National Public Health Service for Wales
National Service Framework (NSF) for Older
People in Wales: supplementary guidance on
care for older people with mental health problems
in general hospital settings.
National Service Framework (NSF)
for Older People in Wales:
supplementary guidance on care for
older people with mental health
problems in general hospital
settings
Author: Sian Price
Date: 27/11/07
Version: 2
Status: Approved
Intended Audience: Welsh Assembly Government
Purpose and Summary of Document:
This document has been produced by the National Public Health Service for Wales
(NPHS) vulnerable adults team to assist Welsh Assembly Government in producing
supplementary guidance to support the National Service Framework (NSF) for Older
People in Wales. This outlines the elements of a general hospital mental health
liaison service for older people with mental health problems and lists examples of
emerging practice.
Publication/Distribution:
The paper will be distributed to WAG and also be placed on the NPHS vulnerable
adults team website
Author: Sian Price - NPHS Vulnerable
Adults Team
Version: 2
Date: 27/11/ 07
Page: 1 of 18
Status: Approved
Intended Audience: Welsh
Assembly Government
National Public Health Service for Wales
National Service Framework (NSF) for Older
People in Wales: supplementary guidance on
care for older people with mental health problems
in general hospital settings.
Contents
Page
3
1
Purpose of this paper
2
Background
3
3
3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8
Service models
Enhanced sector model
Outreach from mental health wards
Liaison mental health nurse
Liaison old age psychiatrist
The shared care ward
The liaison mental health team
Liaison old age psychiatry services
Advantages and disadvantages
4
4
4
4
4
4
4
5
5
4
Functions of a service model
7
5
Staffing levels
7
7
Liaison old age psychiatry service
Appendix - Practice examples from Wales and England on
initiatives /projects designed to meet the needs of older
people with mental health problems in general hospitals
settings.
9
Pontypridd and Rhondda NHS Trust RGN Secondment Programme
Flintshire Social Services, Flintshire Local Health Board, North East
Wales NHS Trust, Alzheimer’s Society and Admiral Nurse Service
Hampshire Partnership NHS Trust
Tameside General Hospital
Discharge co-ordination: older and younger people with dementia
Mental health liaison in Gloucestershire
The development of dementia care in a general hospital setting
Residential home team advisors
9
10
References
17
© 2007 National Public Health Service for Wales
Author: Sian Price - NPHS Vulnerable
Adults Team
Version: 2
Date: 27/11/ 07
Page: 2 of 18
Status: Approved
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11
12
13
14
15
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National Public Health Service for Wales
National Service Framework (NSF) for Older
People in Wales: supplementary guidance on
care for older people with mental health problems
in general hospital settings.
1. Purpose of this paper
The National Service Framework for Older People in Wales1 (NSF) addresses care
needs for older people who need hospital inpatient treatment. The standard states;
“When admission to hospital is necessary for older people, the care they receive is
co-ordinated, efficient and effective in meeting their clinical and non-clinical needs.”
In relation to older people with mental health problems objective 20.3 of the NSF is
for ‘All NHS Trusts to have in place a mental health liaison service for older people
with mental health problems in general hospital settings’.
This paper intends to support commissioners and providers of health care in meeting
objective 20.3 of the NSF by outlining the elements of a general hospital mental
health liaison service for older people with mental health problems. Much of the
content of this paper is based on the Royal College of Psychiatrists report ‘Who
Cares Wins’2.
The appendix outlines some service responses to meeting the needs of older people
with mental health problems in general hospitals settings. These examples are
included to stimulate ideas and developments and are not being specifically
recommended. Many of these examples have not been subject to robust evaluation
of their impact and effectiveness, mainly because they are at an early stage of
development.
2. Background
The proportion of general hospital beds occupied by older people (65 years or older)
is likely to be significant. It has been estimated that a district general hospital with 500
beds will admit 5000 older people each year. Of these 3000 will have, or will develop
whilst in hospital, a mental health problem2. A systematic review demonstrated that
the presence of such mental health problems is an independent predictor of poor
outcome. In particular adverse effects were found on mortality, length of stay and
institutionalisation.
Studies of the prevalence of mental disorder amongst older people in general
hosptials2 suggest that the most common problems will include depression, delirium,
dementia, cognitive impairment, anxiety, schizophrenia and alcoholism. Depression,
dementia and delirium are more common in general hospitals than in the community2.
The National Service Framework1 reports the prevalence of delirium as 15-30% of
older people on medical wards and up to 60% of fractured femur patients.
