This service consists of three teams operating across Leeds offering home-based care to older people experiencing complex, severe and enduring mental health problems including mood disorders, psychosis and dementia.
It also hosts our Memory Assessment Service which provides assessment, diagnosis and treatment for people diagnosed with dementia and mild cognitive impairment – when a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life.
The service consists of many different professionals who work together to provide specialist community-focused mental health services to older adults. Normally we consider those routinely over 65 years of age but this can vary depending on individual need. Also many people aged 65 and over do not consider themselves to be “old” and may have active work and social lives.
We work together with service users, carers and families help them reach their potential, and we support people to enjoy a valued, satisfying and meaningful life.
The aims of our service are:
To offer a full professional assessment of people’s mental health needs
To work with service users and carers to provide a detailed care plan and crisis plan
To see or have contact with service users within 15 days of referral for assessment
To provide a service for people with complex mental health needs, who can be safely supported in the community using the Care Programme Approach (CPA)
To ensure services are accessible to all sections of the Leeds population within each locality, in line with our principles of equality and diversity
To provide a joined up approach to care, working with other mental health, physical health and social care services across Leeds
We aim to see or have contact with service users within 15 days of referral for an assessment. This could take place in your own home, a clinic setting, a care home or a community venue if appropriate.
Members of our team will speak to service users and their carer(s) to better understand:
What’s causing the current distress, what’s triggering it and what’s making it worse?
What strengths a service user has, and what resources they have around them that could help?
We also look at physical health needs and we may ask other colleagues to support with any needs here. Once we’ve done an assessment, we use a technique called formulation to work out a care plan.
Formulation of the service user experience is used to guide the treatment offered by the community mental health service. Formulation is a word we use to describe the bringing together of information gathered during an assessment. It is a series of ideas we might have to describe and understand a service user’s experience.
The formulation will be created and shared with service users (and carers if appropriate) as standard, and will be accessible, easily understood, and be meaningful to the service user.
The formulation will be used to help guide the plan of care and the delivery of any therapies or ‘interventions’ (see below). The formulation will be a working document, with new information included when it is identified.
Interventions and therapies
The following is a brief overview of the kinds of things we might do to help.
Recommend getting involved in psychological therapy groups
A range of specialist occupational therapy interventions – including improving functional ability and social participation
Support with your diet and nutrition
Physical health support including treating any immediate physical health risks
Advice on support to improve lifestyle such as physical and social activity
Following diagnosis and any brief post diagnostic support by a local Memory Assessment Service (MAS), people will be offered referral on to the community mental health team for support with dementia-related problems. This includes a range of interventions working with people with mild, moderate and severe dementia.
All adults aged 65 years and over irrespective of gender, ethnicity, sexuality, culture or physical abilities.
People who have substantial and complex mental health needs which cannot be met within Primary Care, IAPT Services or other Community services.
The CMHT will accept referrals for service users with substantial and complex mental health needs which may include:
People over the age of 65 years with mental disorder and physical illness or frailty that contributes to, or complicates the management of their mental illness.
Significant cognitive, emotional and behavioural problems associated with a mental health diagnosis.
People over the age of 65 years with a primary dementia
People with psychological or social difficulties related to the ageing process, or end-of-life issues, or who feel their needs may be best met by a service for older people.
Co-morbid mental illness in service users with a neurodevelopmental disorder for treatment of the mental disorder where this is the primary issue.
Complex presentations associated with severe mental illness, which impacts a significant risk of self-harm, harm to others, risk of harm from others or serious self-neglect.
People under 65 who have complex physical comorbidities and are best placed with a mental health team with expertise in older peoples’ needs and agreed locally on a case by case/ individual need basis.
Access to service for known service users and carers:
Service users who are known to the CMHTs and have had interventions previously will be triaged following the guidelines above to gain understanding of current reason for referral and any significant changes to presentation. Following discussion with the MDT, consideration should then be given to either offer a review assessment, allocate to care co-ordination or signpost to an alternative service.
The Older People’s Community Mental Health Service comprises of three teams which cover three areas across Leeds (see How to Contact the Service below). It also hosts the Memory Assessment Service.
This service operates from 9am to 5pm, Monday to Friday, excluding bank holidays. We work closely with the Older People’s Intensive Home Treatment Team (IHTT), Inpatient Services (Mental and Physical Health) and wider community neighbourhood teams and primary care (including GPs) in delivering a needs-led service.
Outside of our normal hours, services are provided by people’s GPs unless they have been referred to the Intensive Home Treatment Team, or alternative arrangements have been put in place.
If a health professional has given you a specific phone number to call when you are concerned about your condition or that of a loved one, please continue to use that number.
We recommend the following places where you can find helpful and reliable information with links to further help and support.
MindWell is the single ‘go to’ website for information about mental health in Leeds. It includes advice on practical help with things like housing, benefits or money problems.
The National NHS website
The national NHS website (formerly known as NHS Choices) is the official website of the National Health Service in England. It provides a comprehensive health information service helping you to make the best choices about your health and lifestyle, but also about making the most of NHS and social care services in England.
NHS 111 service
You can call the NHS 111 service 24 hours a day, 365 days a year, if:
you need medical help fast but it’s not a 999 emergency
you think you need to go to A&E or need another NHS urgent care service
you don’t know who to call or you don’t have a GP to call
you need health information or reassurance about what to do next
For less urgent health needs, you should contact your GP or a local pharmacist in the usual way. For immediate, life-threatening emergencies, always call 999.
Please note this is not comprehensive list of services but a few suggestions of how to get started finding help and information.