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2002-2003
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| A study by faculty from the Center for Research on Services for Severe Mental Illness (SMI) demonstrates that using indigenous workers as case finders and a mobile treatment team staffed by psychiatric nurses can decrease levels of psychiatric symptoms in elderly people with psychiatric disorders who reside in a high-risk setting. Background: Elderly people with mental disorders are less likely than younger adults to be diagnosed and to receive needed mental health care. Lack of access to care is one possible cause of this disparity; other causes may include sequelae of the disorders (suspiciousness, fearfulness, withdrawal, irritability and cognitive impairment), stigma, decreased physical mobility, erroneous beliefs that memory problems or depression are aspects of normal aging, difficulty disentangling coexisting medical, psychiatric and social morbidity, and limitations to insurance coverage for mental health care. Whatever the reason, untreated psychiatric disorders put community-dwelling elderly people at risk for nursing home placement or loss of housing due to termination of lease or eviction. Program: An outreach program in Baltimore, MD entitled Psychogeriatric Assessment and Treatment in City Housing (PATCH) targets elderly people living in urban public housing developments. Housing workers are trained to identify and refer residents who may need mental health care to a PATCH nurse. Psychiatric nurses, with consultation and supervision from psychiatrists, provide psychiatric evaluation and treatment in the residents’ homes. NIMH-supported investigators recently evaluated the PATCH program in a prospective randomized trial to determine whether it is more effective than usual care in decreasing levels of depression and other psychiatric symptoms, and in avoiding undesirable moves, such as nursing home placement. A total of 945 (83%) of 1,195 residents in six public housing sites were screened for psychiatric illness; 342 screened positive. Residents in 3 buildings received the PATCH model intervention; residents in the other 3 buildings received usual care (comparison group). Results: Residents with mental disorders who lived in housing sites where the PATCH program was available had significantly fewer symptoms of depression and other psychiatric symptoms at the end of 26 months than residents with mental disorders who lived in the randomly-selected comparison housing sites where the PATCH program was not available. The PATCH program did not prevent residents from being admitted to nursing homes, perhaps because such placements were recommended when it was deemed unsafe for them to live alone. These results demonstrate that a model of care that uses indigenous workers as case finders and a mobile treatment team staffed by psychiatric nurses can decrease levels of psychiatric symptoms in elderly people with psychiatric disorders who reside in a high-risk setting. Significance: The investigators believe the program’s effectiveness rests on the improved case recognition provided by the case finder model and better treatment adherence resulting from on-site care by the PATCH nurses. These findings demonstrate that people with mental illnesses who have not had their needs met in traditional office settings can benefit from home-based evaluation and treatment. This model of care goes beyond simply providing treatment to those who request it, but it also includes systematic approaches for identifying cases, facilitating access to treatment, ensuring delivery of quality care and assessing outcomes of treatment. The effectiveness of this program suggests the importance of modifying public policy to support integrating mental health care with housing, long-term care and medical care systems. Many elders with mental illnesses are out-of-reach of traditional mental health services delivery systems. The study of the PATCH Program shows that these individuals accept and benefit from services that are brought to them rather than relying on their seeking out existing services. Public health nursing has a 125-year tradition of providing care in the community in the homes of those needing services. The PATCH model builds upon this tradition, and its effectiveness shows that a combination of psychiatric and medical nursing best serves the elderly mentally ill.
REFERENCES:
Robbins B, Rye R, German P, Tlasek-Wolfson M, Penrod J, Rabins PV, Black BS. The Psychogeriatric Assessment and Treatment in City Housing (PATCH) program for elders with mental illness in public housing: Getting through the crack in the door. Archives of Psychiatric Nursing 2000; 14 (4): 163-172. Rabins PV, Black BS, Roca R, German P, McGuire M, Robbins B, Rye R, Brant L Effectiveness of a nurse-based outreach program for identifying and treating psychiatric illness in the elderly. JAMA 2000; 283 (21): 2802-2809. Last Updated November 12, 2002
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