Depression may affect up to 53% of general hospital patients and dementia up to
35%.
Research2 suggests that the co-morbid mental health problems of older people in
general hospitals can be prevented and treated. Prevention and treatment have had
a beneficial impact on incidence, length of stay, extent of recovery and need for
Author: Sian Price - NPHS Vulnerable
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National Service Framework (NSF) for Older
People in Wales: supplementary guidance on
care for older people with mental health problems
in general hospital settings.
transfer to institutional care. It has been shown that a liaison mental health service
provides greater benefit than standard consultation.
3. Service models
A range of service models that could improve the delivery of mental health services
for older people in general hospitals have been described. These are outlined below.
The service model chosen will be influenced by a range of factors such as the size
and type of hospital, current service levels, rural/urban issues and the availability of
resources. For example a large tertiary teaching hospital will require a different
service to that provided in a smaller district general hospital. A community hospital
service will require a different service again.
What ever model is chosen it will need to be able to be able to deliver the minimum
functions of older people’s mental health liaison service as set out in box 2 below.
The Royal College of Psychiatrists, in their document, “Who Care Wins”,
recommends that older person’s mental health services in general hospitals currently
providing only a consultation service should move towards a liaison approach.
3.1
Enhanced sector model
This is a model in which a community mental health team has extra staff time (usually
nursing) to provide input to general hospital wards. This model facilitates non-medical
assessment and continuity of care.
3.2
Outreach from mental health wards
In this model staff from mental health wards carry out assessments on general
hospital wards. This is normally on a consultation basis but there is opportunity for
education and training of general ward staff. This model, however, is only practical
when general and mental health wards are on the same site.
3.3
Liaison mental health nurse
This model has a mental health nurse based in a general hospital with dedicated time
to provide a liaison service to the general wards. It offers potential for teaching and
training, shared care and the development of treatment protocols. This service can be
oriented towards high referring wards such as those treating older people.
3.4
The liaison old age psychiatrist
In this model an old age psychiatrist has time dedicated for general hospital work.
The model is similar to that of the liaison mental health nurse but the psychiatrists
medical training will give them a greater understanding of complex medical problems.
Author: Sian Price - NPHS Vulnerable
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3.5
National Service Framework (NSF) for Older
People in Wales: supplementary guidance on
care for older people with mental health problems
in general hospital settings.
The shared care ward
In this model a multidisciplinary team including mental health and general nurses,
psychiatrists, physicians and therapy staff work on a ward where people with complex
mental health and medical needs are cared for. The ward is in a general hospital to
ensure there is access to investigations and specialist medical treatment. This model
allows people such as those, for example, with severe depression or challenging
behaviour and significant physical illness to have their needs appropriately met.
3.6
The liaison mental health team
In this model a multidisciplinary mental health team provides care within a general
hospital. The team operates through a single point of access and provides a
consultation and liaison service. The team works with general hospital disciplines
providing ongoing training and supervision. This facilitates identification and
management of mental disorder co-morbidity.
3.7
Liaison Old Age Psychiatry Services3
This model within a moderate or large general hospital involves a multidisciplinary
liaison team based within the general hospital working with general care teams and
with close links to geriatric medicine services. The provision of shared care wards is
of benefit. The service would cover all in-patients areas in normal working hours.
Close links with community mental health services are essential. Working with
general care teams the aim of the service is to improve care skills, attitudes and
knowledge about mental disorder through training and education. Rapid access to
the specialist mental health team assists with the management of severe and
complex cases. The team functions as advocates for older people, promoting the
routine assessment of mental health needs of all people admitted to DGHs.
Author: Sian Price - NPHS Vulnerable
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3.8
National Service Framework (NSF) for Older
People in Wales: supplementary guidance on
care for older people with mental health problems
in general hospital settings.
Advantages and disadvantages
Box 1 Strengths and weaknesses of different service models2
Model
Advantages
Disadvantages
Enhanced sector model
Low cost
Continuity of care
Low priority
Slow response
Consultation
No specialist expertise
Travelling
Not multidisciplinary
Multiple opinions
Additional staff cost
Outreach
Low cost
Competing priorities
Restricted response time
Limited expertise
Usually consultation
No continuity with community
Liaison nurse
Specialist expertise
Dedicated time
Liaison approach
Nursing expertise
On site
Rapid response
Easy access
Cost
Need medical support
Professional isolation
Increase demand
Discontinuity with community
Model
Advantages
Disadvantages
Shared care
Expertise
Joint working
Staff training
Competing demands
Considerable cost
Risk of becoming convenient
transfer for ‘stuck patients’
Liaison mental health
team
Multi professional expertise
Parity of service with
younger adults and
community
Strong mental health
presence
Strong peer support
Training of multiple
disciplines
Coordinated management
On site
Cost
Discontinuity with community
Liaison old age psychiatry
Access to expertise and
multidisciplinary skills
Rapid response
Cost
Lack of 24 hour service
Lack of continuity of care
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in general hospital settings.
