Carolyn Montana, Dr. John Holmes, Dr. Shenaz Ahmed ..

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Why general hospitals ignore older peoples
mental health needs Carolyn Montana, Dr. John
Holmes, Dr. Shenaz Ahmed Leeds Institute of
Health Sciences, The University of Leeds
Emerging themes and their characteristics
Defining the problem
Methods/Research plan
Phase one
66 of general hospital beds are occupied by
people aged 65 years and over at any one time.
More than half of these patients will also have
mental health needs.
Two important and related factors influence
behaviour
understand nature of care
pilot existing measurement tools

• Perception of role
• Legitimising role
• ethics

Researcher presence
Estimated general hospital prevalence rates (Not
including complex mental health needs)¹
Patient Observation System4
Dementia Care Mapping5

• Willingness
• Atmosphere
• Layout
• Staffing level and role
• Time of day
• Daily routine

observations of ward behaviour
focus groups and interviews3
Ward climate
Resulting in
Interim conclusions

• Non-generalisable
• Highly subjective
• Poor validity
• Condition and setting specific

Six broad themes describing the social behaviour
of ward staff and patients are evident, each with
their own characteristics
staff to patient initiated interactions

• Practical focus
• Planned care focus
• Anticipated response

Leading to
Phase two - current
Total co-morbidity is around 37, whereas the
national average diagnosis rate is around 1 for
any mental health need, and even lower for those
that have complex presentations².

• Looking after each other
• Concern with how seen by others
• Task completion focus
• Lack of confidentiality

Develop measurement tools
staff to staff initiated interactions
Impact?

• Lack of recognition and missed opportunities for
  treatment affects the whole health and social
  care economy. Directly related to this are
• Increased lengths of stay
• Increased rates of institutionalisation
• Increased rates of dependence and disability
• Increased mortality
• Sub-optimal standards of care

staff behaviour

• Talking to no-one
• Doing more than one thing at a time
• Planned task focus

• Small talk
• Provide information on other patients
• Ask what staff are doing

patient to staff initiated interactions
Context

• Establish and reinforce sub-group boundaries
• Other patients behaviour
• Food/relatives

patient to patient initiated interactions
lack of Government policy
ageist approach to health care
patient behaviour

• Doing nothing
• Reading

stigma of mental health needs
unwillingness to care
Older patient
ward level
ignorance
These themes will be explored further within a
theoretical framework in order to develop greater
understanding and open up new ideas.
not our problem
Phase three
lack of training and skills
avoidance
Measure social behaviour
References
Real-time sampling tool

• Department of Health. National service framework
  for older people. 2001. London, DoH.
• Holmes J., House A. O. Psychiatric illness in hip
  fracture. Systematic review. Age Ageing
  200029537-46
• Holmes J. et al Evaluation of Liaison Mental
  Health Services SDO funded study (Work in
  progress)
• Bowie, P., Mountain, G. 5. Using direct
  observation to record the behaviour of long-stay
  patients with dementia. Int J of Ger Psy 8
  857-864
• Brooker, D., Dementia Care Mapping A review of
  the research literature. The Gerontologist, 2005.
  45(1) p. 11-18.
• Leeds Teaching Hospital Trust Privacy and
  Dignity Audit Tool (2001)

Research Question
sub-groups of patients
ward staff
Are there differences in the social behaviour
between hospital staff and older patients with
and without mental health needs?
other recognised features
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