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Home visits for older people: a practical model outside Yorkshire

  • Jeremy Seymour (a1), Rashi Negi (a2), Christopher Flemons (a2), Matthew Impey (a2), Nicola Thomas (a2) and Rachael Witrylak (a2)...
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Abstract
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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1 Benbow, SM, Jolley, D. Doctors in the house. Home visits for older people: a practical model outside Yorkshire. Psychiatr Bull 2009; 33: 315.
2 Negi, R, Seymour, J, Flemons, C, Impey, M, Thomas, N, Witrylak, R. Psychiatric out-patient clinics for older adults: highly regarded by users and carers, but irreplaceable? Psychiatr Bull 2009; 33: 127–9.
3 Benbow, SM. The community clinic – its advantages and disadvantages. Int J Geriatr Psychiatry 1990; 5: 119–21.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Home visits for older people: a practical model outside Yorkshire

  • Jeremy Seymour (a1), Rashi Negi (a2), Christopher Flemons (a2), Matthew Impey (a2), Nicola Thomas (a2) and Rachael Witrylak (a2)...
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eLetters

Yorkshire and beyond: it�s a new world

Susan Mary Benbow, Professor of Mental Health & Ageing
25 January 2010

It is curious Seymour and colleagues (1) feel we confuse community clinics with what they refer to as ‘community-orientated mental health services’. We regard community clinics as an important part of community-orientated older people’s mental health services.

It is good to look at a range of models for delivering services to older people and we should routinely ask patients and carers for their views on all the services they receive (2). Enthusiasm for early referral of patients with memory problems and transfer of 'graduates' to Old Age services have changed expectations, increased the number of people seen for initial assessment and posed quandaries regarding how to achieve responsible and responsive follow up of patients with enduring or relapsing illnesses. At the same time there is increasing demand to work in teams and to liaise with a variety of colleagues, services and agencies. These are not alternatives; rather old age psychiatrists have tofind a balance in how they allocate their time, given competing priorities. Different individuals (and services) will reach different resolutions of these dilemmas.

Nevertheless it is the case that many services experience high numbers of patients who do not attend appointments when outpatient clinics are hospital-based: transport problems anddemands on time allocation from carers argue against their efficacy for older people. So does the absence of immediate appreciation of what life is actually like for the individual and family carers in the home. Much of the information gained on a home visit is non verbal and lost when people are seen in a clinic.

Perhaps part of the problem here is that different people have different understandings of how teams operate and what the role of a doctor is in relation to other team members. The multiplicity of teams developing in some areas has advantages in making more services available to particular groups of patients and their families, but also introduces disadvantages including the following: access criteria may be rigid and problematic for patients who don’t fit into neat categories; demands on the time of staff working with several teams may be considerable and may impact on their commitment to other service areas; each team will need to devote time to liaise with others which may detract from direct care.

We are in the process of preparing a proposal to review work patternswithin Old Age Psychiatry services following on from our earlier studies of workload and stress (3).This should add further substance to the discussion.

Declaration of interest: the authors have no interests to declare.

1Seymour J, Negi R, Flemons C, Impey M, Thomas N, Witrylak R. Home visits for older people: a practical model outside Yorkshire. Psychiatr Bull 2009; 33: 480-1.

2Clark M, Benbow SM, Moreland N, Scott V, Jolley D. Copying letters to older people in mental health services – policy with unfulfilled potential. Quality in Ageing 2008; 9(3): 31-38.

3 Benbow SM, Jolley DJ. Burnout and Stress amongst Old Age Psychiatrists. Int J Geriatr Psychiatry 2002; 17: 710-714.

Susan Mary Benbow, MSc FRCPsych,Professor of Mental Health & Ageing, Centre for Ageing & Mental Health, Staffordshire University, Blackheath Lane,STAFFORD, ST18 0AD. Tel: 01785 353742Fax: 01785 353731Email drsmbenbow@aol.com

And

David Jolley, MSc FRCPsych,Consultant Psychiatrist Pennine Care NHS Foundation Trust, Honorary Reader Manchester University,PSSRU, Dover Street Building,Manchester, M13 9PL.Email David.jolley@manchester.ac.uk
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Conflict of interest: None Declared

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