Integration with general
hospital
Provision of education and
multi-professional training
Frequent review of patients
Link between general
hospital and community
teams
Improved detection of mental
disorder and care of patients
with coexisting physical and
mental health problems
between community and
hospital teams
Some practice examples from the UK are outlined in the Appendix to this document.
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in general hospital settings.
4 Functions of a service model
Whatever the service model chosen, there are minimum functions that the service
should provide as detailed in box 2.
Box 2. Minimum functions of older people’s mental health liaison service

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
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
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Improve detection of common conditions
Assessment, diagnosis and treatment of referred cases
Risk assessment and minimisation
Assessment of all cases of self harm
Ensure that the outcome of assessments are incorporated into care plans
Facilitate the development of care plans that reflect mental health needs
Be able to review patients as appropriate and check adherence to
recommendations
Be available to offer advice on patient care as it pertains to mental health
Facilitate access to mental health care where indicated
Respond quickly where necessary
Be able to work collaboratively with general departments
Monitor those under the care of older peoples mental health services
Promote the rights of older people with mental disorder
Raise awareness of the importance of mental health
Reduce stigma
Engage with carers
Have a clear referral protocol
Have an operational policy
Be able to record clinical data to allow audit
Be the link between the general hospital and mental health services
5 Staffing levels
Liaison Old Age Psychiatry Service3
This is to support the model set outlined in 3.7
For a moderate sized general hospital (300-500 beds)
Registered mental health nurses
2 whole tine equivalents
Senior occupational therapist
1 whole time equivalent
Social worker (ideally able to fulfil
1.5 whole time equivalents
responsibilities of mental health
legislation)
Support worker or OT technical instructor 1 whole time equivalent
Old age psychiatry consultant
2 dedicated weekly sessions
Medical secretary
1 whole time equivalent
Access to clinical psychology
Equivalent to 1 weekly session
All senior staff need experience in older peoples mental health
Author: Sian Price - NPHS Vulnerable
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National Service Framework (NSF) for Older
People in Wales: supplementary guidance on
care for older people with mental health problems
in general hospital settings.
For a large (teaching) hospital (500-1000 beds)
Registered mental health nurses
3 whole time equivalents
Occupational therapists
2 whole time equivalents
Social workers (ideally able to fulfil
2.5 whole time equivalents
responsibilities of mental health
legislation)
Support workers or OT technical
2 whole time equivalents
instructors
Medical secretary
1 whole time equivalent
Administration secretarial support
1 whole time equivalent
Old age psychiatry consultant
3 weekly dedicated sessions
Access to clinical psychology
Equivalent of 2 weekly sessions
All senior staff need experience in older peoples mental health
Author: Sian Price - NPHS Vulnerable
Adults Team
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Date: 27/11/ 07
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National Service Framework (NSF) for Older
People in Wales: supplementary guidance on
care for older people with mental health problems
in general hospital settings.
Appendix
PONTYPRIDD & RHONDDA NHS TRUST
RGN SECONDMENT PROGRAMME
MENTAL HEALTH AND MEDICAL DIRECTORATES
Background
This programme was agreed between the Trusts Mental Health and Medical Directorates in response
to increasing concern about the number of patients on the medical wards, especially the intermediate
care ward, with dementia. Staff felt that their knowledge and skills in managing this group of patients
needed to be improved.
Medical ward staff had received formal training on managing patients with dementia but this training
was not seen as being effective in influencing the care of patients. As a consequence senior staff from
the medical and mental health directorates looked at developing innovative methods of supporting
staff caring for people with dementia, promoting high standards of care and an improved quality of life
for this group of patients. The secondment programme was agreed as a result.
Aim
To provide RGNs with training, education and practical experience in order to develop their skills in
and knowledge of nursing patients with mental health problems, especially those with dementia.
