Jill Manthorpe looks at work on the appropriateness of nursing home placements for older people, while Peter Wilson evaluates a study of mental health services for 16-25 year olds.

Nursing homes

An examination of the appropriateness of nursing home
placements.

About one-quarter of older people living in nursing homes do not
need to be there. This finding, from a multi-disciplinary study
conducted in Glasgow, suggests that nursing home care is too often
seen as the only option. The authors argue that community care
assessments and other processes should be more geared to
rehabilitation, and better knowledge among medical and nursing
staff would help avoid misuse of nursing home resources.

The study was conducted in eight nursing homes, with 304
residents. Of these, some 80 people were assessed as having
low-level dependency needs. This description needs to be taken in
its context, however, for a majority had some confusion. In this
study, while a person might have dementia, he or she was seen to
have low level of need if there were no medical or behavioural
problems.

The circumstances of 63 individuals were examined, with the
research team looking at their community care assessments. They
found these did not always contain sufficient information to
explain the choice of nursing home placement, and that medical
details were limited, although their content in terms of dementia
was generally accurate.

The researchers conclude that many people with a low level of
need may be misplaced in nursing homes. They suggest that social
workers are uncertain about what constitutes nursing care, and
over-estimate need at times. They also suggest that insufficient
assessment and support mean that some people who come into nursing
homes on a temporary basis may stay there because it seems the
easiest option.

This work makes a substantial case for closer attention to be
paid to placement decisions – although it appears that only
community care paperwork was examined and that residents were not
able to make their views available in this instance. These, and the
social workers’ opinions, would be a useful addition to the
research.

Source: G Penrice, et al, “Low dependency residents in
private nursing homes in Glasgow,” Health Bulletin 59 (1),
Scottish executive, 2001Ê

Jill Manthorpe is a senior lecturer in community care at
the University of Hull.

Mental health

A study of the mental health services required for 16-25 year
olds.

This is a useful report highlighting a major gap in service
provision for 16-25 year olds. For far too long, the needs of
people in this age group – who are emerging uncertainly from their
childhood into adult life – have been overlooked and poorly
serviced.

This report is based on interviews and discussions with 45 young
people who have experienced a mental health crisis, together with
the views of mental health professionals, and those in voluntary
sector organisations supporting vulnerable young people.

The key finding that emerges from the young people themselves is
that many could not find the support that they needed. They didn’t
know where help was, they faced long delays in receiving it, and
they were passed around a variety of services and agencies.

The professionals in the report identified a serious lack of
resources, poor communication and co-operation between agencies,
and a lack of specialist knowledge.

Many of these young people simply requested someone to talk to
and to listen to them – to care, to be available, to take them
seriously. Too often they met with adult denial of their
difficulties. The report makes a number of recommendations to
reverse the low priority given to such services. A variety of
provision is clearly needed to meet the different needs of young
people – some for counselling and psychotherapy, some for
practical, financial and career advice, and others for information.
The authors strongly recommend that the government set up a
national service framework for children and young people’s mental
health.

As the report makes clear, adolescent services should no longer
be tagged on to the end of services for children and conveniently
ignored within adult services. New services need to be designed,
which draw upon the experiences of young people, and recognise the
value of what they have to say. These words will be well received
by all practitioners in the broad field of child and adolescent
mental health, and need to be heeded by commissioners of
services.

Karen Smith and Lucy Leon, Turned Upside Down,
Mental Health Foundation, 2001

Peter Wilson is director of YoungMinds.