My experience in the Hazelglen Home Treatment Service in Kitchener Ontario is that intensive home treatment works extremely well with older adults. However, we only treated patients with functional , non-organic mental disorders; patients with dementia were excluded. The rationale for exclusion was that one of the principles of intensive home treatment is to work collaboratively with the patient and firmly engage them in their treatment; plus crises due to functional mental disorders usually have a clear endpoint-the psychotic symptoms or manic symptoms finally improve sufficiently to discharge the patient to regular out patient care. Patients with dementia often lack capacity to engage with treatment ( psychotic patients also do-but it is usually shortlived)-and the course of dementia is steadily downhill.
Unlike Canada–and the US, mental health services in England are arranged with a very clear separation between working age adults and adults over 65. Consequently, intensive home treatment services were originally planned for the 18-65 age group only. However, there is a move to include older adults–not least on the basis of equity. The team in West Sussex county-shortly after it was set up, decided to include older adults. They did not exclude patients with dementia.
Comparing admission rates of older adults six months before the creation of the team, with six months later, it was found that there was a reduction of 31% in admissions, and caregivers but not patients were more satisfied with the service.
Of the 32 patients who avoided admission completely, 17 had depression, 8 dementia, 3 schizophrenia, and 2 other psychotic illnesses