Programme content
1 week comprehensive induction programme
2 month placement on the EMI assessment unit
2 month placement on a functional rehabilitation/early dementia ward
2 month placement on ward for people with dementia and challenging behaviour
During placement time was also spent in day units, the memory clinic and with the EMI Community
Psychiatric Nurse Team. Informal meetings/visits were also arranged with the Community Services
Dementia team and voluntary organisations such as Age Concern and the Alzheimer’s Society.
Every month training was held with time set aside for clinical supervision.
Impact of the programme
The programme was evaluated by means of a questionnaire completed by the secondees. The
findings showed that;
The nurses increased their knowledge and understanding of:
 Strategies for challenging behaviours
 Use and side effects of medication
 How environmental factors affect patients
The secondment resulted in:
 Improved communication across the mental health and medical directorates
 Early detection of both dementia and depression
 Improvement in patient care for older people with mental health problems on the medical wards
Author: Sian Price - NPHS Vulnerable
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People in Wales: supplementary guidance on
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in general hospital settings.
Further information: David Jones, Clinical Nurse Manager [email protected]
FLINTSHIRE ADMIRAL NURSE SERVICE
FLINTSHIRE SOCIAL SERVICES, FLINTSHIRE LOCAL HEALTH BOARD,
NORTH EAST WALES NHS TRUST, ALZHEIMER’S DISEASE SOCIETY
An Admiral Nursing service is being developed in Flintshire. This new initiative is a collaborative
venture and is the first of its kind in Wales. It is being supported by funding form the Big Lottery Fund
and Flintshire Carers. The aim of Admiral Nursing is to promote best practice in dementia care and to
maximise access to appropriate services, facilitating continuity of care. Admiral Nurses work across
functional boundaries, within the NHS and with other agencies.
Admiral Nurses are specialist dementia nurses, working in the community, with families, carers and
supporters of people with dementia.
Admiral nurses:
• work with family carers as their prime focus, and provide a bridge between hospital staff and carers
if the person with dementia is admitted to hospital
• provide practical advice, emotional support, information and skills
• deliver education and training in dementia care
• provide consultancy to professionals working with people with dementia, including those in general
hospital settings
• promote best practice in person- centred dementia care
Further information on Admiral Nurses:http://www.fordementia.org.uk/admiral.htm
The admiral nurses competency framework
The competency framework is the result of a project funded by for dementia and undertaken by the
Royal College of Nursing. Its main aim is to support and facilitate Admiral Nurses to produce portfolios
of evidence about their competency to practice. In addition it provides a structured pathway for those
who wish to work towards the NMCs Higher Level Practice award.
It is made up from a set of ‘outcomes based’ statements structured around eight core competences
used to describe the day-to-day work of the Admiral Nurse. These are;
 Therapeutic work (interventions)
 Sharing information about dementia and carer issues
 Advanced assessment skills
 Prioritising work
 Preventative work and health promotion
 Ethical and person centred care
 Balancing the needs of the carer and the person with dementia
 Promoting best practice
Further information on the competency framework:
http://www.fordementia.org.uk/documents/comp_frame_sum.pdf
Author: Sian Price - NPHS Vulnerable
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Status: Approved
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National Service Framework (NSF) for Older
People in Wales: supplementary guidance on
care for older people with mental health problems
in general hospital settings.
HAMPSHIRE PARTNERSHIP NHS TRUST
MENTAL HEALTH LIAISON SERVICE FOR OLDER PEOPLE
The liaison approach to mental health service provision was adopted by North Hampshire
Hospital in 1998. It replaced a medical consultation model. The service accepts referrals and
provides formal and informal education and training to hospital staff. The team is nurse lead, with
medical support from a CMHT.
It comprises
 Consultant Nurse
 0.1wte occupational therapist
 0.4wte nurse specialist
 CMHT medical support
 Clerical support
Service impact:
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Improved service for older people with mental health problems
Service positively received by older people, relatives/carers and staff members
Referral rate of approximately 30 a month with a decrease from older peoples wards and
an increase in other wards over time
Decreasing rate of inappropriate referrals
Increasing demand for involvement in discharge planning
Perceived increase in allowing choice for older people with mental health problems
Workshops for acute trust staff
Reduction in admissions to mental health units form general hospital
Perceived reduction in appropriate referrals to Community Mental Health Team
Reduction in delayed discharges attributable to mental health, from an average 8 per
week, reportable, to nil
Standard response times more readily met – urgent on day of referral, others within 5
working days
Increased focus on education
Broader base of expertise with OT presence
Source/further information:
http://www.cat.csip.org.uk/_library/MH%20Liaison%20Service%20NH%202006%20Info%20Sheet%201.pdf
http://www.cat.csip.org.uk/_library/Poster%202%20-%20research%202006.pdf
Author: Sian Price - NPHS Vulnerable
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Version: 2
Date: 27/11/ 07
Status: Approved
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National Service Framework (NSF) for Older
People in Wales: supplementary guidance on
care for older people with mental health problems
in general hospital settings.
