow and Jolley have made a useful contribution to the literature in logging the activity of old age psychiatrists in different settings. It is equally valid to ask old users and carers of services what they think of this activity.