Older People's Community Services

About the service

Our Intensive Services for Older People are made up of two teams:

  • The Intensive Home Treatment Team – supporting people who live in their own homes.
  • The Intensive Care Home Treatment Team – supporting people living in 24‑hour care homes.

Both teams assess and support older people who have more acute or complex mental health needs, including dementia.

What we do

Our teams provide intensive support to help people stay well at home and avoid unnecessary hospital admission.

If someone is in hospital, we support a faster and safer discharge and help them settle back into their usual place of residence.

We also step in when a caring arrangement at home or in a care setting is at risk of breaking down, offering support to help keep the person safely in their chosen environment.

Where the teams are based

The Intensive Services for Older People are based at The Mount Hospital. They work closely with the older people’s inpatient wards that are also located there.

The teams also spend much of their time working in our four community localities: North, West, East and South, alongside our older people’s community services.

When the teams operate

  • The Intensive Home Treatment Team is available 8am–9pm, seven days a week, all year round.
  • The Intensive Care Home Treatment Team is available:
    • 8am–8:30pm, Monday to Friday
    • 10am–6pm, Saturday, Sunday and bank holidays.

Who is in the team

Our teams include:

  • Mental health nurses
  • Occupational therapists
  • Psychiatrists
  • Psychologists
  • Therapists
  • Associate practitioners
  • Nursing associates
  • Health support workers
  • Dietitians
  • Pharmacy staff

What to expect from our service

Our teams follow the five step process of:

  1. Assessment
  2. Formulation
  3. Intervention
  4. Evaluation
  5. Transfer of Care

Assessment

Up to two members of our team will undertake urgent assessments within four hours, if the need is identified, otherwise an assessment will generally take place within 24 hours.

Formulation

We’ll then begin our ‘formulation’ which brings together all available information that might be important. It helps everyone build a shared understanding of the issues. It also helps us decide what the person needs and plan the right support for them at that time.

Intervention

Once we’ve completed formulation, there are lots of plans or ‘interventions’ that the Intensive Services could put in place. These include:

  • Practical support, such as help with benefits, housing, telecare and meaningful day activities.
  • Support for carers and families to relieve stress.
  • Medical assessment, treatment and monitoring, including medication review.
  • Psychological therapies which can be provided within a short timeframe, for example anxiety management and mindfulness.
  • Supported self-management and coping strategies.
  • We develop care plans that offer meaningful activity and occupation and address concerns such as disturbed sleep pattern, unsafe behaviour, aggressive behaviour, withdrawn behaviour, and loss of appetite

We’d then look to evaluate these interventions before transferring people into the care of the service they may have previously been under, or back to their GP.

Involving families and carers

We involve families and carers in a person’s care whenever it is helpful and appropriate. This includes:

  • recognising who the carer is as early as possible
  • making sure staff understand carers’ needs and how to work well with them
  • following clear rules about confidentiality and sharing information
  • having named staff who are responsible for supporting carers

Carers receive an introduction to our service, along with information to help them understand what we do and how we can support the person they care for.

We also offer a range of support for carers. By working closely with carers, families and friends, we can build positive relationships and provide better care for everyone involved.

Referral information

Who assesses urgent referrals

Our Intensive Home Treatment Team and our Intensive Care Home Treatment Team are responsible for triaging and assessing all urgent referrals for older people’s services. This includes anyone who needs to be seen within a specific timeframe.

Referrals are discussed with the shift coordinator between 8am and 9pm.

Between 9pm and 8am, referrals are triaged by the Crisis Resolution and Intensive Support Service.

How to refer

External referrals

If you are referring from outside the Trust (for example, from a GP, adult social care, community health services, or hospital services), please download the Single Point of Access referral form from the referrals to mental health services page.

Internal referrals

If you work within the Trust and are referring from Community Mental Health Teams, inpatient wards, the Care Homes Team or Liaison Psychiatry, please discuss the referral with the shift coordinator where possible. After that, send the referral electronically to the duty desk for the Intensive Home Treatment Team or the Intensive Care Home Treatment Team.

Referral criteria

  • Service users who fit the overarching referral criteria for the older people’s community services and require an urgent assessment of their mental health needs, including dementia or suspected dementia, where risk to self or others is of concern.
  • Service users with acute mental health needs, including dementia and suspected dementia that require a period of intensive treatment / intervention, to attempt to prevent hospital admission or facilitate early transfer from a hospital setting.
  • The service user can be safely cared for in the community setting.
  • The service user is willing to engage (where possible) with the service.
  • The service user is registered with a Leeds GP.

Referrals will be accepted according to need, vulnerability, and/or risk and not just age, although we expect to see people aged 65 and over predominantly.

Support for people already known to our service and their carers

People who already use our service, and their carers, can contact us through the Single Point of Access phone number if they are currently receiving care from their local community mental health team or the care homes team.

Outside normal working hours, they can contact NHS 111 for extra support. During working hours, they will be directed straight to their local team.

How to contact our Service

The Intensive Services for Older People

The Mount
44 Hyde Terrace
Leeds
LS2 9LN
Telephone: 0113 8559318 or 0113 8555363

Other advice and support

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 website
  • The NHS UK website
  • 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.

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Page last updated: 24th Mar 2026 2:53pm