TAMESIDE GENERAL HOSPITAL
NURSE LEAD MENTAL HEALTH LIAISON SERVICE
The nurse lead mental health liaison service at Tameside General Hospital was evaluated by
means of a randomised controlled trial. This service model was introduced as an alternative to
a consultation delivered by a psychiatrist. If it were shown to be effected it was expected to
reduce the demands on psychiatrists.
Patients admitted to one of four acute medical wards at Tameside General Hospital in Ashtonunder-Lyne were screened for depression and confusion Those who scored at or above the for
thresholds for depression and/or confusion were allocated to either usual care or to a nursing
led intervention from the mental health liaison nurse service. (A registered mental nurse with
three years post registration experience)
The nurse led intervention had three components; assessment, direct interventions and liaison
support. For example interventions for depression included medications concordance,
enhancing self esteem, managing anxiety, problem solving, addressing role transitions and
adjusting to loss. Liaison support involved encouragement of person centred care, education
about mental disorders, nutrition and safety issues and sign posting to relevant services.
Interventions were tailored to the patient and lasted for a maximum of 6 weeks.
The outcome of the trial suggested that a nurse-led mental health liaison service that accepts
all screened cases form medical wards is unlikely to be effective in reducing general psychiatric
morbidity but services that focus on the prevention of delirium and target particular patient
groups or disorders such as depression are more likely to be effective. The authors argued that
the greatest benefits of such a service might be achieved by targeting at clinical areas such as
rehabilitation or orthopaedic wards or at specific issues like depression or education to prevent
reversible causes of cognitive impairment such as delirium.
Source: Baldwin R, Pratt H, Goring H, Marriott A, Roberts C. Age and Ageing 2004; 33:472478
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National Service Framework (NSF) for Older
People in Wales: supplementary guidance on
care for older people with mental health problems
in general hospital settings.
DISCHARGE CO-ORDINATION:
OLDER AND YOUNGER PEOPLE WITH DEMENTIA
This project was set up by Rotherham Primary Care Trust, Doncaster and South Humber
Healthcare NHS Trust and Rotherham General Hospital Trust in response to concerns
about the hospital discharge of older people with mental health problems. A mental health
discharge coordinator for older people and younger people was appointed. The main
purpose of the post was to work across partner organisations with the aim of improving the
experience of these patient groups admitted to the acute wards by ensuring that they had
access to appropriate services thus facilitating timely and effective discharge.
The discharge coordinator also has a role in advising and training general hospital staff to
try and reduce length of stay for older people with mental health problems on acute wards.
Close involvement with discharge planning enables more appropriate care packages to be
developed. In addition the discharge coordinator spends time on the wards supporting staff
in caring for older people with mental health problems.
Achievements
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Reduction in delayed discharges
Early diagnosis and treatment of mental health problems in older people and
younger people with dementia
Changes to ward environments to improve the experience of older people with
mental health problems. These include a screening tool for people with dementia to
help staff establish the level of supervision needed at mealtimes
An integrated care pathway to facilitate transfer of patients between the acute and
mental health inpatient wards to improve communication and information sharing
Further information: [email protected]
Source: National Service Framework for Older People Standard 4- General Hospital Care
National Network Learning Event, Thursday 22nd September, 2005. Department of Health
Author: Sian Price - NPHS Vulnerable
Adults Team
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Intended Audience: Welsh
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National Service Framework (NSF) for Older
People in Wales: supplementary guidance on
care for older people with mental health problems
in general hospital settings.
MENTAL HEALTH LIAISON IN GLOUCESTERSHIRE
The mental health liaison and education project undertaken by Gloucestershire
Hospitals Foundation Trust and the Gloucestershire Partnership NHS Trust involved the
appointment of two mental health nurses (with clerical support) to train and support stuff
across the whole Trust to improve the recognition of mental health problems through
education and training.
The specific aim of the project was to ensure that older people received the specialist
help that they need and that staff are enabled to provide specialist care for older people
with mental health problems, bridging the gap between general and mental health
services.
The mental health liaison nurses attended ward rounds, handovers and ward meetings
and worked alongside staff. Referrals received by the nurses guided the content of
teaching, being used as case studies.
