Perceived mental health needs and adequacy of service provision to older people in care homes in the UK: A national survey

Objective. To assess perceived need and adequacy of service provision by old age psychiatrists (OAPs) to older people living in care homes in the UK. Methods. A postal survey of managers of a stratified random sample of 2638 (14% of 18,698) care homes in the UK caring for older residents. Reminders were sent to those not returning the questionnaires. Results. The response rate was 64% (n = 1689). Forty-one percent of care home managers felt that at least 50% of their residents needed psychiatric evaluation. Cognitive impairment, depressive symptoms and challenging behaviour was thought to be present in at least a quarter of residents by 78%, 29% and 17% respectively. Thirty-eight percent of managers reported that their homes 'never' received any visits from OAPs and only a half described the current frequency of visits as adequate. Pharmacological advice was perceived to be adequate by about three-quarters but less than a half perceived non-pharmacological advice as adequate. Eighty percent wanted more input for staff education and training. Perceived need (p <0.001), frequency of visits by OAPs (p = 0.001), availability of geriatrician (p = 0.001), amount of non-pharmacological advice (p - 0.014) and direct referral access to OAPs for known patients (p = 0.036) were found to be independent predictors of perceived inadequacy of service provision by OAPs. Conclusion. The survey highlights the perception of unmet need and inadequacy of service provision by OAPs amongst managers of care homes in the UK. The study findings, if confirmed by direct observational studies, may have a considerable impact on already sparse resources with a need to explore efficacy of different models of care in meeting this need. Copyright © 2004 John Wiley & Sons, Ltd.