Elderly Services, Community Care, and Health Economics of Service

Abstract

The first half of this chapter describes how a Community Mental Health Team for Older People (CMHTOP) facilitates specialist assessment, diagnosis, treatment, and management of the over 65s with mental health problems. CMHTOP has two key characteristics: it is multidisciplinary and operates within an integrated care pathway involving statutory organizations, the voluntary sector and informal caregivers/family. This multidisciplinary and integrated approach is common in many high-income countries, as opposed to the single-discipline clinics (usually run by a psychiatrist) seen in low- and middle-income countries. A CMHTOP-based model improves decision-making, continuity of care, and diagnosis of comorbid problems and is more effective in reaching frail older people who have multiple health and social care needs.

The second half of this chapter describes how economic evaluations compare the costs and outcomes of different interventions and services to inform decisions about “best value for money” in the mental health care of older people. This is challenging not only because age-related health outcomes are naturally expected to worsen – or at best stay the same – rather than improve with time but also because care-related costs are spread widely and disproportionately across many different sectors and stakeholders. With dementia as a case in point, large costs are attributable to living arrangements and informal care paid by social services and families during the severe stages of the illness, whereas the cost of therapies and drugs for mild to moderate dementia, incurred by health services, are relatively low.