Achievements

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The majority of referrals were from the rehabilitation service, patients with
suspected dementia and depression formed the majority
Formal teaching took place through training days, workshops and visits to
mental health settings. These focused on person centred care using case
studies
A core care plan to detect depression was developed
A referral pathway for people experiencing mental health problems within the
Trust was proposed
The project raised the profile of mental health and older peoples care in the general
hospital. It was felt that the general health care start and begun to acknowledge the
complexity of the client group.
Further information: [email protected]
Source: National Service Framework for Older People Standard 4- General Hospital
Care National Network Learning Event, Thursday 22nd September, 2005. Department of
Health
Author: Sian Price - NPHS Vulnerable
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Date: 27/11/ 07
Status: Approved
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Intended Audience: Welsh
Assembly Government
National Public Health Service for Wales
National Service Framework (NSF) for Older
People in Wales: supplementary guidance on
care for older people with mental health problems
in general hospital settings.
THE DEVELOPMENT OF DEMENTIA CARE IN A GENERAL
HOSPITAL SETTING
This project was designed to test methods of improving acute hospital care for
patients with dementia and/or acute confusion.
Aims


To examine the extent to which the clinical role of Dementia Care Assistant
could influence and improve the quality of hospital care provided to patients
with dementia and acute confusion
To assess whether the techniques developed by the Dementia Care Assistants
can be transferred to other parts of the hospital through education and training
Project approach


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

Two full time Dementia Care Assistants were appointed to provide direct
patient care, working with the staff team on a 28bed acute elderly care ward.
Their clinical work was supervised by the Consultant Nurse for Older People.
A mapping exercise to identify where in the organisation people with dementia
were cared for
An in depth developmental dementia care programme for two clinical teams
identified as having this developmental need
Implementation of locally developed guidelines for the delivery of effective
dementia care across the organisation
Dementia care awareness for all staff through the hospitals induction
programme
Achievements
Establishment of a dementia care team with improved links to mental health providers
 Extensive education and training provided for clinical staff, with feedback that
this improved staff knowledge and awareness
 Improved quality of care provided to vulnerable and frequently challenging
patients, evident through reduced formal and informal complaints
Further Information: Charlotte Ashburner [email protected],uk
Author: Sian Price - NPHS Vulnerable
Adults Team
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Date: 27/11/ 07
Status: Approved
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Intended Audience: Welsh
Assembly Government
National Public Health Service for Wales
National Service Framework (NSF) for Older
People in Wales: supplementary guidance on
care for older people with mental health problems
in general hospital settings.
RESIDENTIAL HOME ADVISOR TEAM
Overview
The Residential Home Advisor Team is a service, which was set-up in November
2002. The principal Aim of the service is to identify and provide specialist training to
care staff who work with people with Dementia in both local authority and
independent sector care homes within the Borough of Bridgend. A modular training
package – The Dementia Care Training Package, has been developed and is
currently being delivered within a variety of care settings.
The team consists of one WTE Registered Mental Health Nurse and one WTE
Occupational Therapists (x2job share).
Discussions took place to identify how education and underpinning knowledge may
have a positive impact in terms of staff knowledge, confidence and patient care. The
consensus was that medical directorate ward staff might benefit (in terms of
knowledge and skill base) if a specific programme of Dementia care training was set
up and delivered.
As a result the team have been working with, and delivering the adapted, specialist
training package to healthcare staff from the medical directorate
Further information: [email protected]
Author: Sian Price - NPHS Vulnerable
Adults Team
Version: 2
Date: 27/11/ 07
Status: Approved
Page: 17 of 18
Intended Audience: Welsh
Assembly Government
National Public Health Service for Wales
National Service Framework (NSF) for Older
People in Wales: supplementary guidance on
care for older people with mental health problems
in general hospital settings.
References
1. Welsh Assembly Government. National service framework for older people in Wales.
Cardiff: WAG; 2006.
2. The Royal College of Psychiatrists. Who cares wins. Improving the outcome for older
people admitted to the general hospital Guidelines for the development of liaison mental
health services for older people. London: RCP; 2005.
3. Royal College of Psychiatrists. Raising the standard. Specialist services for older people
with mental illness. Report of the Faculty of Old Age Psychiatry. London: RCP; 2006.
Author: Sian Price - NPHS Vulnerable
Adults Team
Version: 2
Date: 27/11/ 07
Status: Approved
Page: 18 of 18
Intended Audience: Welsh
Assembly Government